RESUMO
El fallo agudo del ventrículo derecho (VD) es un síndrome clínico complejo que puede ser causado por muchas causas y es el responsable del 3% al 9% de los ingresos en las unidades de cuidados intensivos con una mortalidad intrahospitalaria del 5 al 17%. Puede presentarse de forma solapada o grave con compromiso hemodinámico severo y shock. El objetivo primario debe ser la identificación y el tratamiento de la causa subyacente de insuficiencia del VD, como la embolia pulmonar aguda, síndrome de dificultad respiratoria aguda, descompensación aguda de la hipertensión pulmonar crónica, infarto VD, o arritmias. Se ha reconocido la importancia de la función del VD en la insuficiencia cardíaca, el infarto de miocardio, la cardiopatía congénita y la hipertensión pulmonar. Actualmente, los avances en ecocardiografía y resonancia magnética nuclear han creado nuevas oportunidades para el estudio de la anatomía y fisiología del VD. La presente revisión ofrece una perspectiva clínica sobre la estructura y función del VD. En esta primera parte, revisaremos la anatomía, fisiología, evaluación y fisiopatología del VD. En la segunda parte, revisaremos la importancia clínica y el manejo y tratamiento del fallo del VD.
Acute failure of the right ventricle Part 1 Anatomy, physiology, functional evaluation and pathophysiology of the right ventricle Acute right ventricular (RV) failure is a complex clinical syndrome that can be caused by many causes and accounts for 3% to 9% of admissions in intensive care units with in-hospital mortality of 5% to 17%. It can present in an overlapping or severe way with severe hemodynamic compromise and shock. The primary objective should be the identification and treatment of the underlying cause of RV insufficiency, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmias. The importance of RV function in heart failure, myocardial infarction, congenital heart disease and pulmonary hypertension has been recognized. Currently, advances in echocardiography and nuclear magnetic resonance have created new opportunities for the study of RV anatomy and physiology. The present review offers a clinical perspective on the structure and function of the RV. In this first part, we will review the anatomy, physiology, evaluation and pathophysiology of the RV. In the second part, we will review the clinical importance and the management and treatment of RV failure.
Falha aguda do ventrículo direito Parte 1 Anatomia, fisiologia, avaliação funcional e fisiopatologia do ventrículo direito A insuficiência aguda do ventrículo direito (VD) é uma síndrome clínica complexa que pode ser causada por muitas causas e representa do 3% a 9% das internações em unidades de cuidados intensivos, com mortalidade intra-hospitalar de 5 a 17%. Pode apresentar-se de forma sobreposta ou severa com comprometimento hemodinâmico grave e choque. O objetivo primário deve ser a identificação e o tratamento da causa subjacente da insuficiência VD, tais como embolia pulmonar aguda, síndrome do desconforto respiratório agudo, hipertensão pulmonar crônica descompensada, VD do miocárdio ou arritmia. A importância da função do VD na insuficiência cardíaca, infarto do miocárdio, cardiopatia congênita e hipertensão pulmonar tem sido reconhecida. Atualmente, os avanços na ecocardiografia e na ressonância magnética nuclear criaram novas oportunidades para o estudo da anatomia e fisiologia do VD. A presente revisão oferece uma perspectiva clínica sobre a estrutura e função do RV. Nesta primeira parte, revisaremos a anatomia, fisiologia, avaliação e fisiopatologia do VD. Na segunda parte, revisaremos a importância clínica e o manejo e tratamento da falha do VD.
RESUMO
Since the first description of pulmonary circulation in the 16th century, the knowledge of the complex interaction between the heart and lungs has greatly improved. Hypoxemia plays a classical role in the development of complications such as pulmonary hypertension and right ventricle (RV) dysfunction in patients presenting with chronic obstructive pulmonary disease (COPD). However, more recent results have revealed the presence of RV vascular structural and functional changes even in patients with mild COPD, without hypoxemia or pulmonary hypertension at rest. Compared to the left ventricle, the anatomy of the RV is unique and complex, which makes its assessment more difficult during routine exams. Therefore, it is common that very little attention is paid to its study. In this article, the physiological aspects of pulmonary circulation and the RV, as well as their impairment in COPD patients, are presented. In addition, important aspects of the recommendations for RV assessment using echocardiography are approached and studies that used other complementary exams to evaluate RV structure and function are revisited. Finally, the findings of studies that assessed the impact of RV dysfunction in the prognosis of patients with COPD are described.