Some paper leaves the impression that a part of the right ventricular failure of patients with a history of long-lasting left ventricular dysfunction is related to the compliance and on the filling state of the pulmonary arterial bed. Should we start moving backward from the left ventricular unloading to the lung circulation unloading? When moving to the ambulatory patients should we try to better phenotype the pulmonary circulation and anticipate the irreversible changes on the pulmonary vein side and in the distribution of the blood inside the lung circulation?
Dear Sir, A very interesting hypothetical question but in common grounds I have to accept the fact that 60% - 70% is due to Myocardial disease than to look in to pulmonary circulation.
Thanks.
RV- LV interelation is very important point of view and pulmonary circulation phenotype is consequence of LV loading
Dr. Tajudeen Abdul Hameed I agree, but almost 100% of the research is pointing at myocardium.
Many patients have the same myocardial problem in the RV as well as the LV, such as idiopathic dilated cardiomyopathy. Others, such those with mitral stenosis, will eventually develop RV myocardial disease via long standing pulmonary hypertension.
So the question is rather naive. The two mechanisms are present depending on the initial etiology. The proportion of one or the other would vary depending where in the world you are practicing. The role of one or the other pathophysiologic mechanism is easy to determine in most patients.
However, like in every aspect of medicine, these two mechanisms may not be so easy to determine in many patients; in some of them perhaps the two mechanisms combined are at play.
Both factors are important. It depends upon the underlying condition of heart. In dilated cardiomyopathy RV dysfunction is the cause of RV failure. Pulmonary artery hypertension has some contribution. But in disease like mitral stenosis.. Severe pulmonary arterial hypertension is the cause of RV failure.. In ischemic heart disease both factors may be responsible for RV failure.. Thanks
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