Journal
JOURNAL OF CLINICAL MEDICINE
Volume 12, Issue 14, Pages -Publisher
MDPI
DOI: 10.3390/jcm12144722
Keywords
right ventricular failure; right heart failure; adaptive hypertrophy; maladaptive hypertrophy; right ventricular-pulmonary artery coupling; pressure-volume loops; hemodynamics; echocardiography; therapy
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Right ventricular failure (RVF) is often caused by increased afterload and disrupted coupling between the right ventricle (RV) and the pulmonary arteries (PAs). This article reviews the concept of RV-PA coupling, assessment techniques, and management strategies for RVF. Treatment options range from fluid management and afterload reduction to vasopressor therapy and mechanical circulatory support.
Right ventricular failure (RVF) is often caused by increased afterload and disrupted coupling between the right ventricle (RV) and the pulmonary arteries (PAs). After a phase of adaptive hypertrophy, pressure-overloaded RVs evolve towards maladaptive hypertrophy and finally ventricular dilatation, with reduced stroke volume and systemic congestion. In this article, we review the concept of RV-PA coupling, which depicts the interaction between RV contractility and afterload, as well as the invasive and non-invasive techniques for its assessment. The current principles of RVF management based on pathophysiology and underlying etiology are subsequently discussed. Treatment strategies remain a challenge and range from fluid management and afterload reduction in moderate RVF to vasopressor therapy, inotropic support and, occasionally, mechanical circulatory support in severe RVF.
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