Skip to main content
SpringerLink
Log in

Update on Right Ventricular Hemodynamic, Echocardiographic and Extra-Cardiac Ultrasound Monitoring

  • Chapter
  • First Online:
Book cover Annual Update in Intensive Care and Emergency Medicine 2020

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

Numerous definitions of right ventricular (RV) dysfunction have been suggested to reinforce its burden and dramatic consequences and also to ensure prompt treatment in reversible situations. Evaluation of patients at risk of RV dysfunction is of primary importance in order to decrease its progression and consequences that can compromise function of the brain and the abdominal organs, such as the liver, the kidneys and the gut. To envisage optimal management, multiple parameters are used to evaluate and follow RV function. These parameters rely on traditional and contemporary right heart catheterization monitoring indices, and echocardiographic modalities, including extra-cardiac echocardiography, to evaluate repercussions of the decreased RV function. The focus of this manuscript is on useful hemodynamic indices quickly available in an intensive care unit setting to evaluate and monitor RV function through tailored management. Echocardiographic parameters and extra-cardiac echocardiographic evaluation of RV repercussions will also help to understand the burden of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Amsallem M, Kuznetsova T, Hanneman K, Denault A, Haddad F. Right heart imaging in patients with heart failure: a tale of two ventricles. Curr Opin Cardiol. 2016;31:469–82.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ghio S, Gavazzi A, Campana C, et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol. 2001;37:183–8.

    Article  CAS  PubMed  Google Scholar 

  3. Bodez D, Ternacle J, Guellich A, et al. Prognostic value of right ventricular systolic function in cardiac amyloidosis. Amyloid. 2016;23:158–67.

    Article  CAS  PubMed  Google Scholar 

  4. Anavekar NS, Skali H, Bourgoun M, et al. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). Am J Cardiol. 2008;101:607–12.

    Article  PubMed  Google Scholar 

  5. Maslow AD, Regan MM, Panzica P, Heindel S, Mashikian J, Comunale ME. 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;95:1507–18.

    Article  PubMed  Google Scholar 

  6. Haddad F, Couture P, Tousignant C, Denault A. The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance, and management. Anesth Analg. 2009;108:422–33.

    Article  PubMed  Google Scholar 

  7. Kormos RL, Teuteberg JJ, Pagani FD, et al. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010;139:1316–24.

    Article  PubMed  Google Scholar 

  8. Denault AY, Pearl RG, Michler RE, et al. Tezosentan and right ventricular failure in patients with pulmonary hypertension undergoing cardiac surgery: the TACTICS trial. J Cardiothorac Vasc Anesth. 2013;27:1212–7.

    Article  CAS  PubMed  Google Scholar 

  9. Denault AY, Bussieres JS, Arellano R, et al. A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients. Can J Anesth. 2016;63:1140–53.

    Article  PubMed  Google Scholar 

  10. Harjola VP, Mebazaa A, Celutkiene J, et al. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail. 2016;18:226–41.

    Article  PubMed  Google Scholar 

  11. Mehra MR, Park MH, Landzberg MJ, Lala A, Waxman AB, International Right Heart Failure Foundation Scientific Working Group. Right heart failure: toward a common language. J Heart Lung Transplant. 2014;33:123–6.

    Article  PubMed  Google Scholar 

  12. Hoeper MM, Benza RL, Corris P, et al. Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension. Eur Respir J. 2019;53:1801906.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Amsallem M, Mercier O, Kobayashi Y, Moneghetti K, Haddad F. Forgotten no more: a focused update on the right ventricle in cardiovascular disease. JACC Heart Fail. 2018;6:891–903.

    Article  PubMed  Google Scholar 

  14. Denault AY, Haddad F, Jacobsohn E, et al. Perioperative right ventricular dysfunction. Curr Opin Anaesthesiol. 2013;26:71–81.

    Article  PubMed  Google Scholar 

  15. Raymond M, Gronlykke L, Couture EJ, et al. Perioperative right ventricular pressure monitoring in cardiac surgery. J Cardiothorac Vasc Anesth. 2019;33:1090–104.

    Article  PubMed  Google Scholar 

  16. Haddad F, Couture P, Tousignant C, et al. The right ventricle in cardiac surgery, a perioperative perspective: I. Anatomy, physiology, and assessment. Anesth Analg. 2009;108:407–21.

    Article  PubMed  Google Scholar 

  17. Denault AY, Chaput M, Couture P, Hébert Y, Haddad F, Tardif JC. Dynamic right ventricular outflow tract obstruction in cardiac surgery. J Thorac Cardiovasc Surg. 2006;132:43–9.

    Article  PubMed  Google Scholar 

  18. Eljaiek R, Cavayas YA, Rodrigue E, et al. High postoperative portal venous flow pulsatility indicates right ventricular dysfunction and predicts complications in cardiac surgery patients. Br J Anaesth. 2019;122:206–14.

    Article  CAS  PubMed  Google Scholar 

  19. Haddad F, Guihaire J, Skhiri M, et al. Septal curvature is marker of hemodynamic, anatomical, and electromechanical ventricular interdependence in patients with pulmonary arterial hypertension. Echocardiography. 2014;31:699–707.

    Article  PubMed  Google Scholar 

  20. Robitaille A, Denault AY, Couture P, et al. Importance of relative pulmonary hypertension in cardiac surgery: the mean systemic-to-pulmonary artery pressure ratio. J Cardiothorac Vasc Anesth. 2006;20:331–9.

    Article  PubMed  Google Scholar 

  21. Rebel A, Nguyen D, Bauer B, Sloan PA, DiLorenzo A, Hassan ZU. Systemic-to-pulmonary artery pressure ratio as a predictor of patient outcome following liver transplantation. World J Hepatol. 2016;8:1384–91.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bianco JC, Mc Loughlin S, Denault AY, Marenchino RG, Rojas JI, Bonofliglio FC. Heart transplantation in patients >/=60 years: importance of relative pulmonary hypertension and right ventricular failure on midterm survival. J Cardiothorac Vasc Anesth. 2018;32:32–40.

    Article  PubMed  Google Scholar 

  23. Saydain G, Awan A, Manickam P, Kleinow P, Badr S. Pulmonary hypertension an independent risk factor for death in intensive care unit: correlation of hemodynamic factors with mortality. Clin Med Insights Circ Respir Pulm Med. 2015;9:27–33.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fitzpatrick JR 3rd, Frederick JR, Hsu VM, et al. Risk score derived from pre-operative data analysis predicts the need for biventricular mechanical circulatory support. J Heart Lung Transplant. 2008;27:1286–92.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Korabathina R, Heffernan KS, Paruchuri V, et al. The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv. 2012;80:593–600.

    Article  PubMed  Google Scholar 

  26. Kang G, Ha R, Banerjee D. Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation. J Heart Lung Transplant. 2016;35:67–73.

    Article  PubMed  Google Scholar 

  27. Gudejko MD, Gebhardt BR, Zahedi F, et al. Intraoperative hemodynamic and echocardiographic measurements associated with severe right ventricular failure after left ventricular assist device implantation. Anesth Analg. 2019;128:25–32.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Alfirevic A, Sale S, Soltesz E. Foretelling right ventricular failure after left ventricular assist device implantation: the tale of the pulmonary artery pulsatility index. Anesth Analg. 2019;128:8–10.

    Article  PubMed  Google Scholar 

  29. Lloyd EA, Gersh BJ, Kennelly BM. Hemodynamic spectrum of “dominant” right ventricular infarction in 19 patients. Am J Cardiol. 1981;48:1016–22.

    Article  CAS  PubMed  Google Scholar 

  30. Morine KJ, Kiernan MS, Pham DT, Paruchuri V, Denofrio D, Kapur NK. Pulmonary artery pulsatility index is associated with right ventricular failure after left ventricular assist device surgery. J Card Fail. 2016;22:110–6.

    Article  PubMed  Google Scholar 

  31. Drazner MH, Hamilton MA, Fonarow G, et al. Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure. J Heart Lung Transplant. 1999;18:1126–32.

    Article  CAS  PubMed  Google Scholar 

  32. Campbell P, Drazner MH, Kato M, et al. Mismatch of right- and left-sided filling pressures in chronic heart failure. J Card Fail. 2011;17:561–8.

    Article  PubMed  Google Scholar 

  33. Guazzi M, Bandera F, Pelissero G, et al. Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol. 2013;305:H1373–81.

    Article  CAS  PubMed  Google Scholar 

  34. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):39.e14.

    Article  Google Scholar 

  35. Haddad F, Denault AY, Couture P, et al. Right ventricular myocardial performance index predicts perioperative mortality or circulatory failure in high-risk valvular surgery. J Am Soc Echocardiogr. 2007;20:1065–72.

    Article  PubMed  Google Scholar 

  36. Tousignant C, Van Orman JR. Pulmonary impedance and pulmonary Doppler trace in the perioperative period. Anesth Analg. 2015;121:601–9.

    Article  PubMed  Google Scholar 

  37. Focardi M, Cameli M, Carbone SF, et al. Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging. 2015;16:47–52.

    Article  PubMed  Google Scholar 

  38. Tousignant C, Desmet M, Bowry R, Harrington AM, Cruz JD, Mazer CD. Speckle tracking for the intraoperative assessment of right ventricular function: a feasibility study. J Cardiothorac Vasc Anesth. 2010;24:275–9.

    Article  PubMed  Google Scholar 

  39. Duncan AE, Sarwar S, Kateby Kashy B, et al. Early left and right ventricular response to aortic valve replacement. Anesth Analg. 2017;124:406–18.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Ternacle J, Berry M, Cognet T, et al. Prognostic value of right ventricular two-dimensional global strain in patients referred for cardiac surgery. J Am Soc Echocardiogr. 2013;26:721–6.

    Article  PubMed  Google Scholar 

  41. Fusini L, Tamborini G, Gripari P, et al. Feasibility of intraoperative three-dimensional transesophageal echocardiography in the evaluation of right ventricular volumes and function in patients undergoing cardiac surgery. J Am Soc Echocardiogr. 2011;24:868–77.

    Article  PubMed  Google Scholar 

  42. Scheinfeld MH, Bilali A, Koenigsberg M. Understanding the spectral Doppler waveform of the hepatic veins in health and disease. Radiographics. 2009;29:2081–98.

    Article  PubMed  Google Scholar 

  43. Denault AY, Beaubien-Souligny W, Elmi-Sarabi M, et al. Clinical significance of portal hypertension diagnosed with bedside ultrasound after cardiac surgery. Anesth Analg. 2017;124:1109–15.

    Article  PubMed  Google Scholar 

  44. Duerinckx AJ, Grant EG, Perrella RR, Szeto A, Tessler FN. The pulsatile portal vein in cases of congestive heart failure: correlation of duplex Doppler findings with right atrial pressures. Radiology. 1990;176:655–8.

    Article  CAS  PubMed  Google Scholar 

  45. Beaubien-Souligny W, Benkreira A, Robillard P, et al. Alterations in portal vein flow and intrarenal venous flow are associated with acute kidney injury after cardiac surgery: a prospective observational cohort study. J Am Heart Assoc. 2018;7:e009961.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Benkreira A, Beaubien-Souligny W, Mailhot T, et al. Portal hypertension is associated with congestive encephalopathy and delirium after cardiac surgery. Can J Cardiol. 2019;35:1134–41.

    Article  PubMed  Google Scholar 

  47. Tremblay JA, Beaubien-Souligny W, Elmi-Sarabi M, Desjardins G, Denault AY. Point-of-care ultrasonography to assess portal vein pulsatility and the effect of inhaled milrinone and epoprostenol in severe right ventricular failure: a report of 2 cases. A A Case Rep. 2017;9:219–23.

    Article  PubMed  Google Scholar 

  48. Beaubien-Souligny W, Bouchard J, Desjardins G, et al. Extracardiac signs of fluid overload in the critically ill cardiac patient: a focused evaluation using bedside ultrasound. Can J Cardiol. 2017;33:88–100.

    Article  PubMed  Google Scholar 

  49. Iida N, Seo Y, Sai S, et al. Clinical implications of intrarenal hemodynamic evaluation by Doppler ultrasonography in heart failure. JACC Heart Fail. 2016;4:674–82.

    Article  PubMed  Google Scholar 

  50. Fukamachi K, McCarthy PM, Smedira NG, Vargo RL, Starling RC, Young JB. Preoperative risk factors for right ventricular failure after implantable left ventricular assist device insertion. Ann Thorac Surg. 1999;68:2181–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine Division, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, QC, Canada

    E. J. Couture

  2. Department of Anesthesiology and Critical Care Division, Montreal Heart Institute and Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, QC, Canada

    A. Y. Denault

Authors
  1. E. J. Couture
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Y. Denault
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Y. Denault .

Editor information

Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Couture, E.J., Denault, A.Y. (2020). Update on Right Ventricular Hemodynamic, Echocardiographic and Extra-Cardiac Ultrasound Monitoring. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2020. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-37323-8_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-37323-8_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-37322-1

  • Online ISBN: 978-3-030-37323-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation