Case Report: PDF OnlyAssessment of the Response of Right Ventricular Performance to Decreasing Levels of Mechanical Assistance by On-Line Pressure Area RelationshipsMandarino, William A.; Gorcsan, John III*; Armitage, John M.; Griffith, Bartley P.; Kormos, Robert L.Author Information *From the Divisions of Cardiothoracic Surgery and Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania. Supported in part by Veteran's Administration Merit Review Grant. Submitted for publication July 1993; accepted in revised form November 1993. Reprint requests: Robert L. Kormos, C-700 Presbyterian University Hospital, Pittsburgh, PA 15213. ASAIO Journal: October 1994 - Volume 40 - Issue 4 - p 1032-1035 Free Abstract The rapid assessment of the response of right ventricular (RV) performance to decreasing levels of mechanical assistance may be an important adjunct in determining if a patient can tolerate the removal of such a device. This report describes the use of on-line pressure area relationships to assess RV function in a patient supported with an RV assist device (RVAD). Mid RV short axis cross-sectional area was measured on-line by transesophageal echocardiography with an automated endocardial border detection feature. RV pressure was measured with a high fidelity catheter. Pressure and area were plotted simultaneously on a computer workstation interfaced with the pressure and echo systems to yield on-line pressure area loops. The following indices of RV performance were calculated while RVAD flow was decreased in 1 L/min increments: stroke work' (SW′ = ∫PdA)[mmHg*cm2], stroke area (SA = Maximum Area-Minimum Area)[cm2], and fractional area change (FAC = SA/Maximum Area*100)[%]. SW', SA, and FAC significantly increased with decreasing RVAD flow: SW'(from 32 to 61 mmHg*cm2), SA (from 2.58 to 4.37 cm2), and FAC (from 20 to 32%). In conclusion, the increase in these parameters of RV performance with decreasing mechanical assistance suggested that this patient would tolerate removal of the RVAD, which was subsequently successful. This method of on-line pressure area relationships may be useful to predict the need for further mechanical assistance.ASAIO Journal1994; 40:1032-1035. © Lippincott-Raven Publishers.