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Management of right ventricular dysfunction in the perioperative setting

Zarbock, Alexander; Van Aken, Hugo; Schmidt, Christoph

Current Opinion in Anesthesiology: August 2014 - Volume 27 - Issue 4 - p 388–393
doi: 10.1097/ACO.0000000000000092
DRUGS IN ANESTHESIA: Edited by Klaus Hahnenkamp

Purpose of review This review summarizes the approach to and recent developments in the treatment of acute right ventricular dysfunction and failure in the perioperative setting. Right ventricular failure, defined as the inability to deliver sufficient blood flow through the pulmonary circulation at normal central venous pressure, is a common problem in the perioperative setting and is associated with an increased mortality. The failure of the right ventricle is caused by reduced right ventricular contractility or an increased right ventricular afterload or both.

Recent findings Management of acute right ventricular failure continues to be challenging because of the poor understanding of the pathophysiology, difficulties in diagnosing, the absence of guidelines, and limited therapeutic options. Recent research efforts have led to an improved understanding of the underlying mechanisms and have established a reasonable therapeutic framework.

Summary Right ventricular dysfunction may cause venous congestion and systemic hypoperfusion. After identifying right ventricular dysfunction, the primary goal is to correct reversible causes of excessive load or reduced right-ventricular contractility. If the underlying abnormalities cannot be reversed, diuretic, vasodilator, or inotropic therapy may be required.

Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Munster, Germany

Correspondence to Alexander Zarbock, MD, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Munster, Germany. Tel: +49 251 8347252; fax: +49 251 88704; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.