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Dynamic right ventricular outflow tract obstruction in cardiac surgery

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Presentation on theme: "Dynamic right ventricular outflow tract obstruction in cardiac surgery"— Presentation transcript:

1 Dynamic right ventricular outflow tract obstruction in cardiac surgery
André Y. Denault, MD, FRCPC, Miguel Chaput, MD, Pierre Couture, MD, FRCPC, Yves Hébert, MD, FRCSC, François Haddad, MD, FRCPC, Jean-Claude Tardif, MD, FRCPC  The Journal of Thoracic and Cardiovascular Surgery  Volume 132, Issue 1, Pages (July 2006) DOI: /j.jtcvs Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Septal myomectomy and aortic surgery in a 68-year-old man complicated by dynamic RVOT obstruction appearing during weaning from cardiopulmonary bypass. (A)The systolic gradient between the right ventricle and the pulmonary artery was 28 mm Hg. (B,C,D) An M-mode view from a mid-oesophageal right-ventricular inflow-outflow view at 63° is illustrated with the systolic dynamic obstruction of the right ventricular outflow (LA, left atrium; Pa, arterial pressure; Ppa, pulmonary artery pressure; Prv, right ventricular pressure; RA, right atrium; RV, right ventricle). The Journal of Thoracic and Cardiovascular Surgery  , 43-49DOI: ( /j.jtcvs ) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 A 68-year-old man underwent aortic valve replacement. He became hemodynamically unstable with right ventricular dysfunction and went back on cardiopulmonary bypass. Inotropes were started. On the second weaning attempt, he developed severe right ventricular outflow tract obstruction confirmed with the paceport of the pulmonary artery catheter and through continuous-wave Doppler interrogation of the tricuspid regurgitant flow in a mid-oesophageal right ventricular inflow-outflow view at 61°. The measured pressure gradient of the tricuspid regurgitant flow was 75 mm Hg (with a right ventricular systolic pressure of 80 mm Hg) and the pulmonary artery pressure (Ppa) was 30/16 mm Hg during the echocardiographic measurement. (EKG, electrocardiogram; Pa, arterial pressure; Prv, right ventricular pressure). The Journal of Thoracic and Cardiovascular Surgery  , 43-49DOI: ( /j.jtcvs ) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

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