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The Right Ventricle—You May Forget It, But It Will Not Forget You

1
Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, 4031 Basel, Switzerland
2
Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(2), 432; https://doi.org/10.3390/jcm9020432
Received: 31 December 2019 / Revised: 23 January 2020 / Accepted: 27 January 2020 / Published: 5 February 2020
(This article belongs to the Special Issue Anesthesia for the High-Risk Patient)
Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether. View Full-Text
Keywords: right ventricle; right ventricular; dysfunction; failure; shock; perioperative; postoperative; management; prevention right ventricle; right ventricular; dysfunction; failure; shock; perioperative; postoperative; management; prevention
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MDPI and ACS Style

Wanner, P.M.; Filipovic, M. The Right Ventricle—You May Forget It, But It Will Not Forget You. J. Clin. Med. 2020, 9, 432. https://doi.org/10.3390/jcm9020432

AMA Style

Wanner PM, Filipovic M. The Right Ventricle—You May Forget It, But It Will Not Forget You. Journal of Clinical Medicine. 2020; 9(2):432. https://doi.org/10.3390/jcm9020432

Chicago/Turabian Style

Wanner, Patrick M.; Filipovic, Miodrag. 2020. "The Right Ventricle—You May Forget It, But It Will Not Forget You" J. Clin. Med. 9, no. 2: 432. https://doi.org/10.3390/jcm9020432

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