Acute Right Ventricular Failure: Pathophysiology, Diagnostic Approach with Emphasis on the Role of Echocardiography.

Right ventricular function is one of the important predictors of survival in heart failure patients. In the past, there has been only limited knowledge regarding right-sided heart failure when compared to left-sided failure. However, there are more emerging data in recent years, and several studies have emphasized the unique features of the right ventricle regarding its anatomy, pathophysiology, clinical consequences, diagnostic modalities, and treatment options. Despite that, management of acute right ventricular failure is still challenging. This article summarizes an overview of acute right heart failure including pathophysiology, causes, clinical features, and diagnostic work-up with emphasis on the role of echocardiography.

[Right Atrial Thrombus Formation as Complications in the Presence of Hemodialysis Catheter and Central Venous Catheter]. / Rechtsatriale Thromben als Komplikation bei Hämodialysekathetern und zentralen Venenkathetern.

HISTORY: Case 1: admission to hospital of a 65-year-old female patient with multiple cerebral infarctions after surgery due to a benign tumor for detection of cardiac source of embolism by echocardiography. During surgery a central venous catheter has been placed into the internal jugular vein.Case 2: admission to hospital of a 59-year-old female with urosepsis due to infectious urinary stasis due to dislocated double J-catheter and suspected endocarditis. A chronic hemodialysis catheter has been placed 4 months ago. DIAGNOSIS/FINDINGS: In both cases right atrial thrombotic formations could be detected by echocardiography. Further, morphological und functional changes of the right atrium and ventricle as well as the tricuspid valve could be observed. THERAPY AND COURSE: In case 1 the patient was treated with therapeutic anticoagulation with phenprocoumon. In contrast, surgery (thrombectomy) was recommended in case 2 due to the increased risk of cardiac thromboembolism and the morphological und functional impairment of the tricuspid valve. CONCLUSION: Echocardiography permits the detection of thrombotic formations in the right heart. Therapeutic procedures should be defined individually and interdisciplinarily.

[Papillary Fibroelastoma of the Pulmonary and Tricuspid Valve in Asymptomatic Patients]. / Papilläres Fibroelastom an Pulmonal- und Trikuspidalklappe bei asymptomatischen Patienten.

HISTORY: Case 1: admission to hospital of a 72-year-old male patient due to suspect tumor at the pulmonary valve. At admission the patient was hemodynamically stable with known coronary one vessel heart disease and arterial hypertension.Case 2: admission to hospital of a 74-year-old female patient due to symptoms of de novo angina pectoris with known coronary three vessel heart disease. FINDINGS AND DIAGNOSIS: In both patients suspect tumors could have been detected at the pulmonary- and tricuspid valve by transthoracic echocardiography. In case 1 coronary angiography showed a complex coronary three vessel heart disease with indication for surgery. In case 2 coronary angiography showed a subtotal stenosis of the RCA which could have been treated by percutaneous coronary intervention (PCI). THERAPY AND COURSE: In both cases the tumor were highly suspective to be benigne. Despite of the certain risk of embolism, surgery was only recommended in case 1 because the patient needed surgical revascularisation anyway due to the complex coronary three vessel heart disease. In case 2 the RCA stenosis has been treated by PCI and surgery has not been recommended. CONCLUSIONS: Echocardiography can help to detect cardiac tumors whereas the diagnosis can only be confirmed by biopsy. Further therapeutic procedures should be defined individually.