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Dynamic right ventricular outflow tract obstruction in cardiac surgery.
André Y Denault1, Miguel Chaput, Pierre Couture
1Department of Anesthesiology, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada. denault@videotron.ca
The Journal of Thoracic and Cardiovascular Surgery
|June 27, 2006
Summary
Right ventricular outflow tract obstruction, a cause of hemodynamic instability, was found in 1% of cardiac surgery patients. Early diagnosis via pulmonary artery catheter is crucial for managing this condition.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Cardiac Physiology
Background:
- Right ventricular outflow tract obstruction (RVOTO) is a known cause of hemodynamic instability.
- RVOTO has not been previously described in the context of non-congenital cardiac surgery.
Purpose of the Study:
- To determine the prevalence of RVOTO in patients undergoing cardiac surgery.
- To assess the association between RVOTO and hemodynamic instability post-cardiac surgery.
Main Methods:
- Retrospective analysis of 670 cardiac surgery patients to identify RVOTO (RV systolic to pulmonary artery peak gradient > 25 mm Hg).
- Prospective study of 130 patients to validate prevalence and clinical significance.
- Diagnosis confirmed using pulmonary artery catheter measurements and transesophageal echocardiography.
Main Results:
- RVOTO prevalence was 1% in the retrospective cohort and 4% in the prospective cohort.
- Significant RVOTO was associated with hemodynamic instability in 91% of affected patients.
- Transesophageal echocardiography revealed end-systolic obliteration of the right ventricular outflow tract.
Conclusions:
- Right ventricular outflow tract obstruction is a significant, diagnosable complication of cardiac surgery.
- Pulmonary artery catheter paceport measurements facilitate easy diagnosis.
- RVOTO should be considered in patients with unexplained hemodynamic instability, particularly with echocardiographic findings of systolic right ventricular cavity obliteration.