Forgotten No More: A Focused Update on the Right Ventricle in Cardiovascular Disease

Publication date: Available online 10 October 2018Source: JACC: Heart FailureAuthor(s): Myriam Amsallem, Olaf Mercier, Yukari Kobayashi, Kegan Moneghetti, Francois HaddadAbstractIn the last decade, there has been renewed interest in the study of the right ventricle. It is now well established that right ventricular function is a strong predictor of mortality, not only in heart failure but also in pulmonary hypertension, congenital heart disease, and cardiothoracic surgery. The right ventricle is part of a cardiopulmonary unit with connections to the pulmonary circulation, venous return, atria, and left ventricle. In this context, ventriculoarterial coupling, interventricular interactions, and pericardial constraint become important to understand right ventricular adaptation to injury or abnormal loading conditions. This state-of-the-art review summarizes major advances that occurred in the field of right ventricular research over the last decade. The first section focuses on right ventricular physiology and pulmonary circulation. The second section discusses the emerging data on right ventricular phenotyping, highlighting the importance of myocardial deformation (strain) imaging and assessment of end-systolic dimensions. The third section reviews recent clinical trials involving patients at risk for or with established right ventricular failure, focusing on beta blockade, phosphodiesterase inhibition, and mechanical support of the failing right heart. The final section presen...
Source: JACC: Heart Failure - Category: Cardiology Source Type: research

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Abstract Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension (PH). The prognosis of PVOD patients remains poor, since no effective medical therapy is yet available. Imatinib is a tyrosine kinase inhibitor specific for platelet-derived growth factor receptor and is expected as a treatment option for pulmonary arterial hypertension (PAH). Recently, it has been reported that imatinib improved functional capacity of a patient with PVOD. We here report a patient with suspected PVOD who has been successfully treated with imatinib and is alive for 6 years after diagnosis. A 57-year-old woman ...
Source: The Tohoku Journal of Experimental Medicine - Category: Research Authors: Tags: Tohoku J Exp Med Source Type: research
CONCLUSIONS: PDE5 inhibitors appear to have clear beneficial effects in group 1 PAH. Sildenafil, tadalafil and vardenafil are all efficacious in this clinical setting, and clinicians should consider the side-effect profile for each individual when choosing which PDE5 inhibitor to prescribe.While there appears to be some benefit for the use of PDE5 inhibitors in PH-left-heart disease, it is not clear based on the mostly small, short-term studies, which type of left-heart disease stands to benefit. These data suggest possible harm in valvular heart disease. There is no clear benefit for PDE5 inhibitors in pulmonary hypertens...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
The number of heart and lung transplantations has risen over the years, and they remain the mainstay of treatment for end-stage heart failure and end-stage lung diseases. From the assessment of the donor's heart to intraoperative management during separation from cardiopulmonary bypass (CPB) to the postoperative follow-up of heart transplant patients, echocardiography plays a vital role throughout this process. Patients with chronic lung diseases also may have cardiovascular compromise secondary to pulmonary hypertension, pre-existing coronary artery disease, or valvular heart disease.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research
This Medicine MCQ Test Series contains 20 questions which can be attempted over 40 seconds each. After submission, answers and discussion will be displayed. Medicine MCQ Test Series 1 Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Medicine MCQ - CVS Source Type: blogs
Pulmonary hypertension (PH) is frequent in left heart disease (LHD), as a consequence of the underlying condition. Significant advances have occurred over the past 5 years since the 5th World Symposium on Pulmonary Hypertension in 2013, leading to a better understanding of PH-LHD, challenges and gaps in evidence. PH in heart failure with preserved ejection fraction represents the most complex situation, as it may be misdiagnosed with group 1 PH. Based on the latest evidence, we propose a new haemodynamic definition for PH due to LHD and a three-step pragmatic approach to differential diagnosis. This includes the ident...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: World Symposium on Pulmonary Hypertension Source Type: research
ADULT CARDIAC SURGERY patients have complex pathologies that may require the administration of pulmonary vasodilators, inopressors, inodilators, and/or vasopressors to facilitate separation from cardiopulmonary bypass (CPB). These pathologies include valvular heart disease, left heart failure with preserved or reduced ejection fraction, primary or secondary pulmonary hypertension (PH), preexisting or postcardiotomy right ventricular dysfunction (RVD), and postcardiotomy low cardiac output syndrome (LCOS).
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
In conclusion, EIPH was documented in about one-third of HCM patients. EIPH was a significant predictor of HCM-related morbidity in patients with HCM.
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
ConclusionPost-rheumatic mitral valve regurgitation is the pathology the most encountered. Pulmonary hypertension is the most common echocardiographic complication of the disease. Five years mortality is very high in our setting. Due to financial limitation and illiteracy of parents, the follow-up of patients is difficult.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
Abstract BACKGROUND: We used dual Doppler echocardiography to measure the time interval between the mitral and tricuspid valve opening (MO-TO time), which we expected would reflect the balance between left and right ventricular hemodynamics. Methods and Results: We prospectively enrolled 60 patients with heart failure (HF) and sinus rhythm. The MO-TO time was measured in addition to routine echocardiography parameters, invasive hemodynamic parameters and plasma B-type natriuretic peptide (BNP) level in all patients. Patients were divided into 2 groups based on the MO-TO time: MOP (mitral opening preceding tric...
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
ConclusionOur results suggest that treprostinil, besides vasodilation, might exert its beneficial effect through an inhibition of platelet activation, resulting in a decreased number and procoagulant activity of circulating MVs.
Source: Pediatric Pulmonology - Category: Respiratory Medicine Authors: Tags: ORIGINAL ARTICLE: PULMONARY HYPERTENSION Source Type: research
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