Thoracic Epidural Anesthesia Reduces Right Ventricular Systolic Function With Maintained Ventricular-Pulmonary Coupling

Abstract

URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2844. Unique identifier: NTR2844.

Dominance of free wall radial motion in global right ventricular function of heart transplant recipients

“…40 Beyond the aforementioned potential causes, loss of the substantial innervation of the RV myocardium may be an other important factor resulting in complex functional changes of the RV. 41 However, it has been suggested that the transplanted heart can be reinnervated by both sympathetic and parasympathetic fibers. 42,43 Hypothetically, the slow recovery of longitudinal function can be a result of reinnervation as well.…”

Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement

“…15 Homeometric autoregulation describes maintenance of RV systolic function in response to elevated pulmonary vascular resistance (PVR), an intrinsic adaptation that enables the RV to maintain stroke volume without having to depend on the Frank-Starling mechanism. 16 However, intraoperative interventions that either compromise RV homeometric autoregulation (e.g. sympathetic block such as spinal anaesthesia, thoracic epidural, vasovagal stimuli, or anaesthetic drugs with a negative inotropic effect) or that disproportionately decrease the compliance in small pulmonary vessels (e.g.…”

“…23,59 An increase in CVP with systemic hypotension often indicates the onset of RV failure and circulatory collapse. 16 The choice of advanced monitoring such as pulmonary artery catheter, transpulmonary dilution (i.e. LiDCO, PiCCO), or transoesophageal echocardiography (TOE) depends on local availability/expertise.…”

Right heart failure in pulmonary hypertension: Diagnosis and new perspectives on vascular and direct right ventricular treatment

“…Table 1 summarises clinical studies in which conductance catheters were used to assess contractility and/or RV–arterial coupling. The studies included patients with PAH (Tello et al, 2019), idiopathic or systemic sclerosis‐associated PAH (Tedford et al, 2013; Hsu et al, 2016), systemic sclerosis without pulmonary hypertension (Tedford et al, 2013), chronic thromboembolic pulmonary hypertension (CTEPH; McCabe et al, 2014; Axell et al, 2017; Tello et al, 2019), chronic thromboembolic disease without pulmonary hypertension (McCabe et al, 2014; Axell et al, 2017), tetralogy of Fallot (Latus et al, 2013), and heart failure with preserved ejection fraction (EF; Rommel et al, 2018), as well as patients undergoing lung resection (Wink et al, 2016). The main difference between these studies is the method used to assess RV–arterial coupling.…”

“…In four of the studies (Latus et al, 2013; Tedford et al, 2013; Hsu et al, 2016; Rommel et al, 2018), E es was measured using a multi‐beat method (Figure 1) with preload reduction either by balloon occlusion of the inferior vena cava or through the Valsalva manoeuvre (first shown to significantly reduce RV preload in 2013, Wang et al, 2013, and validated for multi‐beat measurement of pressure–volume loops using inferior vena cava balloon occlusion, Tedford et al, 2013). In the remaining four studies (McCabe et al, 2014; Wink et al, 2016; Axell et al, 2017; Tello et al, 2019), the conductance catheter was used to measure precisely the ESP as one of the essential values required for determination of coupling via the single‐beat method (Brimioulle et al, 2003). In the single‐beat method, E a is calculated as ESP/SV and E es is calculated as ( P max − ESP)/SV, where P max is estimated as the maximal theoretical pressure that would build up through clamping of the pulmonary valve.…”