GAGAL VENTRIKEL KANAN AKUT: PENEGAKAN DIAGNOSIS DAN MANAJEMEN TATALAKSANA
Abstract
Gagal ventrikel kanan akut merupakan sindrom progresif dengan kongesti sistemik akibat gangguan pengisian ventrikel kanan dan/atau penurunan output aliran ventrikel kanan. Saat gagal ventrikel kanan akut berkembang, terjadi regurgitasi trikuspid yang semakin menurunkan curah jantung. Etiologi gagal ventrikel kanan yang paling umum di unit perawatan intensif adalah kegagalan ventrikel kiri, iskemia ventrikel kanan, emboli paru akut, hipertensi pulmonal, sepsis, cedera paru akut, dan tamponade jantung. Diagnosis gagal ventrikel kanan akut yang efektif secara optimal dilakukan dengan kombinasi teknik termasuk ekokardiografi, pencitraan dan kateterisasi yang juga dapat digunakan untuk memantau respons pengobatan. Penatalaksanaan gagal ventrikel kanan akut berfokus untuk menstabilkan hemodinamik, mengoptimalkan kondisi pembebanan, dan mengobati potensi penyebab reversibel. Penanganan aritmia yang cepat juga penting untuk menghindari lingkaran setan hipotensi, iskemia, dan aritmia lebih lanjut. Artikel ini meninjau mengenai etiologi, patofisiologi, penegakan diagnosis dan manajemen tatalaksana pada kasus gagal ventrikel kanan akut.
Downloads
References
Haddad F, Doyle R, Murphy DJ, Hunt SA. Right Ventricular Function in Cardiovascular Disease, Part II. Circulation. 2008;117(13):1717–31.
Mahjoub Y, Pila C, Friggeri A, Zogheib E, Lobjoie E, Tinturier F, et al. Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle*. Crit Care Med. 2009;37(9).
Vieillard-Baron A, Naeije R, Haddad F, Bogaard HJ, Bull TM, Fletcher N, et al. Diagnostic workup, etiologies and management of acute right ventricle failure : A state-of-the-art paper. Intensive Care Med [Internet]. 2018;44(6):774—790. Available from: https://doi.org/10.1007/s00134-018-5172-2
Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, et al. Right Ventricular Function and Failure. Circulation. 2006;114(17):1883–91.
Dell’Italia LJ. The right ventricle: anatomy, physiology, and clinical importance. Curr Probl Cardiol. 1991;16(10):658–720.
Lahm T, Douglas IS, Archer SL, Bogaard HJ, Chesler NC, Haddad F, et al. Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med. 2018;198(4):e15–43.
Paridon SM, Mitchell PD, Colan SD, Williams R V, Blaufox A, Li JS, et al. A Cross-Sectional Study of Exercise Performance During the First 2 Decades of Life After the Fontan Operation. J Am Coll Cardiol. 2008;52(2):99–107.
Zong P, Tune JD, Downey HF. Mechanisms of Oxygen Demand/Supply Balance in the Right Ventricle. Exp Biol Med. 2005;230(8):507–19.
Arrigo M, Huber LC, Winnik S, Mikulicic F, Guidetti F, Frank M, et al. Right Ventricular Failure: Pathophysiology, Diagnosis and Treatment. Card Fail Rev. 2019 Nov;5(3):140–6.
Green EM, Givertz MM. Management of Acute Right Ventricular Failure in the Intensive Care Unit. Curr Heart Fail Rep. 2012;9(3):228–35.
Harjola VP, Mebazaa A, Čelutkienė J, Bettex D, Bueno H, Chioncel O, et al. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail [Internet]. 2016 Mar 1;18(3):226–41. Available from: https://doi.org/10.1002/ejhf.478
Anton VN, E. WB, Nico W. The Relationship Between the Right Ventricle and its Load in Pulmonary Hypertension. J Am Coll Cardiol. 2017 Jan 17;69(2):236–43.
Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res. 2017 Oct 1;113(12):1474–85.
Ventetuolo CE, Klinger JR. Management of Acute Right Ventricular Failure in the Intensive Care Unit. Ann Am Thorac Soc. 2014 May 14;11(5):811–22.
Dandel M, Hetzer R. Temporary assist device support for the right ventricle: pre-implant and post-implant challenges. Heart Fail Rev [Internet]. 2018;23(2):157–71. Available from: https://doi.org/10.1007/s10741-018-9678-z
Wrobel JP, Thompson BR, Williams TJ. Mechanisms of pulmonary hypertension in chronic obstructive pulmonary disease: A pathophysiologic review. The Journal of Heart and Lung Transplantation [Internet]. 2012;31(6):557–64. Available from: https://www.sciencedirect.com/science/article/pii/S1053249812010054
Arrigo M, Huber LC. Eponyms in Cardiopulmonary Reflexes. Am J Cardiol [Internet]. 2013;112(3):449–53. Available from: https://www.sciencedirect.com/science/article/pii/S0002914913009168
Grignola JC, Domingo E. Acute Right Ventricular Dysfunction in Intensive Care Unit. La Gerche A, editor. Biomed Res Int. 2017;2017:8217105.
HOEPER MM, GALIÈ N, MURALI S, OLSCHEWSKI H, RUBENFIRE M, ROBBINS IM, et al. Outcome after Cardiopulmonary Resuscitation in Patients with Pulmonary Arterial Hypertension. Am J Respir Crit Care Med. 2002 Feb 1;165(3):341–4.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015 Mar 1;16(3):233–71.
Kucher N, Walpoth N, Wustmann K, Noveanu M, Gertsch M. QR in V1 – an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism. Eur Heart J. 2003 Jun 1;24(12):1113–9.
Valsangiacomo Buechel ER, Mertens LL. Imaging the right heart: the use of integrated multimodality imaging. Eur Heart J [Internet]. 2012 Apr 1;33(8):949–60. Available from: https://doi.org/10.1093/eurheartj/ehr490
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography: Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and . Journal of the American Society of Echocardiography [Internet]. 2010 Jul 1;23(7):685–713. Available from: https://doi.org/10.1016/j.echo.2010.05.010
Spruijt OA, Bogaard HJ, Heijmans MW, Lely RJ, van de Veerdonk MC, de Man FS, et al. Predicting pulmonary hypertension with standard computed tomography pulmonary angiography. Int J Cardiovasc Imaging [Internet]. 2015;31(4):871–9. Available from: https://doi.org/10.1007/s10554-015-0618-x
Metkus TS, Tampakakis E, Mullin CJ, Houston BA, Kolb TM, Mathai SC, et al. Pulmonary arterial compliance in ARDS: clinical determinants and association with outcome from the FACTT cohort. Crit Care Med. 2017;45(3):422.
Dalabih M, Rischard F, Mosier JM. What’s new: the management of acute right ventricular decompensation of chronic pulmonary hypertension. Intensive Care Med [Internet]. 2014;40(12):1930–3. Available from: https://doi.org/10.1007/s00134-014-3459-5
Belenkie I, Sas R, Mitchell J, Smith ER, Tyberg J V. Opening the pericardium during pulmonary artery constriction improves cardiac function. J Appl Physiol [Internet]. 2004 Mar 1;96(3):917–22. Available from: https://doi.org/10.1152/japplphysiol.00722.2003
Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness: an update. Ann Intensive Care [Internet]. 2016;6(1):111. Available from: https://doi.org/10.1186/s13613-016-0216-7
Vieillard-Baron A, Evrard B, Repessé X, Maizel J, Jacob C, Goudelin M, et al. Limited value of end-expiratory inferior vena cava diameter to predict fluid responsiveness impact of intra-abdominal pressure. Intensive Care Med [Internet]. 2018;44(2):197–203. Available from: https://doi.org/10.1007/s00134-018-5067-2
Vignon P, Repessé X, Bégot E, Léger J, Jacob C, Bouferrache K, et al. Comparison of Echocardiographic Indices Used to Predict Fluid Responsiveness in Ventilated Patients. Am J Respir Crit Care Med [Internet]. 2016 Sep 21;195(8):1022–32. Available from: https://doi.org/10.1164/rccm.201604-0844OC
Morelli A, Teboul JL, Maggiore SM, Vieillard-Baron A, Rocco M, Conti G, et al. Effects of levosimendan on right ventricular afterload in patients with acute respiratory distress syndrome: A pilot study*. Crit Care Med [Internet]. 2006;34(9). Available from: https://journals.lww.com/ccmjournal/Fulltext/2006/09000/Effects_of_levosimendan_on_right_ventricular.3.aspx
Russ MA, Prondzinsky R, Carter JM, Schlitt A, Ebelt H, Schmidt H, et al. Right ventricular function in myocardial infarction complicated by cardiogenic shock: Improvement with levosimendan*. Crit Care Med [Internet]. 2009;37(12). Available from: https://journals.lww.com/ccmjournal/Fulltext/2009/12000/Right_ventricular_function_in_myocardial.3.aspx
Jardin F, Vieillard-Baron A. Is there a safe plateau pressure in ARDS? The right heart only knows. Intensive Care Med [Internet]. 2007;33(3):444–7. Available from: https://doi.org/10.1007/s00134-007-0552-z
MORIMONT P, GUIOT J, DESAIVE T, TCHANA-SATO V, JANSSEN N, CAGNINA A, et al. Veno-venous extracorporeal CO2 removal improves pulmonary hemodynamics in a porcine ARDS model. Acta Anaesthesiol Scand [Internet]. 2015 Apr 1;59(4):448–56. Available from: https://doi.org/10.1111/aas.12497
Investigators WG for the AR for ARDST (ART). Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA [Internet]. 2017 Oct 10;318(14):1335–45. Available from: https://doi.org/10.1001/jama.2017.14171
Afshari A, Brok J, Møller AM, Wetterslev J. Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome and Acute Lung Injury in Adults and Children: A Systematic Review with Meta-Analysis and Trial Sequential Analysis. Anesth Analg [Internet]. 2011;112(6). Available from: https://journals.lww.com/anesthesia-analgesia/Fulltext/2011/06000/Inhaled_Nitric_Oxide_for_Acute_Respiratory.29.aspx
Copyright (c) 2023 Medika Alkhairaat : Jurnal Penelitian Kedokteran dan Kesehatan
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with Medika Alkhairaat : Jurnal Penelitian Kedokteran dan Kesehatan agree to the following terms:
1. Authors retain copyright and grant Journal Medika Alkhairaat right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/) that allows others to remix, adapt, build upon the work non-commercially with an acknowledgement of the work’s authorship and initial publication in Journal Medika Alkhairaat.
2. Authors are permitted to copy and redistribute the journal’s published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in Journal Medika Alkhairaat.
