Right Ventricular Dysfunction in Cardiac Anesthesia: Perioperative Assessment and Underlying Mechanisms.

Area of Science:

• Cardiology
• Anesthesiology
• Cardiac Surgery

Background:

• Right ventricular (RV) function is increasingly recognized as a vital prognostic indicator in cardiovascular disease management and cardiac anesthesia.
• Perioperative stress during cardiac surgery can lead to RV dysfunction, impacting patient outcomes and weaning from cardiopulmonary bypass.
• Despite its significance, RV function during cardiac anesthesia remains less understood compared to left ventricular function.

Purpose of the Study:

• To provide a comprehensive overview of the current understanding of perioperative RV dysfunction in adult cardiac surgery.
• To elucidate the basic RV anatomy, physiology, and pathophysiology relevant to perioperative dysfunction.
• To summarize current methods for evaluating perioperative RV function, with an emphasis on echocardiography.

Main Methods:

• Review of current literature on RV function and dysfunction in the context of cardiac surgery.
• Discussion of RV anatomy, physiology, and pathophysiology.
• Summary and evaluation of diagnostic modalities for perioperative RV function assessment, particularly echocardiography.
• Analysis of perioperative factors influencing RV function and mechanisms of RV failure.

Main Results:

• RV dysfunction is a significant concern in cardiac surgery, affecting up to half of hemodynamically unstable patients postoperatively.
• Accurate assessment of perioperative RV function is challenging due to limited available modalities.
• Echocardiography is identified as the most practical tool for perioperative RV function evaluation in cardiac surgery.
• Several perioperative factors and underlying mechanisms contribute to RV dysfunction and failure.

Conclusions:

• Understanding RV function is crucial for managing patients undergoing cardiac surgery.
• Echocardiography offers the most practical approach for perioperative RV assessment.
• Further research is needed to fully clarify the mechanisms and management of perioperative RV dysfunction.