Table 1. Pre-operative assessment of RV failure illustrating some “red-flag” indicators.
| Red flag indicators | Adult | Infant/child |
|---|---|---|
| Symptoms | Fatigue/exercise intolerance/dyspnea on exertion | Fatigue/inability to keep up with peers/long naps |
| Pre-syncope or syncope | Syncope | |
| Feeding intolerance | Feeding intolerance/diaphoresis | |
| Cachexia | Poor growth curve | |
| Signs | Tachycardia/S3 gallop/parasternal heave | Tachycardia/S3 gallop/parasternal heave |
| Tachypnea | Tachypnea | |
| Elevated JVP | Peri-orbital/ankle/presacral edema | |
| Ankle/presacral edema | Abdominal distension/ascites | |
| Abdominal distension/ascites | Hepatomegaly | |
| Hepatomegaly | ||
| Serum markers | Elevated plasma Cr, Bilirubin/BNP/NT-proBNP | Elevated plasma Cr, Bilirubin/BNP/NT-proBNP |
| ECG | Sinus tachycardia | Sinus tachycardia |
| Atrial arrythmias | Atrial arrythmias | |
| Echocardiography parameters | IVS bowing (end-systole or end-diastole) into LV | IVS bowing (end-systole or end-diastole) into LV |
| RVFAC <25% | RVFAC <25% | |
| TAPSE <1.4 cm | TAPSE <2SD of age-related values | |
| RV longitudinal strain ≤–15% | RV longitudinal strain |
RV, right ventricular; JVP, jugular venous pressure; Cr, creatinine; BNP, brain natriuretic peptide; NT-proBNP, N-terminal pro-brain natriuretic peptide; ECG, electrocardiogram; IVS, interventricular septum; LV, left ventricle; RVFAC, right ventricle fractional area change; TAPSE, tricuspid annular plane systolic excursion.