The right ventricle after cardiopulmonary bypass: new insights on its adaptive physiology
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EDITORIAL
The right ventricle after cardiopulmonary bypass: new insights on its adaptive physiology Gabriele Via1 · Guido Tavazzi2,3 · Karim Bendjelid4 Received: 25 February 2020 / Accepted: 5 March 2020 © Springer Nature B.V. 2020
Post cardiopulmonary bypass (CPB) right ventricular (RV) dysfunction has been extensively described in cardiac surgery in past years, and attributed to either cardioplegia, myocardial hypothermia, cardiac stunning, and pericardiectomy [1–3]. More recently, both a different contraction pattern [4, 5] and a dissociation of RV output from RV longitudinal contraction [6] have been described in this context, leading to some re-interpretation of what previously observed. In the present issue of the Journal of Clinical Monitoring and Computing Korshin et al. describe interesting echocardiographic observations which cast further light on the increasingly studied behaviour of the right ventricle (RV) after on-pump cardiac surgery [7]. By speckle tracking analysis of RV regional contraction and motion, the authors elegantly characterized the RV contractility pattern in different phases of uncomplicated CABG surgery, in patients with baseline normal biventricular function. Their observational study analyses data acquired from a previous work of theirs. Regardless of the limitations the authors themselves acknowledge (mostly the retrospective nature of the study and the small population), their work has its strength in the rigorous methodology of the echocardiographic acquisition and analysis, and in the simultaneous assessment of macro-hemodynamics with the pulmonary artery catheter. The TEE views studied (A4Ch and transgastric modified RV inflow–outflow) take into account * Gabriele Via [email protected] 1
Cardiac Anesthesia and Intensive Care Dept., Fondazione Cardiocentro Ticino, Lugano, Switzerland
2
Anesthesia, Intensive Care and Pain Therapy, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
3
Anesthesia and Intensive Care, Emergency Dept., Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
4
Department of Anaesthesia, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
the complex RV geometry, while invasive hemodynamic monitoring characterized the cardiovascular changes from anaesthesia induction to weaning from CPB and sternotomy closure. Interestingly, while a constant reduction in longitudinal function from pre to post-bypass to chest closure (measured both as TAPSE, S′ and speckle tracking derived RV longitudinal displacement) was observed, in post-CPB both free wall and septum speckle tracking-derived transversal displacement increased, and contributed to preserving stroke volume (SV). Post chest closure SV reduction was then observed, due to both RV end-diastolic volume reduction, and loss of this “septal compensation” [7, 8]. However, as paradoxical septal motion (PSM) is a frequent echocardiographic finding after CPB, we may speculate that all the septal features, observed in
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