Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, China
Title: Management of acute decompensated right sided heart failure associated with postoperative pulmonary hypertension
Jing-Bin Huang, Medicine Doctor, now is an Associate Professor of Surgery, director of Department of Cardiothoracic surgery, The Affiliated Ruikang Hospital of Guangxi Traditional Chinese Medical College, member of Chinese Medical Doctor Association and China Association for cardio-thoracic surgery. He got his bachelor of medicine, master of medicine in surgery at Sun Yat-Sen University, Medicine Doctor's degree (M.D.) at Peking Union Medical College and Tsinghua University, China. Currently his researches focus on the basic and clinical studies of cardiothoracic surgery, especially on pulmonary arterial hypertension associated with congenital heart disease. His 13 papers have been published in journals indexed by SCI, and he is the author of 3 books published by NOVA, USA, and 1 book published by InTech, Europe.
Pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: Principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance. Therefore, a detailed update on the management of PH and RV failure in adult critical care is provided. Clinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. Advances in diagnosis and management have granted insights into the following pathophysiologic mechanisms of RV dysfunction: Impaired RV contractility, RV pressure overload, and RV volume overload. Emerging imaging modalities, such as cardiac MRI, and new therapeutic agents, such as pulmonary selective vasodilators, have expanded our options for evaluation and management, respectively. An improved understanding of pathophysiology and technologic progress provides us with new pathways in the diagnosis and hemodynamic support of these often critically ill patients.