The right ventricle: From physiology to clinical applications Antoine Vieillard-Baron, Boulogne, France
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The right ventricle: From physiology
to clinical applications
Antoine Vieillard-Baron, Boulogne, France
No disclosure for this lecture
(i)
The right ventricle is a “fragile” ventricle
TV closing
PV opening
PV closing
Redington Br Heart J 1990
Flow (inflow/outflow)
Rig
ht
atri
al p
ress
ure
The RV is functioning below
its unstressed volumeFluid overload may induce RV
failure
J Physiol 1914
Clinical application number 1
Intensive Care Med 2018
Am J Respir Crit Care Med 2002
Clinical application number 2
Elzinga 1990
“Anrep mechanism”
(ii) A certain “acute adaptation” to PH
is possible (in theory)
2 major limits in ICU
- Frequent systemic inflammation
- Associated hypotension
Circ Res 1954
Maximal pressure to which
the RV can compensate
(mmHg)
Just following VAC, PP 12 VAC 2 hours later
PP 12, low blood pressure
Vlahakes Circulation 1981
Control RV failure Phenylephrine
MAP 76+/-12 48+/-11 108+/-19
RVEDP 4+/-2 13+/-7 8+/-4
RV coronary
driving P
65+/-12 23+/-9 78+/-21
CO 2.8+/-0.8 1.5+/-0.8 2.4+/-07
SAP 80 mmHg NE 1µg/kg/min
SAP 110 mmHg
Clinical application number 3
RV is very sensitive to
hypotension and NE is a “good”
drug for the RV
(iii)
The RV shares a wall with the LV
Clinical application number 4
Any RV failure has an impact on
the LV
Circulation 1982
RV LV RV
LV
Am J Physiol 1957
(iv)
The right ventricle is key for the systemic
venous return
Am J Physiol 1959
Clinical application number 5
Look at the SVC
Am J Respir Crit Care Med 2017
(v)
The right ventricle is submitted to the
respiration….and is responsible for PPV
Clinical application number 6
Intensive Care Med 2016
CONCLUSION
• The RV is THE ventricle in the critically ill
patients
• A good knowledge of its physiology and
pathophysiology should help you to better
care your patients.
http://www.echo-rea.uvsq.fr
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