A 74-Year-Old Man With Refractory Hypotension After Spine Surgery

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A 74-Year-Old Man With Refractory Hypotension After Spine Surgery Eric Tesoriero, DO, Somnath Bose, MD, Achikam Oren-Grinberg, MD, Akiva Leibowitz, MD CHEST Volume 152, Issue 1, Pages e1-e5 (July 2017) DOI: 10.1016/j.chest.2017.01.042 Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 1 Apical four-chamber view. Still image that is directed posteriorly as the coronary sinus is seen. Although the left ventricle is foreshortened, dimensions of the right ventricle (×---×) and left ventricle (+---+) are recorded. CHEST 2017 152, e1-e5DOI: (10.1016/j.chest.2017.01.042) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 2 Apical four-chamber view with M mode across the tricuspid annulus. The tricuspid annular plane systolic excursion is recorded and is 1.19 cm. CHEST 2017 152, e1-e5DOI: (10.1016/j.chest.2017.01.042) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 3 Apical four-chamber view with continuous wave Doppler interrogation of tricuspid regurgitation. The pulmonary artery systolic pressure can be estimated by the velocity of the tricuspid regurgitation jet. The relationship 4v2 + right atrial pressure (central venous pressure), which is the right ventricular systolic pressure, is equal to the pulmonary artery systolic pressure as long as there is no pulmonic stenosis or right ventricular outflow tract obstruction. CHEST 2017 152, e1-e5DOI: (10.1016/j.chest.2017.01.042) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 4 CT angiogram of the chest. A, CT evidence of right ventricular strain, showing a right ventricular diameter greater than the left ventricular diameter and abnormal septal position. B, Bilateral proximal pulmonary emboli are demonstrated. CHEST 2017 152, e1-e5DOI: (10.1016/j.chest.2017.01.042) Copyright © 2017 American College of Chest Physicians Terms and Conditions

Figure 5 Pulmonary artery angiogram. A, Filling defects in right pulmonary artery. B, Improved perfusion of right middle and lower lobar arteries following mechanical embolectomy. CHEST 2017 152, e1-e5DOI: (10.1016/j.chest.2017.01.042) Copyright © 2017 American College of Chest Physicians Terms and Conditions