Ablation of Atrial Flutter in Severe Pulmonary Hypertension: Pushing the Outside of the Envelope
From the New England Cardiac Arrhythmia Center, the Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA. Journal of Cardiovascular Electrophysiology
(Impact Factor: 2.96).
06/2012; 23(11). DOI: 10.1111/j.1540-8167.2012.02401.x
Available from: Mardi Gomberg-Maitland
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ABSTRACT: Management of acute right ventricular failure, both with and without coexisting pulmonary hypertension, is a common challenge encountered in the intensive care setting. Both right ventricular dysfunction and pulmonary hypertension portend a poor prognosis, regardless of the underlying cause and are associated with significant morbidity and mortality. The right ventricle is embryologically distinct from the left ventricle and has unique morphologic and functional properties. Management of right ventricular failure and pulmonary hypertension in the intensive care setting requires tailored hemodynamic management, pharmacotherapy, and often mechanical circulatory support. Unfortunately, our understanding of the management of right ventricular failure lags behind that of the left ventricle. In this review, we will explore the underlying pathophysiology of the failing right ventricle and pulmonary vasculature in patients with and without pulmonary hypertension and discuss management strategies based on evidence-based studies as well as our current understanding of the underlying physiology.
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