Right ventricular dysfunction.
OBJECTIVE
Until recently the right ventricle's role in myocardial dynamics has not been fully appreciated. This article provides an overview of the pathophysiology, imaging and management of right ventricular dysfunction.


RESULTS
That levosimendan may promote right ventricular function opens new avenues for treatment. In addition there are existing therapies such as phosphodiesterase inhibitors and nitric oxide, which offer yet further modalities to improve outcome in right ventricular failure. How these drugs are used, in combination or alone, in conjunction with ventilatory and cardiovascular strategies has not been evaluated in multicentred randomized controlled trials.


CONCLUSIONS
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.
Woods
Justin
J
Department of Anaesthesia and Intensive Care Medicine, St George's Hospital, London, UK.
Monteiro
Patricia
P
Rhodes
Andrew
A
D002316:Cardiotonic Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004452:Echocardiography; D006353:Heart-Assist Devices; D006801:Humans; D008279:Magnetic Resonance Imaging; D045265:Natriuretic Peptides / Q000378:metabolism; D012121:Respiration, Artificial; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*
D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D045265:Natriuretic Peptides; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents