Pressure-Volume Loops for Reviewing Right Ventricular Physiology and Failure in the Context of Left Ventricular Assist Device Implantation.

IF 1.1 Q3 ANESTHESIOLOGY Seminars in Cardiothoracic and Vascular Anesthesia Pub Date : 2023-12-01 Epub Date: 2023-09-01 DOI:10.1177/10892532231198797
Stefaan Bouchez, Joachim Erb, Luc Foubert, Eckhard Mauermann
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引用次数: 1

Abstract

Right ventricular (RV) function is complex as a number of determinants beyond preload, inotropy and afterload play a fundamental role. In particular, arterial elastance (Ea), ventriculo-arterial coupling (VAC), and (systolic) ventricular interdependence play a vital role for the right ventricle. Understanding and actively visualizing these interactions in the failing RV as well as in the altered hemodynamic and morphological situation of left ventricular assist device (LVAD) implantation may aid clinicians in their understanding of RV dysfunction and failure. While, admittedly, hard data is scarce and invasive pressure-volume loop measurements will not become routine in cardiac surgery, we hope that clinicians will benefit from the comprehensive, simulation-based review of RV pathology. In particular, the aim of this article is to first, address and clarify the pathophysiologic hemodynamic factors that lead to RV dysfunction and then, second, expand upon this basis examining the changes occurring by LVAD implantation. This is illustrated using Harvi software which shows elastance, ventricular arterial coupling, and ventricular interdependence by simultaneously showing pressure volume loops of the right and left ventricle.

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在左心室辅助装置植入的背景下,压力-容量循环对右室生理和衰竭的回顾。
右心室(RV)的功能是复杂的,许多决定因素超出了前负荷,肌力和后负荷发挥基本作用。特别是,动脉弹性(Ea)、心室-动脉耦合(VAC)和(收缩)心室相互依赖对右心室起着至关重要的作用。了解和积极观察这些相互作用在衰竭的左心室以及左心室辅助装置(LVAD)植入后血流动力学和形态学的改变可能有助于临床医生理解左心室功能障碍和衰竭。然而,不可否认的是,硬数据很少,有创压力-容量环路测量不会成为心脏手术的常规方法,我们希望临床医生能从全面的、基于模拟的右心室病理回顾中受益。特别是,本文的目的是首先解决和澄清导致左室功能障碍的病理生理血流动力学因素,然后,在此基础上进一步探讨左室辅助装置植入后发生的变化。通过同时显示左、右心室的压力容积循环,哈维软件显示了弹性、心室动脉耦合和心室相互依赖。
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CiteScore
3.60
自引率
14.30%
发文量
31
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