Echokardiographische Beurteilung des rechten Herzens beim perioperativen und intensivmedizinischen Patienten

摘要

Reliable information on the structure and function of the right heart is essential for optimal haemodynamic management of critically ill patients. The right ventricle plays a pivotal, yet often neglected role in the circulation and its failure is often responsible for haemodynamic instability and poor outcome. The low pressure pump of the right ventricle is excessively sensitive to acute increases in its afterload caused by pulmonary embolism, pulmonary vasoconstriction, left ventricular failure or inappropriate ventilator setting and, consequently, is susceptible to acute failure. Alternatively, right ventricular failure can be caused by ischaemia, infarction or volume overload. In the diagnosis of right ventricular failure, echocardiography is superior to invasive haemodynamic monitoring and allows for choosing the best therapy and following its effects. The echocardiographic study of the right heart is based on two-dimensional, M-mode, Doppler and tissue Doppler techniques. Although both transthoracic and transoesophageal methods have comparable diagnostic power, in ventilated patients with poor or inaccessible transthoracic windows the transoesophageal approach frequently has to be used. With regard to the right heart, the echocardiographic study must determine size and function of the right ventricle, estimate its preload and afterload, quantify the pressures in the pulmonary circulation, evaluate the function of tricuspid and pulmonic valves and identify intracardiac shunts, emboli or vegetations. This review covers the applications of echocardiography in the diagnosis of right heart abnormalities in perioperative, critical care and emergency settings.