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The Right Ventricle—You May Forget It, But It Will Not Forget You

Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsen...

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Detalles Bibliográficos
Autores principales: Wanner, Patrick M., Filipovic, Miodrag
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074056/
https://www.ncbi.nlm.nih.gov/pubmed/32033368
http://dx.doi.org/10.3390/jcm9020432
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author Wanner, Patrick M.
Filipovic, Miodrag
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Filipovic, Miodrag
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description Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether.
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spelling pubmed-70740562020-03-19 The Right Ventricle—You May Forget It, But It Will Not Forget You Wanner, Patrick M. Filipovic, Miodrag J Clin Med Review Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether. MDPI 2020-02-05 /pmc/articles/PMC7074056/ /pubmed/32033368 http://dx.doi.org/10.3390/jcm9020432 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Wanner, Patrick M.
Filipovic, Miodrag
The Right Ventricle—You May Forget It, But It Will Not Forget You
title The Right Ventricle—You May Forget It, But It Will Not Forget You
title_full The Right Ventricle—You May Forget It, But It Will Not Forget You
title_fullStr The Right Ventricle—You May Forget It, But It Will Not Forget You
title_full_unstemmed The Right Ventricle—You May Forget It, But It Will Not Forget You
title_short The Right Ventricle—You May Forget It, But It Will Not Forget You
title_sort right ventricle—you may forget it, but it will not forget you
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074056/
https://www.ncbi.nlm.nih.gov/pubmed/32033368
http://dx.doi.org/10.3390/jcm9020432
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