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right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support

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World Journal of Cardiology 2023年第4期15卷 165-173页

作者： Chiara Lazzeri Manuela Bonizzoli Stefano Batacchi Giovanni Cianchi Andrea Franci Filippo Socci Marco Chiostri Adriano Peris ICU and ECMO Center Florence 50134Italy

BACKGROUND The prognostic role of right ventricle dilatation and dysfunction(RVDD)has not been elucidated in patients with coronavirus disease(COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation(ECMO)support.AIM To assess whether pre veno-venous(VV)ECMO RVDD were related to inintensive care unit(ICU)mortality.METHODS We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU(an ECMO referral center)from 31th March 2020 to 31th August 2021.An echocardiographic exam was performed immediately before VV ECMO implantation.RESULTS Males were prevalent(73.8%)and patients with a body mass index>30 kg/m^(2) were the majority(46/61,75%).The overall in-ICU mortality rate was 54.1%(33/61).RVDD was detectable in more than half of the population(34/61,55.7%)and associated with higher simplified organ functional assessment(SOFA)values(P=0.029)and a longer mechanical ventilation duration prior to ECMO support(P=0.046).Renal replacement therapy was more frequently needed in RVDD patients(P=0.002).A higher in-ICU mortality(P=0.024)was observed in RVDD patients.No echo variables were independent predictors of in-ICU death.CONCLUSION In patients with COVID-related respiratory failure on ECMO support,RVDD(dilatation and dysfunction)is a common finding and identifies a subset of patients characterized by a more severe disease(as indicated by higher SOFA values and need of renal replacement therapy)and by a higher in-ICU mortality.RVDD(also when considered separately)did not result independently associated with in-ICU mortality in these patients.

关键词： right ventricle Echocardiography Mortality COVID Acute respiratory distress syndrome right ventricle-pulmonary circulation coupling

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Influence of positive end-expiratory pressure upregulation on the right ventricle in critical patients with acute respiratory distress syndrome:an observational cohort study

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Emergency and Critical Care Medicine 2023年第3期3卷 97-103页

作者： Hui Liu Mengjie Song Li Wang Jianguo Xiao Feihu Zhou Department of Critical Care Medicine First Medical CenterChinese PLA General HospitalBeijingChina Ultrasound Department First Medical CenterChinese PLA General HospitalBeijingChina

Background This study aimed to investigate the influence of positive end-expiratory pressure(PEEP)on the right ventricle(RV)of mechanical ventilation-assisted patients through echocardiography.Methods Seventy-six patients assisted with mechanical ventilation were enrolled in this study.Positive end-expiratory pressure was upregulated by 4 cm H_(2)O to treat acute respiratory distress syndrome,wherein echocardiography was performed before and after this process.Hemodynamic data were also recorded.All variables were compared before and after PEEP upregulation.The effect of PEEP was also evaluated in patients with and without decreased static lung compliance(SLC).Results Positive end-expiratory pressure upregulation significantly affected the RV function.Remarkable differences were observed in the following:Tei index(P=0.027),pulmonary artery pressure(P=0.039),tricuspid annular plane systolic excursion(P=0.014),early wave/atrial wave(P=0.002),diaphragm excursion(P0.05).Furthermore,the cardiac output of the RV was not significantly affected.In patients with decreased SLC(n=41),there were more significant changes in diaphragm excursion(P<0.001),inferior vena cava collapse index(P=0.025),pulmonary artery pressure(P<0.001),and tricuspid annular plane systolic excursion(P=0.007)than in those without decreased SLC(n=35).Conclusion Positive end-expiratory pressure upregulation significantly affected the RV function of critically ill patients with acute respiratory distress syndrome,especially in those with decreased SLC.

关键词： Echocardiography Positive end-expiratory pressure right ventricle Static lung compliance Tei index

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Tissue Doppler,speckling tracking and four-dimensional echocardiographic assessment of right ventricular function in children with dilated cardiomyopathy

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World Journal of Clinical Pediatrics 2022年第1期11卷 71-84页

作者： Mohammed Al-Biltagi Osama Elrazaky Wegdan Mawlana Esraa Srour Ahmed Hamdy Shabana Department of Pediatrics Faculty of MedicineTanta UniversityTanta 31512AlgharbiaEgypt Department of Pediatrics University Medical CenterArabian Gulf UniversityManama 26671ManamaBahrain

BACKGROUND right ventricular(RV)function is frequently overlooked during dilated cardiomyopathy(DCM)evaluation.AIM To evaluate RV function in children with idiopathic DCM using relatively recent echocardiographic modalities.METHODS We prospectively studied the cardiac function in 50 children with idiopathic DCM and 50 healthy children as a control group,using four-dimensional echocardiography(4-DE),Tissue Doppler Imaging(TDI),and two-dimensional-speckles tracking echocardiography(2-D-STE).RV EF was measured by 4-DE.RESULTS The auto left(LV)ejection fractions(EF)measured by 2-D-STE were significantly lower in the patients'group than in the control.The sphericity index was also significantly lower in children with DCM than in the control.RV EF measured by 4-DE was significantly lower in the patient's group than the control.RV S wave,e´/a'ratio,myocardial performance index(MPI),and tricuspid annular plane systolic excursion(TAPSE)were significantly impaired in children with DCM than in control.Both LV and RV global longitudinal strains(GLS)were significantly reduced in children with DCM than in control.RVGLS was significantly associated with the duration since diagnosis,tricuspid annulus S wave,RV MPI,and TAPSE,but not with the age of the patients,RV EF,or e´/a'ratio.CONCLUSION There was impairment of the RV LGS and other systolic and diastolic parameters in children with DCM.STE and TDI can help to detect the early decline of RV function.

关键词： Tissue Doppler Speckling tracking Echocardiography Dilated cardiomyopathy Children right ventricle

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Acute right ventricular myocardial injury and sudden cardiac arrest in a patient with persistent spontaneous coronary vasospasm

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Chinese Medical Journal 2011年第8期124卷 1275-1277页

作者： Hung Ming-Yow Liu Ju-Chi Hao Wen-Rui Wu Cheng-Hsueh Hung Ming-Jui Graduate Institute of Clinical Medical Sciences College ofMedicine Chang Gung University Taoyuan 333 Taiwan China Division of Cardiology Department of Internal Medicine TaipeiMedical University-Shuang Ho Hospital Taipei MedicalUniversity Taipei 235 Taiwan China Department of Cardiology Chang Gung Memorial Hospital at Keelung Keelung 204 Taiwan China

Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronaxy vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt,accurate diagnosis and appropriate management of the coronary vasospasm.

关键词： cardiac arrest coronary vasospasm right ventricle myocardial injury

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Prenatal Diagnosis of right Dominant Heart in Fetuses： A Tertiary Center Experience over a 7-year Period

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Chinese Medical Journal 2017年第5期130卷 574-580页

作者： Juan Feng Mei Zhu Hao Liang Qiao Li Department of Ultrasound Shandong Provincial Hospital AffiLiated to Shandong University Jinan Shandong 250021 China

Background： right dominant heart （RDH） in fetuses can occur with a number of cardiac as well as noncardiac anomalies. Analysis of the enlargement of the right cardiac chamber in the fetus remains a major challenge for sonographers and echocardiographers. The aim of this study was to report the experience with prenatal diagnosis of RDH in the fetuses over a 7-year period. Methods： Fetuses with prenatal diagnosis of RDH from July 2009 to July 2016 were evaluated in two different categories： according to the gestational age, Group I （n = 154, second trimester） and Group II （n = 298, third trimester）; and according to the fetal echocardiography diagnosis, Group A （n = 452, abnormal cardiac structure） and Group B （n = 90, normal cardiac structure）. Differences in categorical variables were assessed by Chi-square exact test and continuous variables were evaluated by independent Student＇s t-test or Mann Whitney U-test depending on parametric or nonparametric nature of the data. Results： Over a 7-year period, 452 fetuses were referred for the assessment of suspected RDH. Left-sided obstructive lesions were observed most frequently in the fetuses with RDH. When comparing Group I with Group II and Group A with Group B, the latter groups exhibited significant differences in the right/left ventricle （RV/LV） ratio （1.435 vs. 1.236, P = 0.002; 1.309 vs. 1.168, P = 0.047）, RV width Z-score （1.626 vs. 1.104, P〈 0.001; 1.553 vs. 0.814, P= 0.014）, and above ＋2 cutoff percentages （14.3% vs. 22.5%; P= 0.038; 21.5% vs. 12.2%, P = 0.046）. Multivariable logistic regression revealed no variables associated with perinatal survival. Conclusions： The study demonstrates that RDH warrants careful attention to the possible presence of a structural cardiac anomaly, especially left-sided obstructive lesions. A diagnosis of RDH is best supported by a combination of the RV Z-score and RV/LV ratio. Most of the fetuses with RDH and structurally normal hearts had favorable outcomes.

关键词： Fetal Echocardiography Prenatal Diagnosis right ventricle Z-score

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Assessment of right ventricular function by pressure-volume loops in off-pump coronary artery bypass surgery

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Chinese Medical Journal 2008年第10期121卷 932-938页

作者： ZHAO Hong-wei WU An-shi LIU Yu RUI Yan WU Di LIU Juan ZHAO Qiu-hua GUO Shu-rong ZHANG Yong-qian YUE Yun Department of Anesthesiology Beijing Chaoyang Hospital Capital Medical University Beijing100020 China

Background right ventricular function plays an important role in the hemodynamic derangement during off-pump coronary artery bypass （OPCAB） surgery. Pressure-volume loops have been shown to provide load-independent information of cardiac function. Therefore, the aim of this study was to investigate the feasibility of construction of right ventricular pressure-volume loops with pressure and volume data measured by a volumetric pulmonary artery catheter （PAC） and to evaluate right ventricular systolic and diastolic function by end-systolic elastance （EEs） and end-diastolic stiffness （EED） in OPCAB surgery. Methods Twenty-eight patients who underwent OPCAB surgery were included. After anesthesia induction, a volumetric PAC was placed via the right internal jugular vein. Data were recorded at： anesthesia steady-state before skin incision （T1）; 5 minutes after the stabilizer device was placed for anastomosis on the heart＇s anterior wall （T2）, lateral wall （T3）, posterior wall （T4）, respectively; after sternal closure （T5）. Three sets of data were collected at each time point： first, hemodynamic variables were measured; second, right ventricular EEs and EED were calculated; third, right ventricular pressure-volume loops were constructed with pressure and volume data measured from end-diastole point, end-isovolumic systole point, peak-ejection point, end-systole point and end-isovolumic diastole point. Results right ventricular pressure-volume loops generally shifted to the left during OPCAB surgery. Especially, the end-diastolic point shifted upward and to the left at T2--T5 compared with that at T1. Decrease in right ventricular ejection fraction, stroke volume index and end-diastolic volume index occurred （P 〈0.05） at T4 compared with values at TI. Pulmonary vascular resistance index at T4 increased relatively compared with that at T2 and T3. The change of EEs was not statistically significant during operation. right atrial pressure increased only during coronary anastomoses （T2-- T4, P 〈0.05）, whereas EED increa

关键词： right ventricle cardiac function off-pump coronary artery bypass surgery pressure-volume loop pulmonary artery catheter

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Value of Coronary Sinus During Computed Tomography Pulmonary Angiography for Predicting Pulmonary Hypertension in Patients with Acute Pulmonary Embolism

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Cardiology Discovery 2023年第2期3卷 78-84页

作者： Chuang Zhang Qian Xin Hongling Xu Xiangyu Wang Zhiqiang Yan Shengtao Sun Xiangmin Shi Mei Tian Department of Cardiology The Sixth Medical Center of People’s Liberation Army General HospitalBeijing 100048China Department of Cardiology The Eighth Medical Center of People’s Liberation Army General HospitalBeijing 100091China Department of Radiology The Eighth Medical Center of People’s Liberation Army General HospitalBeijing 100091China Department of Radiology The Sixth Medical Center of People’s Liberation Army General HospitalBeijing 100048China.

Objective:Computed tomography pulmonary angiography(CTPA)parameters are valuable for predicting pulmonary hypertension(PH)in patients with pulmonary embolism(PE).However,few studies have used the coronary sinus ostium area(CSOA),derived from CTPA,to detect PH.This study aimed to compare the prognostic values of the CSOA,coronary sinus ostium diameter(CSOD),and right ventricular(RV)/left ventricular(LV)ratio for PH.Methods:This study retrospectively analyzed 78 patients(mean age,(51.94±12.33)years;53.8%male)with acute PE confirmed by CTPA at the Sixth and Eighth Medical Centers of the People’s Liberation Army General Hospital between June 2018 and June 2020.Patients were categorized into 2 groups using a pulmonary artery systolic pressure(PASP)cut-off of 30 mmHg.CTPA parameters were compared between these groups.Results:Patients with PASP>30 mmHg(n=22)had a larger CSOA,CSOD,RV diameter,RV/LV ratio,and inferior vena cava diameter compared with patients with PASP≤30 mmHg(n=56).The CSOA had an area under the receiver-operating characteristic curve(AUC,0.84;95%confidence interval(CI),0.74–0.94;P30 mmHg.

关键词： Angiography Computed tomography Coronary sinus Diagnosis Pulmonary embolism Pulmonary hypertension right ventricle

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A male with chronic thromboembolic pulmonary hypertension caused by isolated noncompaction of ventricular myocardium

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Chinese Medical Journal 2012年第15期125卷 2797-2799页

作者： XING Ai-ping HU Xiao-yun DU Yong-cheng LIU Zhi-hong ZHANG Li-qin Department of Respiration Medicine First Hospital ShanxiMedical University Taiyuan Shanxi 030001 China Department of Respiration Medicine the Provincial People'sHospital of Shanxi Province Taiyuan Shanxi 030012 China

Noncompaction of the ventricular myocardium （NVM） is a rare disease of endomyocardialmorphogenesis characterized by numerous, prominent trabeculations and deep intertrabecular recesses. It is commonly associated with congenital heart disease. Isolated noncompaction of the ventricular myocardium （INVM） is thought to be caused by arrest of normal embryogenesis of the endocardium and myocardimn. A significant amount of data on INVM are available for the left ventricle but right ventricular involvement is rare.

关键词： noncompaction, chronic thromboembolic pulmonary hypertension right ventricle

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right Ventricular Myxoma—A Case Report

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Case Reports in Clinical Medicine 2016年第4期5卷 158-164页

作者： Ramachandran Muthiah Thoothukudi Medical College Hospital Thoothukudi India

From an epidemiologic perspective, cardiac myxomas are best divided into the following 2 categories: those that arise in isolation and those that arise in the setting of a syndrome (so called Carney Complex). The former account for about 90% - 95% of cases, while the later account for a minority of cases and those arise from the right or left ventricle constitute as 3% each. Real-time two-dimensional echocardiography has proved to be extremely useful in defining intracavitary masses. With two-dimensional echocardiography accurate visualization of the right ventricular body and outflow tract can be accomplished consistently. The acoustic nature and anterior location of the right ventricular myxomas make them appear as bright, mobile masses. The mobile nature of the tumor can easily be appreciated and its point of attachment, or stalk can be visualized accurately. Background of this case illustrates the transthoracic 2D echocardiographic pattern of right ventricular myxoma and its attachment by a pedicle to the anterior papillary muscle, masquerading as ball-valve thrombus and cardiac “stone” in tilted parasternal long axis-3 chamber views in a 15-year-old girl. Mahaim criteria to distinguish myxoma from organizing thrombus had been highlighted.

关键词： Myxoma right ventricle Echocardiography Ball-Valve Thrombus Cardiac “Stone”

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right Ventricular Endomyocardial Fibrosis in Neonate—A Case Report

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Case Reports in Clinical Medicine 2016年第5期5卷 170-175页

作者： Ramachandran Muthiah Thoothukudi Medical College Hospital Thoothukudi India

Endomyocardial fibrosis is characterized by the formation of fibrous tissue in the endocardium. Although the disease may affect both ventricles, isolated or not, the right ventricle is more frequently involved. Endocardial fibrosis may be present in the entire ventricular cavity, being usually more marked in the apical region and right ventricular inflow tract. Its etiology, however, still remains unknown. Background—Reports on endomyocardial fibrosis in pediatric patients are not common. It is more frequent from the fourth year of age on, with few reports in the first 2 years of life. This case aimed at reporting right ventricular endomyocardial fibrosis in 7 days old male neonate, in addition to discussing the etiopathogenesis and future perspective of the disease.

关键词： Apical Fibrosis right ventricle Tricuspid Regurgitation Echocardiography Neonate

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