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| INTERESTING IMAGE |
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| Year : 2015 | Volume
: 1
| Issue : 2 | Page : 111-112 |
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Echocardiographic Features of Refractory Right Ventricular Failure Treated with Atrial Septostomy-Following Mitral Valve Replacement
Vishnu Datt, Deepak K Tempe, Shailendra Motwani
Department of Anesthesiology and Critical Care, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| Date of Web Publication | 1-Jun-2015 |
Correspondence Address:
Dr. Vishnu Datt
Professor of Anaesthesiology, Room No. 619, Academic Block, GIPMER, New Delhi - 110 002
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2394-7438.157930
How to cite this article:
Datt V, Tempe DK, Motwani S. Echocardiographic Features of Refractory Right Ventricular Failure Treated with Atrial Septostomy-Following Mitral Valve Replacement. MAMC J Med Sci 2015;1:111-2 |
How to cite this URL:
Datt V, Tempe DK, Motwani S. Echocardiographic Features of Refractory Right Ventricular Failure Treated with Atrial Septostomy-Following Mitral Valve Replacement. MAMC J Med Sci [serial online] 2015 [cited 2021 Feb 27];1:111-2. Available from: https://www.mamcjms.in/text.asp?2015/1/2/111/157930 |
A 20-year-old male, a case of severe mitral stenosis with mitral valve area of 0.6 cm 2 , peak gradient/mean gradient - 28/14 mmHg , mild mitral regurgitation, severe tricuspid regurgitation with right ventricular (RV) systolic pressure of 70 mmHg presented with New York Heart Association class III symptoms. Mitral valve replacement was performed under standard cardiopulmonary bypass (CPB) technique and narcotic based general anesthesia.
Despite the use of adrenaline (0.05 μg/kg/min), dobutamine (5 μg/kg/min), nitroglycerin (NTG) (1 μg/kg/min), milrinone (0.375 μg/kg/min), noradrenaline (0.05 μg/kg/min) in left atrium (LA), prolonged CPB support, and inhalational NTG (2.5 μg/kg/min) and milrinone (50 μg/kg over 5 min), the pulmonary artery pressures remained suprasystemic that is, 85 mmHg against systolic arterial pressure of 75 mmHg.
Transesophageal echocardiography revealed dilated and severely hypokinetic RV with the interventricular septal shift to left suggestive of high RV pressure. In contrast, left ventricle (LV) was inadequately filled and hypercontractile [Figure 1]a and b, Video 1. However, hypotension was as a consequence of loss of transpulmonary contribution to fill the LA and LV due to RV failure. Tricuspid annuloplasty and atrial septostomy (0.75 cm) were performed to offload the RV [Figure 2]. Following septostomy the LV filling improved and inter ventricular septum shifted towards RV [Figure 3] resulting in some improvement in the hemodynamics and patient was weaned off CPB with very high inodilators support. However, he died in cardiac intensive care unit due to refractory pulmonary hypertension and RV failure on 3 rd postoperative day. | Figure 1: (a) Midesophageal four chamber view showing dilated right ventricular, deviated interventricular septum to the left. Also showing the inter trial septum shifting toward the left atrium suggestive of increased right-sided pressures. (b) Transgastric short axis view of both ventricles showing dilated right ventricular (RV), deviated interventricular septum to left and small size and under filled left ventricle (LV) suggestive of high RV pressure and loss of transpulmonary contribution to fill the LV due to RV failure (RA: right atrium, LA: left atrium)
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 | Figure 2: Midesophageal bicaval view showing the right to left shunt (Red color) across the atrial septostomy, suggestive of high right atrial pressure. Atrial septostomy was performed to offload the dilated right ventricle and to fill the left ventricle (RA: right atrium, LA: left atrium)
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 | Figure 3: Transgastric short axis view of both ventricles showing adequately filled left ventricle and inter ventricle septum shifted towards right ventricle (LV: left ventricle, RV: right ventricle)
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[Figure 1], [Figure 2], [Figure 3]
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