Right Ventricular Function
Patients with right coronary artery disease may be susceptible to right ventricular ischemia and infarction when right ventricular distension or increased afterload occurs resulting in diminished cardiac performance and reduced right coronary perfusion pressure. The interrelationships of aortic end-diastolic pressure, afterload volume, coronary perfusion pressure, and pulmonary vascular resistance, play a significant role in the management of right sided cardiac performance. Assessment of these variables prior to treatment is essential in order to avoid compromised function.
Common treatment for systemic hypotension in the period prior to initiating cardiopulmonary bypass incorporates the use of phenylephrine, an ð1-adrenergic agonist. Indication for use is primarily for hypotension induced by a reduction in systemic vascular resistance (SVR) as opposed to compromised cardiac output. The perceived advantage of utilizing phenylephrine is its’ impact on increasing coronary perfusion pressure while having minimal chronotropic side effect.
Tuman KJ, McCarthy RJ, March RJ, Guynn TP, Ivankovitch AD. Effects of phenylphrine or volume loading on right ventricular function in patients undergoing myocardial revascularization. Journal of Cardiothoracic and Vascular Anesthesia. 1995;9:2-8.