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Echocardiographic Evaluation and Monitoring of Right Ventricular Function and Pulmonary Artery Pressures

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Hemodynamic Monitoring Using Echocardiography in the Critically Ill

Abstract

Right ventricular (RV) dysfunction is common in critically ill patients. It is associated with multiple clinical scenarios frequently encountered by the intensivist, including acute cor pulmonale, acute RV dysfunction of sepsis, and acute RV infarction. In addition, assessment of right-heart function is essential to assess a subject’s preload responsiveness since acute cor pulmonale is also associated with respiratory variations in pulse pressure or stroke volume. Finally, the clinical symptoms of tamponade and acute RV failure are very similar. Echocardiography is the best available method to diagnose and monitor right-heart function at the bedside.

When evaluating RV dysfunction, we have to evaluate its severity and differentiate impairment in RV contractility from an increased RV afterload. Pulmonary artery pressure (usually systolic pulmonary artery pressure from tricuspid regurgitant flow with continuous Doppler), can be measured, but it can be underestimated in low-flow conditions. Septal dyskinesia is the echocardiographic hallmark of sudden elevations of RV systolic overload. Septal dyskinesia can be assessed qualitatively (observation of paradoxical septal motion) and quantitatively (measurement of the systolic EI). This sign differentiates RV dysfunction, which does not always impair cardiac output, from RV failure. RV diastolic overload is synonymous with RV dilation, which is best assessed semiquantitatively (characterized as normal, moderately, or severely dilated, based on the ratio of RV to left ventricular end-diastolic areas).

RV contractility can be assessed by visual inspection or by systolic movement of the tricuspid annulus (time-movement mode or tissue Doppler imaging), but these indices are also affected by left atrial pressure.

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Acknowledgement: Assistance in preparation of this chapter from Dr. Stephen Huang noted.

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Authors and Affiliations

  1. 2821 Michaelangelo Drive, Suite 303, Edinburg, TX, 78539, USA

    Adolfo Kaplan

  2. University of Sydney, Nepean Hospital, Sydney, Australia

    Antony Mc Lean

  3. Intensive Care Unit, University Hospital Ambroise Paré, 9 avenue Charles-de-Gaulle, 92104, Boulogne Cedex, France

    Antoine Vieillard-Baron

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  1. Adolfo Kaplan
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Correspondence to Adolfo Kaplan .

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Editors and Affiliations

  1. , Department of Intenisve Care, Erasme University Hospital, route de Lennik 808, Bruxelles, 1070, Belgium

    Daniel de Backer

  2. Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, rue Ambroise Paré 2, Paris CX 10, 75475, France

    Bernard P. Cholley

  3. , Unité de Réanimation Médicale, Centre Hospitalier Universitaire, Avenue Laennec, Amiens Cedex 1, 80054, France

    Michel Slama

  4. Ambroise Paré, Intensive Care & Reanimation Unit, Centre Hospitalier Universitaire, avenue Charles de Gaulle 9, Boulogne Cedex, 92104, France

    Antoine Vieillard-Baron

  5. Hôpital Dupuytren, Dépt. Soin Intensive, Université de Limoges, avenue Martin Luther King 2, Limoges, 87042, France

    Philippe Vignon

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Kaplan, A., Lean, A.M., Vieillard-Baron, A. (2011). Echocardiographic Evaluation and Monitoring of Right Ventricular Function and Pulmonary Artery Pressures. In: de Backer, D., Cholley, B., Slama, M., Vieillard-Baron, A., Vignon, P. (eds) Hemodynamic Monitoring Using Echocardiography in the Critically Ill. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-87956-5_13

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  • DOI: https://doi.org/10.1007/978-3-540-87956-5_13

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