Management of acute right ventricular failure.
The thin-walled right ventricle compensates poorly for any increase in afterload, and its output abruptly decreases with small elevations in pulmonary vascular resistance. In patients who have acute right ventricular (RV) dysfunction following bypass, it is, therefore, important to maintain pulmonary vascular resistance at normal or reduced levels. The location and movement of the RV septum may have a dramatic impact on RV contraction, and abnormalities of left ventricular function all affect RV function. Inadequate intraoperative protection has also been implicated in impaired RV function, and there is some evidence that caution is required during removal of air from the left side of the heart and resumption of ventilation. Volume expansion, pharmacological intervention, and mechanical devices have all been used successfully in patients with RV failure. Volume loading is the basis of treatment when the pulmonary vascular resistance is normal. When this alone is insufficient, or when pulmonary vascular resistance is elevated, inotropic agents may be useful. Clinical reports have demonstrated that amrinone, a member of the new class of inotropic fraction-III phosphodiesterase inhibitors, is an effective agent for the management of RV dysfunction following bypass. Correction of septal wall dislocation may be achieved with intraaortic balloon pumps.
Hines
R L
RL
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510.
D000208:Acute Disease; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D016278:Ventricular Function, Right