Right ventricular failure after repair of left ventricular aneurysm

Abstract

This report summarizes the experience in two patients who have manifested severe right ventricular (RV) failure after resection of large left ventricular (LV) aneurysms involving the ventricular septum. In the first patient, early postoperative right atrial (RA) mean pressure (14 mm Hg) was similar to the mean pulmonary artery (PA) pressure (16 mm Hg) and exceeded left atrial (LA) pressure (10 mm Hg). A right-to-left shunt through a patent foramen ovale allowed adequate cardiac output at the expense of arterial desaturation. As RV function slowly improved, LA pressure exceeded RA pressure, pulmonary artery pulse pressure increased, and the shunt disappeared as the foramen ovale closed. In the second patient, initial attempts to wean from cardiopulmonary bypass with catecholamines and intra-aortic balloon pump were unsuccessful because of RV failure. RA pressure was 30 mm Hg and LA pressure was 12 mm Hg with a balloon-augmented peak arterial pressure of only 80 mm Hg. A ventricular assist pump (RA to PA) was used to wean the patient from bypass and resulted in adequate LA pressure (17 mm Hg), low RA pressure (6 mm Hg), and adequate cardiac index (1.9 L/min/m 2 ). On the operative and first postoperative day, there was no pulse pressure generated from RV contraction and all PA pulse pressure (40115 mm Hg) was due to the assist pump. Beginning on postoperative day 2, the RV generated increasing PA pulse pressures. The patient was weaned from the RV assist device, which was removed on postoperative day 3; then the PA pressure was 36/18 mm Hg, RA pressure 16 mm Hg, and LA pressure 18 mm Hg. Both patients remain well. These case histories would indicate that the lack of septal motion may not be a contraindication to repair of LV aneurysm as has previously been suggested; however, in such patients, the possibility of RV failure would make the availability of an assist pump advisable. Recovery of RV function can be expected within a few days.