Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Right ventricular failure in cardiosurgical patients

Authors: E.S. Nikitin, Z.O. Saydalieva

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2018-15-2-92-100

UDC: 616.124.3-008.64:616.1-089

Link: Clinical Physiology of Blood Circulaiton. 2018; 15 (2): 92-100

Quote as: Nikitin E.S., Saydalieva Z.O. Right ventricular failure in cardiosurgical patients. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2018; 15 (2): 92–100 (in Russ.). DOI: 10.24022/1814-6910-2018-15-2-92-100

Received / Accepted:  27.02.2018/13.03.2018

Full text:  

Abstract

Modern advances in the study of blood circulation pathophysiology in right ventricular failure demonstrate that a violation of right ventricular function can play an important role in the development of pulmonary edema in the postoperative period, one of the most frequent variants of postoperative pulmonary complications. Development of pulmonary edema with insufficient right ventricle may be due to impaired lymph drainage – the main way to remove fluid from the interstitium of the lungs. At the same time, to date, the exact relationship between postoperative right ventricular failure and pulmonary edema in cardiosurgical patients has not been studied. Clarification of the role of right ventricular failure in the development of pulmonary edema can play an important role in improving the management of patients in the early postoperative period.

References

  1. Haddad F., Couture P., Tousignant C., Denault A.Y. The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance, and management. Anesth. Analg. 2009; 108 (2): 422–33.
  2. Kaul T.K., Fields B.L. Postoperative acute refractory right ventricular failure: incidence, pathogenesis, management and prognosis. Cardiovasc. Surg. 2000; 8 (1): 1–9.
  3. Mebazaa A., Pitsis A.A., Rudiger A., Toller W., Longrois D., Ricksten S.E. et al. Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery. Crit. Care. 2010; 14 (2): 201.
  4. Guerra M. The right ventricle in cardiac surgery: the surgeon perspective. Rev. Port. Cir. Cardiotorac. Vasc. 2010; 17 (4): 209–16.
  5. John R., Lee S., Eckman P., Liao K. Right ventricular failure – a continuing problem in patients with left ventricular assist device support. J. Cardiovasc. Transl. Res. 2010; 3 (6): 604–11.
  6. Nguyen T., Cao L., Movahed A. Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential. Echocardiography. 2014; 31 (9): 1159–65.
  7. Hullin R. Heart transplantation: current practice and outlook to the future. Swiss Med. Wkly. 2014; 144: 13977.
  8. Argiriou M., Kolokotron S.M., Sakellaridis T., Argiriou O., Charitos C., Zarogoulidis P. et al. Right heart failure post left ventricular assist device implantation. J. Thorac. Dis. 2014; 6 (Suppl. 1): 52–9.
  9. Lorenz C.H., Walker E.S., Morgan V.L., Klein S.S., Graham T.P. Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J. Cardiovasc. Magn. Reson. 1999; 1: 7–21.
  10. Dell’Italia L.J. The right ventricle: anatomy, physiology, and clinical importance. Curr. Probl. Cardiol. 1991; 16: 653–720.
  11. Haddad F., Couture P., Tousignant C., Denault A.Y. The right ventricle in cardiac surgery, a perioperative perspective: I. Anatomy, physiology, and assessment. Anesth. Analg. 2009; 108 (2): 407–21.
  12. Lee F.A. Hemodynamics of the right ventricle in normal and disease states. Cardiol. Clin. 1992; 10: 59–67.
  13. McDonald M.A., Ross H.J. Trying to succeed when the right ventricle fails. Curr. Opin. Cardiol. 2009; 24 (3): 239–45.
  14. Maslow A.D., Regan M.M., Panzica P., Heindel S., Mashikian J., Comunale M.E. Precardiopulmonary bypass right ventricular function is associated with poor outcome after coronary artery bypass grafting in patients with severe left ventricular systolic dysfunction. Anesth. Analg. 2002; 95 (6): 1507–18.
  15. Pinzani A., Gevigney G., Pinzani V., Ninet J., Milon H., Delahaye J.P. Preand postoperative right cardiac insufficiency in patients with mitral or mitral-aortic valve diseases. Arch. Mal. Coeur. Vaiss. 1993; 86: 27–34.
  16. Reichert C.L., Visser C.A., van den Brink R.B., Koolen J.J., van Wezel H.B., Moulijn A.C. et al. Prognostic value of biventricular function in hypotensive patients after cardiac surgery as assessed by transesophageal echocardiography. J. Cardiothorac. Vasc. Anesth. 1992; 6: 429–32.
  17. Hosenpud J.D., Bennett L.E., Keck B.M., Fiol B., Boucek M.M., Novick R.J. The Registry of the International Society for Heart and Lung Transplantation: seventeenth official report – 2000. J. Heart Lung. Transplant. 2000; 19: 909–31.
  18. Grimm J.C., Magruder J.T., Kemp C.D., Shah A.S. Late complications following continuous-flow left ventricular assist device implantation. Front. Surg. 2015; 2: 42.
  19. Lo C., Murphy D., Summerhayes R., Quayle M., Burrell A.J.C., Bailey M.J. et al. Right ventricular failure after implantation of continuous flow left ventricular assist device: analysis of predictors and outcomes. Clin. Transplant. 2015; 9 (9): 763–70.
  20. Itagaki S., Hosseinian L., Varghese R. Right ventricular failure after cardiac surgery: management strategies. Semin. Thorac. Cardiovasc. Surg. 2012; 24 (3): 188–94.
  21. Koprivanac M., Kelava M., Sirić F., Cruz V.B., Moazami N., Mihaljević T. Predictors of right ventricular failure after left ventricular assist device implantation. Croat. Med. J. 2014; 55 (6): 587–95.
  22. Ochiai Y., McCarthy P.M., Smedira N.G., Banbury M.K., Navia J.L., Feng J. et al. Predictors of severe right ventricular failure after implantable left ventricular assist device insertion: analysis of 245 patients. Circulation. 2002; 106 (12 Suppl. 1): 198–202.
  23. Atluri P., Goldstone A.B., Fairman A.S., MacArthur J.W., Shudo Y., Cohen J.E. et al. Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era. Ann. Thorac. Surg. 2013; 96 (3): 857–63.
  24. Vlahakes G.J. Right ventricular failure following cardiac surgery. Coron. Artery Dis. 2005; 16 (1): 27–30.
  25. Piazza G., Goldhaber S.Z. The acutely decompensated right ventricle: pathways for diagnosis and management. Chest. 2005; 128 (3): 1836–52.
  26. Redington A.N. Physiopathology of right ventricular failure. Semin. Thorac. Cardiovasc. Surg. Pediatr. Card. Surg. Annu. 2006; 9 (1): 3–10.
  27. Simon M.A. Assessment and treatment of right ventricular failure. Nat. Rev. Cardiol. 2013; 10 (4): 204–18.
  28. Levick J.R. An introduction to cardiovascular physiology. 5th ed. London: Hodder-Arnold; 2010.
  29. Murray J.F. Pulmonary edema: pathophysiology and diagnosis. Int. J. Tuberc. Lung. Dis. 2011; 15: 155–60.
  30. Гриппи М.А. Патофизиология легких. М.; 2005. [Grippi M.A. Pathophysiology of the lungs. Moscow; 2005 (in Russ.).]
  31. MacIver D.H., Clark A.L. The vital role of the right ventricle in the pathogenesis of acute pulmonary edema. Am. J. Cardiol. 2015; 115 (7): 992–1000.
  32. Kemp C.D., Conte J.V. The pathophysiology of heart failure. Cardiovasc. Pathol. 2012; 21 (5): 365–71.
  33. Schwinger R.H.G., Bohm M., Koch A., Schmidt U., Morano I., Eissner H.J. et al. The failing human heart is unable to use the Frank – Starling mechanism. Circ. Res. 1994; 74: 959–69.
  34. Riquet M., Hidden G., Debesse B. Thoracic duct collaterals of lymphatic and pulmonary origin. Anatomy and chylothorax after pulmonary surgery. Ann. Chir. 1989; 43 (8): 646–57.
  35. Riquet M., Mordant P., Pricopi C., Achour K., Le Pimpec Barthes F. Anatomy, micro-anatomy and physiology of the lymphatics of the lungs and chest wall. Rev. Pneumol. Clin. 2013; 69 (2): 102–10.
  36. Jawad H., Sirajuddin A., Chung J.H. Review of the international association for the study of lung cancer lymph node classification system: localization of lymph node stations on CT imaging. Clin. Chest. Med. 2013; 34 (3): 353–63.
  37. Cecconi M., Johnston E., Rhodes A. What role does the right side of the heart play in circulation? Crit. Care. 2006; 10 (Suppl. 3): 5.
  38. Mac Sweeney R., McAuley D.F., Matthay M.A. Acute lung failure. Semin. Respir. Crit. Care. Med. 2011; 32 (5): 607–25.
  39. Woodcock T.E., Woodcock T.M. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br. J. Anaesth. 2012; 108: 384–94.
  40. Parker J.C., Townsley M.I. Physiological determinants of the pulmonary filtration coefficient. Am. J. Physiol. Lung. Cell. Mol. Physiol. 2008; 295: 235–7.
  41. Clark A.L., Cleland J.G. Causes and treatment of oedema in patients with heart failure. Nat. Rev. Cardiol. 2013; 10: 156–70.
  42. MacIver D.H., Dayer M.J., Harrison A.J. A general theory of acute and chronic heart failure. Int. J. Cardiol. 2013; 165: 25–34.
  43. MacIver D.H., Townsend M. A novel mechanism of heart failure with normal ejection fraction. Heart. 2008; 94: 446–9.
  44. Nations J., Brown G. Right upper lobe pulmonary edema: an uncommon presentation of severe mitral regurgitation. Am. J. Respir. Crit. Care. Med. 2012; 185: 5953.
  45. MacIver D.H., Dayer M.J. An alternative approach to understanding the pathophysiological mechanisms of chronic heart failure. Int. J. Cardiol. 2012; 154: 102–10.
  46. Osterwalder J.J. Cardiogenic pulmonary edema – truth and myths in the perspective of emergency medicine. Praxis (Bern 1994). 2012; 101: 1251–9.
  47. Shupak A., Guralnik L., Keynan Y., Yanir Y., Adir Y. Pulmonary edema following closed-circuit oxygen diving and strenuous swimming. Aviat. Space Environ. Med. 2003; 74: 1201–4.
  48. Liner M.H., Andersson J.P. Pulmonary edema after competitive breath hold diving. J. Appl. Physiol. 2008; 104: 986–90.
  49. Hopkins S.R. Point: pulmonary edema does occur in human athletes performing heavy sea-level exercise. J. Appl. Physiol. 2010; 109: 1270–2.
  50. Carter E.A., Koehle M.S. Immersion pulmonary edema in female triathletes. Pulm. Med. 2011; 2011: 261–404.
  51. Casey H., Dastidar A.G., MacIver D. Swimminginduced pulmonary oedema in two triathletes: a novel pathophysiological explanation. J. R. Soc. Med. 2014; 107: 450–2.
  52. Vandenheuvel M.A., Bouchez S., Wouters P.F., De Hert S.G. A pathophysiological approach towards right ventricular function and failure. Eur. J. Anaesthesiol. 2013; 30 (7): 386–94.
  53. Toller W., Heringlake M., Guarracino F., Algotsson L., Alvarez J., Argyriadou H. et al. Preoperative and perioperative use of levosimendan in cardiac surgery: European expert opinion. Int. J. Cardiol. 2015; 184: 323–36.
  54. Green E.M., Givertz M.M. Management of acute right ventricular failure in the intensive care unit. Curr. Heart Fail. Rep. 2012; 9 (3): 228–35.
  55. Hess M.L., Cooke R.H., Varma A. Right ventricular dysfunction: lessons learned from mechanical circulatory assist devices. Am. J. Med. Sci. 2014; 347 (1): 80–3.
  56. Bonow R.O., Carabello B.A., Kanu C. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006; 114: 84–231.
  57. Cheng D.C., Edelist G. Isoflurane and primary pulmonary hypertension. Anaesthesia. 1988; 43: 22–4.
  58. Fortier S., DeMaria R.G., Lamarche Y., Malo O., Denault A., Desjardins F. et al. Inhaled prostacyclin reduces cardiopulmonary bypass-induced pulmonary endothelial dysfunction via increased cyclic adenosine monophosphate levels. J. Thorac. Cardiovasc. Surg. 2004; 128: 109–16.
  59. Lamarche Y., Malo O., Thorin E., Denault A.Y., Carrier M., Roy J. et al. Inhaled but not intravenous milrinone prevents pulmonary endothelial dysfunction after cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg. 2005; 130: 83–92.
  60. Haché M., Denault A.Y., Bélisle S., Robitaille D., Couture P., Sheridan P. et al. Inhaled epoprostenol (prostacyclin) and pulmonary hypertension before cardiac surgery. J. Thorac. Cardiovasc. Surg. 2003; 125: 642–9.
  61. Fattouch K., Sbraga F., Sampognaro R., Bianco G., Gucciardo M., Lavalle C. et al. Treatment of pulmonary hypertension in patients undergoing cardiac surgery with cardiopulmonary bypass: a randomized, prospective, double-blind study. J. Cardiovasc. Med. (Hagerstown). 2006; 7: 119–23.
  62. Наумов А.Б., Баутин А.Е., Кутин А.М., Поваренков А.С., Козырев И.М. Применение левосимендана для лечения кардиогенного шока, связанного с развитием острой правожелудочковой недостаточности после аортокоронарного шунтирования. Кардиология и сердечно-сосудистая хирургия. 2009; 1: 79–81. [Naumov A.B., Bautin A.E., Kutin A.M., Povarenkov A.S., Kozyrev I.M. The use of levosimendan for the treatment of cardiogenic shock associated with the development of acute right ventricular failure after coronary artery bypass grafting. Kardiologiya i Serdechno-Sosudistaya Khirurgiya (Cardiology and Cardiovascular Surgery, Russian journal). 2009; 1: 79–81 (in Russ.).]
  63. Pierrakos C., Velissaris D., Franchi F., Muzzi L., Karanikolas M., Scolletta S. Levosimendan in critical illness: a literature review. J. Clin. Med. Res. 2014; 6 (2): 75–85.
  64. Бокерия Л.А., Никитин Е.С., Лобачёва Г.В., Бахтадзе З.Ш., Сайдалиева З.О., Макрушин И.М. Лечение правожелудочковой недостаточности в ближайшем послеоперационном периоде у пациентов, перенесших вмешательство на сердце в условиях искусственного кровообращения. Клиническая физиология кровообращения. 2012; 1: 10–6. [Bockeria L.A., Nikitin E.S., Lobacheva G.V., Bakhtadze Z.Sh., Saydalieva Z.O., Makrushin I.M. Treatment of right ventricular failure in the immediate postoperative period in patients who underwent cardiac surgery in conditions of artificial circulation. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2012; 1: 10–6 (in Russ.).]
  65. Fischer L.G., Van Aken H., Bürkle H. Management of pulmonary hypertension: Physiological and pharmacological considerations for anesthesiologists. Anesth. Analg. 2003; 96: 1603–16.
  66. Lepore J.J., Maroo A., Bigatello L.M., Dec G.W., Zapol W.M., Bloch K.D., Semigran M.J. Hemodynamic effects of sildenafil in patients with congestive heart failure and pulmonary hypertension: combined administration with inhaled nitric oxide. Chest. 2005; 127: 1647–53.
  67. Rubin L.J. Endothelin receptor antagonists for the treatment of pulmonary artery hypertension. Life Sci. 2012; 91 (13–14): 517–21.
  68. Баландюк А.В. Побудительная спирометрия и ингаляция оксида азота для профилактики дыхательных осложнений при операциях с искусственным кровообращением: Дис. ... канд. мед. наук. М.; 2005. [Balandyuk A.V. Incentive spirometry and inhalation of nitric oxide for the prevention of respiratory complications during operations with artificial blood circulation: Cand. med. sc. Diss. Мoscow; 2005 (in Russ.).]
  69. Barst R.J., Rubin L.J., Long W.A., McGoon M.D., Rich S., Badesch D.B. et al. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. The Primary Pulmonary Hypertension Study Group. N. Engl. J. Med. 1996; 334: 296–302.
  70. Price L.C., Wort S.J., Finney S.J., Marino P.S., Brett S.J. Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review. Crit. Care. 2010; 14 (5): 169.
  71. Медресова А.Т. Использование неинвазивной вентиляции для профилактики послеоперационных легочных осложнений у кардиохирургических пациентов: Дис. ... канд. мед. наук. М.; 2012. [Medresova A.T. Use of noninvasive ventilation for prevention of postoperative pulmonary complications in cardiac surgery patients: Cand. med. sc. Diss. Мoscow; 2012 (in Russ.).]
  72. Kormos R.L. Solutions for right ventricular failure: innovation driven by need. J. Thorac. Cardiovasc. Surg. 2015; 149 (3): 933–4.
  73. Gorazd Voga B.Y. Right ventricular function in critically ill patients. Signa Vitae. 2017; 13 (Suppl. 1): 24–6.
  74. Wang X.T., Liu D.W., Zhang H.M., Long Y., Guan X.D., Qiu H.B. et al. Experts consensus on the management of the right heart function in critically ill patients. Zhonghua Nei Ke Za Zhi. 2017; 56 (12): 962–73.

About Authors

Nikitin Evgeniy Stanislavovich, Dr. Med. Sc., Head of Intensive Care Unit for Older Children with Congenital Heart Disease Saydalieva Zulikhan Obusup’yanovna, Resuscitator

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