Abstract
The importance of right ventricular (RV) function in maintaining global cardiac performance is the focus of this discussion. The physiological determinants of normal right ventricular function will be discussed, with particular emphasis on the afterload and contractility characteristics of the right ventricle. Numerous clinical conditions have been shown to affect RV performance. These conditions include positive-pressure ventilation, ischemia, pulmonary hypertension, and cardiac surgery. Present methods for the perioperative evaluation of RV function include angiography, radionuclide techniques, thermodilution techniques, echocardiography, and magnetic resonance imaging. Traditional modalities for the treatment of RV dysfunction consist of pharmacological interventions (i.e., vasodilators and inotropes) and/or mechanical assist devices. Newer pharmacological strategies for the treatment of RV failure and associated pulmonary hypertension include the phosphodiesterase fraction III inhibitors and the prostaglandins, specifically PGE1. In summary, the accurate evaluation of perioperative RV performance combined with new treatment options will ensure maximal preservation of RV performance.
Full text
PDF












Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BING R. J., HEIMBECKER R., FALHOLT W. An estimation of the residual volume of blood in the right ventricle of normal and diseased human hearts in vivo. Am Heart J. 1951 Oct;42(4):483–502. doi: 10.1016/0002-8703(51)90146-9. [DOI] [PubMed] [Google Scholar]
- Berger H. J., Matthay R. A., Pytlik L. M., Gottschalk A., Zaret B. L. First-pass radionuclide assessment of right and left ventricular performance in patients with cardiac and pulmonary disease. Semin Nucl Med. 1979 Oct;9(4):275–295. doi: 10.1016/s0001-2998(79)80014-8. [DOI] [PubMed] [Google Scholar]
- Biondi J., Hines R., Rafferty T., Rogol P., Scott W., Barash P. The effect of high frequency positive pressure ventilation on right and left ventricular function. Anesth Analg. 1986 Jun;65(6):679–682. [PubMed] [Google Scholar]
- Calvin J. E., Driedger A. A., Sibbald W. J. Does the pulmonary capillary wedge pressure predict left ventricular preload in critically ill patients? Crit Care Med. 1981 Jun;9(6):437–443. doi: 10.1097/00003246-198106000-00001. [DOI] [PubMed] [Google Scholar]
- Cohn J. N., Guiha N. H., Broder M. I., Limas C. J. Right ventricular infarction. Clinical and hemodynamic features. Am J Cardiol. 1974 Feb;33(2):209–214. doi: 10.1016/0002-9149(74)90276-8. [DOI] [PubMed] [Google Scholar]
- Conahan T. J., 3rd, Andrews R. W., MacVaugh H., 3rd Cardiovascular effects of protamine sulfate in man. Anesth Analg. 1981 Jan;60(1):33–36. [PubMed] [Google Scholar]
- D'Ambra M. N., LaRaia P. J., Philbin D. M., Watkins W. D., Hilgenberg A. D., Buckley M. J. Prostaglandin E1. A new therapy for refractory right heart failure and pulmonary hypertension after mitral valve replacement. J Thorac Cardiovasc Surg. 1985 Apr;89(4):567–572. [PubMed] [Google Scholar]
- Dell'Italia L. J., Starling M. R., Blumhardt R., Lasher J. C., O'Rourke R. A. Comparative effects of volume loading, dobutamine, and nitroprusside in patients with predominant right ventricular infarction. Circulation. 1985 Dec;72(6):1327–1335. doi: 10.1161/01.cir.72.6.1327. [DOI] [PubMed] [Google Scholar]
- Farrar D. J., Compton P. G., Hershon J. J., Hill J. D. Right ventricular function in an operating room model of mechanical left ventricular assistance and its effects in patients with depressed left ventricular function. Circulation. 1985 Dec;72(6):1279–1285. doi: 10.1161/01.cir.72.6.1279. [DOI] [PubMed] [Google Scholar]
- Ferlinz J., Delvicario M., Gorlin R. Incidence of right ventricular asynergy in patients with coronary artery disease. Am J Cardiol. 1976 Nov 4;38(5):557–563. doi: 10.1016/s0002-9149(76)80002-1. [DOI] [PubMed] [Google Scholar]
- Ghignone M., Girling L., Prewitt R. M. Volume expansion versus norepinephrine in treatment of a low cardiac output complicating an acute increase in right ventricular afterload in dogs. Anesthesiology. 1984 Feb;60(2):132–135. doi: 10.1097/00000542-198402000-00009. [DOI] [PubMed] [Google Scholar]
- Greeley W. J., Kern F. H., Ungerleider R. M., Kisslo J. A. Intramyocardial air causes right ventricular dysfunction after repair of a congenital heart defect. Anesthesiology. 1990 Nov;73(5):1042–1046. doi: 10.1097/00000542-199011000-00037. [DOI] [PubMed] [Google Scholar]
- Grose R., Strain J., Yipintosoi T. Right ventricular function in valvular heart disease: relation to pulmonary artery pressure. J Am Coll Cardiol. 1983 Aug;2(2):225–232. doi: 10.1016/s0735-1097(83)80157-0. [DOI] [PubMed] [Google Scholar]
- Habazettl H., Conzen P. F., Vollmar B., Yekebas E., Gutmann R., Hobbhahn J., Brendel W., Peter K. Pulmonary hypertension after heparin-protamine: roles of left-sided infusion, histamine, and platelet-activating factor. Anesth Analg. 1990 Dec;71(6):637–644. doi: 10.1213/00000539-199012000-00011. [DOI] [PubMed] [Google Scholar]
- Hess W., Arnold B., Veit S. The haemodynamic effects of amrinone in patients with mitral stenosis and pulmonary hypertension. Eur Heart J. 1986 Sep;7(9):800–807. doi: 10.1093/oxfordjournals.eurheartj.a062142. [DOI] [PubMed] [Google Scholar]
- Hines R., Barash P. G. Intraoperative right ventricular dysfunction detected with a right ventricular ejection fraction catheter. J Clin Monit. 1986 Jul;2(3):206–208. doi: 10.1007/BF01620554. [DOI] [PubMed] [Google Scholar]
- Hoffman M. J., Greenfield L. J., Sugerman H. J., Tatum J. L. Unsuspected right ventricular dysfunction in shock and sepsis. Ann Surg. 1983 Sep;198(3):307–319. doi: 10.1097/00000658-198309000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jardin F., Farcot J. C., Boisante L., Curien N., Margairaz A., Bourdarias J. P. Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med. 1981 Feb 12;304(7):387–392. doi: 10.1056/NEJM198102123040703. [DOI] [PubMed] [Google Scholar]
- Kay H. R., Afshari M., Barash P., Webler W., Iskandrian A., Bemis C., Hakki A. H., Mundth E. D. Measurement of ejection fraction by thermal dilution techniques. J Surg Res. 1983 Apr;34(4):337–346. doi: 10.1016/0022-4804(83)90081-1. [DOI] [PubMed] [Google Scholar]
- Klein H. O., Tordjman T., Ninio R., Sareli P., Oren V., Lang R., Gefen J., Pauzner C., Di Segni E., David D. The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead. Circulation. 1983 Mar;67(3):558–565. doi: 10.1161/01.cir.67.3.558. [DOI] [PubMed] [Google Scholar]
- Laver M. B. Myocardial ischaemia. Dilemma between information available and information demand. Br Heart J. 1983 Sep;50(3):222–230. doi: 10.1136/hrt.50.3.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Laver M. B., Strauss H. W., Pohost G. M. Herbert Shubin Memorial Lecture. Right and left ventricular geometry: adjustments during acute respiratory failure. Crit Care Med. 1979 Dec;7(12):509–519. [PubMed] [Google Scholar]
- Leetma H. E., Gertler M. M., Guthrie R. G., Starr T., Saluste E. The use of cyclic AMP in ischemic vascular disorders. Recent Adv Stud Cardiac Struct Metab. 1973;3:291–301. [PubMed] [Google Scholar]
- Lowenstein E., Johnston W. E., Lappas D. G., D'Ambra M. N., Schneider R. C., Daggett W. M., Akins C. W., Philbin D. M. Catastrophic pulmonary vasoconstriction associated with protamine reversal of heparin. Anesthesiology. 1983 Nov;59(5):470–473. doi: 10.1097/00000542-198311000-00022. [DOI] [PubMed] [Google Scholar]
- Matthay R. A., Berger H. J. Cardiovascular performance in chronic obstructive pulmonary diseases. Med Clin North Am. 1981 May;65(3):489–524. doi: 10.1016/s0025-7125(16)31511-5. [DOI] [PubMed] [Google Scholar]
- Miller D. C., Moreno-Cabral R. J., Stinson E. B., Shinn J. A., Shumway N. E. Pulmonary artery balloon counterpulsation for acute right ventricular failure. J Thorac Cardiovasc Surg. 1980 Nov;80(5):760–763. [PubMed] [Google Scholar]
- Prewitt R. M., Ghignone M. Treatment of right ventricular dysfunction in acute respiratory failure. Crit Care Med. 1983 May;11(5):346–352. doi: 10.1097/00003246-198305000-00005. [DOI] [PubMed] [Google Scholar]
- Prielipp R. C., Rosenthal M. H., Pearl R. G. Hemodynamic profiles of prostaglandin E1, isoproterenol, prostacyclin, and nifedipine in vasoconstrictor pulmonary hypertension in sheep. Anesth Analg. 1988 Aug;67(8):722–729. [PubMed] [Google Scholar]
- RUSHMER R. F., THAL N. The mechanics of ventricular contraction; a cinefluorographic study. Circulation. 1951 Aug;4(2):219–228. doi: 10.1161/01.cir.4.2.219. [DOI] [PubMed] [Google Scholar]
- Ritchie J. L., Zaret B. L., Strauss H. W., Pitt B., Berman D. S., Schelbert H. R., Ashburn W. L., Berger H. J., Hamilton G. W. Myocardial imaging with thallium-201: a multicenter study in patients with angina pectoris or acute myocardial infarction. Am J Cardiol. 1978 Sep;42(3):345–350. doi: 10.1016/0002-9149(78)90926-8. [DOI] [PubMed] [Google Scholar]
- Ross J., Jr Acute displacement of the diastolic pressure-volume curve of the left ventricle: role of the pericardium and the right ventricle. Circulation. 1979 Jan;59(1):32–37. doi: 10.1161/01.cir.59.1.32. [DOI] [PubMed] [Google Scholar]
- Sibbald W. J., Paterson N. A., Holliday R. L., Anderson R. A., Lobb T. R., Duff J. H. Pulmonary hypertension in sepsis: measurement by the pulmonary arterial diastolic-pulmonary wedge pressure gradient and the influence of passive and active factors. Chest. 1978 May;73(5):583–591. doi: 10.1378/chest.73.5.583. [DOI] [PubMed] [Google Scholar]
- Slutsky R., Karliner J., Ricci D., Kaiser R., Pfisterer M., Gordon D., Peterson K., Ashburn W. Left ventricular volumes by gated equilibrium radionuclide angiography: a new method. Circulation. 1979 Sep;60(3):556–564. doi: 10.1161/01.cir.60.3.556. [DOI] [PubMed] [Google Scholar]
- Taylor R. R., Covell J. W., Sonnenblick E. H., Ross J., Jr Dependence of ventricular distensibility on filling of the opposite ventricle. Am J Physiol. 1967 Sep;213(3):711–718. doi: 10.1152/ajplegacy.1967.213.3.711. [DOI] [PubMed] [Google Scholar]
- Wackers F. J., Giles R. W., Hoffer P. B., Lange R. C., Berger H. J., Zaret B. L. Gold- 195m, a new generator-produced short-lived radionuclide for sequential assessment of ventricular performance by first pass radionuclide angiocardiography. Am J Cardiol. 1982 Jul;50(1):89–94. doi: 10.1016/0002-9149(82)90013-3. [DOI] [PubMed] [Google Scholar]
