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Mechanical Support of the Failing Right Heart

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Clinical Cases in Right Heart Failure

Part of the book series: Clinical Cases in Cardiology ((CCC))

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Abstract

Predominant right heart failure (RHF) is found in 5% of patients with myocardial infarction complicated by cardiogenic shock. The mortality rates of cardiogenic shock from RHF and left heart failure (LHF) are similar. The initial management of acute RHF should focus on the treatment of the underlying etiology, the correction of metabolic derangements, the maintenance of atrioventricular synchrony, and appropriate systemic perfusion and oxygenation. The hemodynamic parameters suggestive of RHF include elevated right atrial pressure (RAP), RAP: pulmonary capillary wedge pressure ratio (RAP/ PCWP) >0.86, and pulmonary artery pulsatility index (PAPi) <1. Percutaneous mechanical support options for acute RHF include Impella RP, TandemHeart Protek Duo, and Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO). The implantation of a contemporary durable left ventricular assist device (LVAD) in a right ventricle has been reported. The CentriMag right ventricular assist system can also be used as a bridge to recovery or transplant.

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Authors and Affiliations

  1. Division of Advanced Heart Failure and Cardiac Transplant, Massachusetts General Hospital, Boston, MA, USA

    Sunu S. Thomas & Erin Coglianese

  2. Harvard Medical School, Boston, MA, USA

    Sunu S. Thomas & Erin Coglianese

  3. Cardiovascular Service Line, Maine Medical Center, Portland, ME, USA

    Maxwell E. Afari

  4. Tufts University School of Medicine, Boston, MA, USA

    Maxwell E. Afari

Authors
  1. Sunu S. Thomas
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  2. Maxwell E. Afari
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  3. Erin Coglianese
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Corresponding author

Correspondence to Erin Coglianese .

Editor information

Editors and Affiliations

  1. St. Elizabeth’s Medical Center, Boston, MA, USA

    Lana Tsao

  2. Maine Medical Center, Portland, ME, USA

    Maxwell E. Afari

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Thomas, S.S., Afari, M.E., Coglianese, E. (2020). Mechanical Support of the Failing Right Heart. In: Tsao, L., Afari, M. (eds) Clinical Cases in Right Heart Failure. Clinical Cases in Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-38662-7_9

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  • DOI: https://doi.org/10.1007/978-3-030-38662-7_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-38661-0

  • Online ISBN: 978-3-030-38662-7

  • eBook Packages: MedicineMedicine (R0)

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