ABSTRACT
El fallo agudo del ventrículo derecho (VD) es un síndrome clínico complejo que puede ser causado por muchas causas y es el responsable del 3% al 9% de los ingresos en las unidades de cuidados intensivos con una mortalidad intrahospitalaria del 5 al 17%. Puede presentarse de forma solapada o grave con compromiso hemodinámico severo y shock. El objetivo primario debe ser la identificación y el tratamiento de la causa subyacente de insuficiencia del VD, como la embolia pulmonar aguda, síndrome de dificultad respiratoria aguda, descompensación aguda de la hipertensión pulmonar crónica, infarto VD, o arritmias. Se ha reconocido la importancia de la función del VD en la insuficiencia cardíaca, el infarto de miocardio, la cardiopatía congénita y la hipertensión pulmonar. Actualmente, los avances en ecocardiografía y resonancia magnética nuclear han creado nuevas oportunidades para el estudio de la anatomía y fisiología del VD. La presente revisión ofrece una perspectiva clínica sobre la estructura y función del VD. En esta primera parte, revisaremos la anatomía, fisiología, evaluación y fisiopatología del VD. En la segunda parte, revisaremos la importancia clínica y el manejo y tratamiento del fallo del VD.
Acute failure of the right ventricle Part 1 Anatomy, physiology, functional evaluation and pathophysiology of the right ventricle Acute right ventricular (RV) failure is a complex clinical syndrome that can be caused by many causes and accounts for 3% to 9% of admissions in intensive care units with in-hospital mortality of 5% to 17%. It can present in an overlapping or severe way with severe hemodynamic compromise and shock. The primary objective should be the identification and treatment of the underlying cause of RV insufficiency, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmias. The importance of RV function in heart failure, myocardial infarction, congenital heart disease and pulmonary hypertension has been recognized. Currently, advances in echocardiography and nuclear magnetic resonance have created new opportunities for the study of RV anatomy and physiology. The present review offers a clinical perspective on the structure and function of the RV. In this first part, we will review the anatomy, physiology, evaluation and pathophysiology of the RV. In the second part, we will review the clinical importance and the management and treatment of RV failure.
Falha aguda do ventrículo direito Parte 1 Anatomia, fisiologia, avaliação funcional e fisiopatologia do ventrículo direito A insuficiência aguda do ventrículo direito (VD) é uma síndrome clínica complexa que pode ser causada por muitas causas e representa do 3% a 9% das internações em unidades de cuidados intensivos, com mortalidade intra-hospitalar de 5 a 17%. Pode apresentar-se de forma sobreposta ou severa com comprometimento hemodinâmico grave e choque. O objetivo primário deve ser a identificação e o tratamento da causa subjacente da insuficiência VD, tais como embolia pulmonar aguda, síndrome do desconforto respiratório agudo, hipertensão pulmonar crônica descompensada, VD do miocárdio ou arritmia. A importância da função do VD na insuficiência cardíaca, infarto do miocárdio, cardiopatia congênita e hipertensão pulmonar tem sido reconhecida. Atualmente, os avanços na ecocardiografia e na ressonância magnética nuclear criaram novas oportunidades para o estudo da anatomia e fisiologia do VD. A presente revisão oferece uma perspectiva clínica sobre a estrutura e função do RV. Nesta primeira parte, revisaremos a anatomia, fisiologia, avaliação e fisiopatologia do VD. Na segunda parte, revisaremos a importância clínica e o manejo e tratamento da falha do VD.
ABSTRACT
Objective To evaluate the risk factors,diagnostic index of the restrictive right ventricle physiology(rRV) and the impact of the mid-term outcome of the patients.Methods Eighty patients(30 in rRV group and 50 in non-rRV group) undergoing TOF repair admitted in our department from Oct 2011 to May 2012 were studied.Perioperative clinical data were collected and echo data were recorded after operation.Mixed linear regression for repeated measures was used to compare the variables and analyze the correlations.Results Patients in rRV group were younger with longer cardiopulmonary bypass(CPB) time,aortic cross clamp time,ventilation time,intensive care unit and hospital stay compared with those in non-rRV group(P<0.01,respectively).The younger patients with longer CPB time had high risk of rRV by logistic regression analysis.Within 7 days post operation,the increase of saturation of venous oxygenation and decrease of oxygen extraction ration were slower in rRV group than those in non-rRV group(P<0.05,respectively).Lactate decreased in both groups,but was higher in rRV group throughout the 7 days(P=0.03).NT-proBNP was higher in rRV group throughout the 7 days than that in non-rRV group.NT-proBNP≥4750pg/ml often indicated the patients in the state of rRV.CRP slightly increased in 1-2 days post operation,and decreased thereafter,and the decrease was slower in rRV group(P=0.08).With regard to the mid-term outcome,there was no significant differences in the incidences of the obstruction of the right ventricle outflow and main pulmonary artery,the stenosis of the branch of pulmonary artery and the degree of the pulmonary valve regurgitation.Conclusion rRV is associated with significantly higher levels of NT-proBNP and CRP.The incidence of rRV correlates with age on operation and positively correlates with CPB time.NT-proBNP would be regarded as an indicator of the incidence of rRV.The study indicated the rRV would have impact on the early outcome of the patients but there was no significant effect on mid-term outcome.