Abstract
It has long been appreciated that the cardiovascular system plays a vital role in surgical illnesses. Although attention has, historically, been largely focused on the left ventricle, it has become apparent in recent years that the right ventricle may contribute significantly to an absolute or relative failure of cardiovascular adaptation to acute and chronic disease states. Many of the physiological principles governing left ventricular function also determine right ventricular function. Thus, the right ventricle is affected by changes in afterload, preload, and contractility. Since many surgically relevant disease states may potentially alter such determinants of right ventricular function, some consideration of right ventricular function and its effect on global cardiac function in the surgical patient is warranted. In this review, we have attempted to provide a brief overview of normal right ventricular physiology as well as the pathophysiology and therapy of right ventricular dysfunction that may be seen in the surgical patient.
Résumé
Depuis longtemps il est connu que l'appareil cardio-vasculaire joue un rôle vital au cours de la maladie chirurgicale. Si, historiquement, l'attention a été concentrée sur le ventricule gauche, il est apparu au cours des récentes années que le ventricule droit peut contribuer largement à une défaillance relative ou absolue de l'adaptation cardio-vasculaire à des états pathologiques chroniques ou aigus. Les bases physiologiques qui concernent le ventricule gauche s'appliquent aussi au fonctionnement du ventricule droit. C'est ainsi que ce dernier est affecté par des modifications de la précharge, de la postcharge et de la contractilité. Le fait que de nombreuses affections relevant de la chirurgie puissent altérer ces facteurs justifie la considération que l'on doit accorder au fonctionnement du ventricule droit et à son effet sur le fonctionnement global du coeur. Dans cette revue générale, les auteurs de l'article ont tenté de préciser brièvement la physiologie du ventricule droit ainsi que la physio-pathologie et le traitement de l'altération fonctionnelle de ce ventricule susceptible d'être observée chez le malade chirurgical.
Resume
Desde hace largo tiempo se sabe que el sistema cardiovascular juega un papel vital en la enfermedad quirúrgica. En tanto que históricamente la atención ha sido concentrada principalmente en el ventrículo izquierdo, sólo en años recientes se ha hecho evidente que el ventrículo derecho puede contribuir en forma significativa a una falla absoluta o relativa de la adaptation cardiovascular a diversas condiciones clínicas agudas y crónicas. Muchos de los principios fisiológicos que gobiernan la función del ventrículo izquierdo tambien lo son de la función del ventriculo derecho. Es así como el ventrículo derecho se halla afectado por cambios en la poscarga, la precarga, y la contractilidad. Puesto que muchas condiciones clínicas quirúrgicas pueden potencialmente alterar tales factores determinantes de la función ventricular derecha, se justifica poner en consideración la función del ventrículo derecho y su efecto sobre la función cardiaca global en el paciente quirúrgico. En esta revisión hemos tratado de presentar una visión de la fisiología normal del ventrículo derecho asf como de la patofisiología y terapia de la disfunción ventricular derecha que puede presentarse en el paciente quirúrgico.
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Supported in part by a grant from the Ontario Heart Foundation (#AN 505).
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Raper, R., Sibbald, W.J. Right ventricular function in the surgical patient. World J. Surg. 11, 154–160 (1987). https://doi.org/10.1007/BF01656397
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DOI: https://doi.org/10.1007/BF01656397