Right ventricular dysfunction

Abstract

Acute right ventricular dysfunction is relatively common. There is a lack of convincing evidence in favour of any single treatment modality. Imaging methods now permit a more accurate evaluation of the right ventricle and its function. Combining treatments may offer significant advantages and the imaging and monitoring available allows real-time assessment of the response to intervention. This article illustrates how incomplete our knowledge of this condition and its management within the critical care setting is and reinforces previous calls for suitably designed trials to evaluate and develop guidelines for existing strategies and therapeutic agents.

Diagnóstico e tratamento da hipertensão pulmonar: uma atualização

“…(8) Because the RV presents the aforementioned particularities and CMRI allows a more detailed visualization of the RV, CMRI is currently considered the gold standard for a noninvasive evaluation of the RV. (9,10) Studies in which CMRI was used to evaluate patients with PH showed that, when compared with control group patients, PH patients presented with a significant increase in end-systolic and end-diastolic volumes, as well as in right ventricular muscle mass, together with a significant reduction in right ventricular ejection fraction. Other studies have shown ventricular septal bowing, together with a reduction in the LV volume in early diastole, revealing impaired left ventricular function associated with right ventricular dysfunction.…”

Is Right Ventricular Failure Common in the Intensive Care Unit? How Should It Be Managed?

“…33 Intravenous administration of epoprostenol causes systemic hypotension. Further, intravenous use of this drug is complicated by its very short half-life, requiring administration through continuous infusion, its (6)(7)(8)(9)(10)(11)(12) due to short duration of action concentration, mandating infusion through a central venous catheter, and its instability at room temperature so that ice packs must be used to keep it cold before and during infusion. Inhaled epoprostenol has an effect on hemodynamics and oxygenation similar to that of NO in patients with acute respiratory distress syndrome (ARDS).…”

“…Contrast ventriculography is invasive and provides limited incremental information when compared to echocardiography. 9 Echocardiography is a noninvasive, portable modality that can be used to assess the size and function of the RV. Right and left heart hemodynamics can be estimated using Doppler techniques.…”

A porcine model for acute ischaemic right ventricular dysfunction

“…The treatment of acute right ventricular ischaemia-accompanied RVF is complicated by the fact that routine treatment strategies are based on left ventricular failure (LVF), which has a different pathogenesis and natural course. To date, no single treatment of RVF has shown convincing evidence of success [8,9].…”

“…The clinical importance of right ventricular function has only recently been appreciated. Although some research has been reported in this area [8,10], further studies of all aspects of RVF including pathogenesis, haemodynamic measurements and management, including novel treatment strategies and prognosis, are required. Due to the heterogeneity of the patient population, the wide variation in the pathogenesis of RVF and the relatively low incidence of pure RVF in clinical practice, reliable and reproducible animal models are called for.…”