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

Figures

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  Figure 1. The progression from right ventricular (RV) dysfunction to failure is a continuum marked by progressive RV dilation and increases in heart rate to maintain cardiac index. When the compensatory mechanisms are exhausted, ventriculo-arterial uncoupling occurs with a drop in cardiac index and pulmonary pressures as well as a rise in central venous pressure, late markers of RV failure and imminent cardiovascular demise. Abbreviations: CI, cardiac index; CVP, central venous pressure; PAP, pulmonary artery pressure; PVR, pulmonary vascular resistance; RV, right ventricular; RVV, right ventricular volume; SV, stroke volume. Modified from Haddad et al. [8] Vonk Noordegraaf et al. [11] and Wanner PM & Filipovic M. (Der rechte Ventrikel—das Wichtigste für den Intensivmediziner. In: Eckart, Forst, Briegel, eds.: Intensivmedizin. Kompendium und Repetitorium zur interdisziplinären Weiter- und Fortbildung. ecomed Verlagsgesellschaft AG & Co., Landsberg. 2018) [12].

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  Figure 2. Vicious circle of right ventricular failure. Abbreviations: CI, cardiac index; IVS, interventricular septum; LV, left ventricular; MAP, mean arterial pressure; mPAP, mean pulmonary artery pressure; Pit, intrathoracic pressure; PVR, pulmonary vascular resistance; RV, right ventricular; SVR, systemic vascular resistance. Modified from Wanner PM & Filipovic M. (Der rechte Ventrikel—das Wichtigste für den Intensivmediziner. In: Eckart, Forst, Briegel, eds.: Intensivmedizin. Kompendium und Repetitorium zur interdisziplinären Weiter- und Fortbildung. ecomed Verlagsgesellschaft AG & Co., Landsberg. 2018) [12].

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  Figure 3. Transthoracic echocardiogram (parasternal short axis view) showing massive D-shaping of the interventricular septum.

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  Figure 4. Transthoracic echocardiogram (apical 4-chamber view) showing massive right ventricular dilation (RV diameter > LV diameter).

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  Figure 5. Transthoracic echocardiogram (apical 4-chamber view) showing severe tricuspid regurgitation due to massive RV dilation.

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  Figure 6. Measurement of tricuspid annular plane systolic excursion (TAPSE) as a measure of RV systolic function. Values < 17 mm are considered pathological (here 10 mm).

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  Figure 7. Transesophageal echocardiogram (midesophageal 4-chamber view) showing severe dilation of the right-sided cardiac chambers, bowing of the interatrial septum into the LV due to elevated right atrial pressures and a hyperechogenic structure in the RA and RV, in this case a clot in transit.