Perioperative right heart failure: etiology and pathophysiology

A considerable amount of literature has been devoted to compromise of the right ventricle in spontaneous myocardial infarction. Little information is available regarding disproportionate dysfunction of the right ventricle associated with cardiac operation and the recovery period therefrom. Recognition of the problem is of paramount importance, if support measures are to be implemented. A great deal has yet to be learned regarding the appropriate support for the acutely failing right ventricle. Much remains to be accomplished regarding the assessment of right ventricle reserve, defining the role of risk factors, and quantitating the value of measures to optimally protect the right ventricle from injury during the perioperative period. Recognizing that the integrity of the right ventricle can be altered by numerous preoperative, perioperative and postoperative factors will provide an enlightened disposition on the part of the surgical team. Awareness of these considerations in the planning and conduct of surgical procedures should reduce morbidity and mortality from perioperative right ventricular failure. The imposition of new or unexpected morbidity during operation on a relatively unrelated problem represents surgical imperfection. Appropriate effort toward minimizing insult of the right ventricle could result in significantly decreasing the incidence and severity of perioperative right ventricular failure before the impetus of the continuing clinical problem dictates improvement in techniques to more appropriately treat this frequently preventable problem.