Cardiology clinics
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The right ventricle is frequently affected by pulmonary arterial hypertension of postcapillary obstructive origin. The disorders that cause states of pulmonary venous hypertension arise in the left ventricle, left atrium, or pulmonary veins. Biochemical factors, the pericardium, interventricular septum, and pulmonary arterial system combine to communicate the effects of these disorders to the right ventricle. ⋯ Exercise may serve to magnify the abnormalities of right ventricular function. Correction of left-sided heart lesions with improvement in pulmonary venous hypertension is associated with favorable effects on the right ventricle. In states of left-sided heart failure, the level of right ventricular function may provide important prognostic information.
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Our approach to the clinical management of uremic and dialysis-associated pericarditis has been presented previously and is outlined in Figure 1. In hemodynamically stable patients with no effusion and in those with small to medium effusions, we recommend initial therapy with intensified dialysis. Close monitoring, perhaps every third day, with echocardiography should be carried out. ⋯ Under these circumstances, we prefer that pericardiocentesis be performed in the operating room immediately before the induction of anesthesia for the definitive surgical procedure. Although pericardiectomy is a definitive procedure for pericarditis with effusion in the uremic patient, the procedure has substantial morbidity. The results of subxiphoid pericardiotomy are encouraging, and it is clear that it can be carried out safely in patients who are debilitated or who are at increased risk from general anesthesia and major surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Doppler echocardiography can provide insight into the diastolic properties of the left ventricle. The hemodynamic origins of the diastolic mitral flow velocity profile are reviewed and Doppler information is compared to other measures of left ventricular diastolic function. Factors affecting the mitral diastolic flow velocity in both normal populations and pathologic conditions are discussed and the reported normal indexes of diastolic transmitral velocity are criticized.
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Review
Clinical assessment of ventricular function after surgical treatment of congenital heart defects.
The assessment of ventricular function has contributed to the current surgical evaluation and surgical treatment of congenital heart defects, but many issues remain unresolved. The challenge of assessing ventricular function after surgical repair of congenital heart defects includes not only the general problem of distinguishing adverse loading conditions from myocardial failure but also more unique problems of right heart function and developmental differences in ventricular function. ⋯ Many of the technologies and methods are currently available and there is the beginning of a move toward better designed clinical trials and analysis of results. The assessment of ventricular function will become increasingly important as surgical techniques are improved and we are left with the more difficult choices between competing approaches.