Management of acute right ventricular failure primarily involves correcting reversible causes of excessive load or reduced contractility, followed by diuretic, vasodilator, or inotropic therapy.
This review outlines a therapeutic framework for managing acute perioperative right ventricular failure, emphasizing the correction of reversible causes followed by targeted pharmacological therapy.
PURPOSE OF REVIEW: This review summarizes the approach to and recent developments in the treatment of acute right ventricular dysfunction and failure in the perioperative setting. Right ventricular failure, defined as the inability to deliver sufficient blood flow through the pulmonary circulation at normal central venous pressure, is a common problem in the perioperative setting and is associated with an increased mortality. The failure of the right ventricle is caused by reduced right ventricular contractility or an increased right ventricular afterload or both. RECENT FINDINGS: Management of acute right ventricular failure continues to be challenging because of the poor understanding of the pathophysiology, difficulties in diagnosing, the absence of guidelines, and limited therapeutic options. Recent research efforts have led to an improved understanding of the underlying mechanisms and have established a reasonable therapeutic framework. SUMMARY: Right ventricular dysfunction may cause venous congestion and systemic hypoperfusion. After identifying right ventricular dysfunction, the primary goal is to correct reversible causes of excessive load or reduced right-ventricular contractility. If the underlying abnormalities cannot be reversed, diuretic, vasodilator, or inotropic therapy may be required.
Zarbock et al. (Tue,) conducted a review in Acute right ventricular dysfunction and failure in the perioperative setting. Management of acute right ventricular failure (diuretic, vasodilator, or inotropic therapy) was evaluated. Management of acute right ventricular failure primarily involves correcting reversible causes of excessive load or reduced contractility, followed by diuretic, vasodilator, or inotropic therapy.