Assessment of the response of right ventricular performance to decreasing levels of mechanical assistance by on-line pressure area relationships.
The rapid assessment of the response of right ventricular (RV) performance to decreasing levels of mechanical assistance may be an important adjunct in determining if a patient can tolerate the removal of such a device. This report describes the use of on-line pressure area relationships to assess RV function in a patient supported with an RV assist device (RVAD). Mid RV short axis cross-sectional area was measured on-line by transesophageal echocardiography with an automated endocardial border detection feature. RV pressure was measured with a high fidelity catheter. Pressure and area were plotted simultaneously on a computer workstation interfaced with the pressure and echo systems to yield on-line pressure area loops. The following indices of RV performance were calculated while RVAD flow was decreased in 1 L/min increments: stroke work' (SW' = integral of PdA)[mmHg*cm2], stroke area (SA = Maximum Area-Minimum Area)[cm2], and fractional area change (FAC = SA/Maximum Area*100)[%]. SW', SA, and FAC significantly increased with decreasing RVAD flow: SW'(from 32 to 61 mmHg*cm2), SA (from 2.58 to 4.37 cm2), and FAC (from 20 to 32%). In conclusion, the increase in these parameters of RV performance with decreasing mechanical assistance suggested that this patient would tolerate removal of the RVAD, which was subsequently successful. This method of on-line pressure area relationships may be useful to predict the need for further mechanical assistance.
Mandarino
W A
WA
Division of Cardiothoracic Surgery, University of Pittsburgh, Pennsylvania.
Gorcsan
J
J
Armitage
J M
JM
Griffith
B P
BP
Kormos
R L
RL
D000703:Analog-Digital Conversion; D002648:Child; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D012770:Shock, Cardiogenic / Q000503:physiopathology / Q000628:therapy*; D012815:Signal Processing, Computer-Assisted; D016278:Ventricular Function, Right / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*