Successful management of right ventricular failure with the ventricular assist pump following aortic valve replacement and coronary bypass grafting.

Right ventricular failure is an infrequent but potentially lethal complication of cardiac surgical procedures. We have successfully treated a patient with right ventricular failure with the use of a right ventricular assist pump (RVAP). This patient had aortic stenosis and coronary artery disease involving the circumflex and right coronary arteries. He also had chronic obstructive pulmonary disease with mild pulmonary hypertension (mean pulmonary artery pressure of 26 mm Hg) and evidence of mild right ventricular failure (right ventricular pressure of 40/14 mm Hg). Gated radionuclide angiography, performed preoperatively, showed that the right ventricle had normal wall motion. Right ventricular failure prevented discontinuation of cardiopulmonary bypass despite use of an intra-aortic balloon pump. The right atrial pressure was 20 mm Hg with a left atrial pressure of 8 to 10 mm Hg. Bypass was readily discontinued following implantation of the RVAP. Recovery of the patient's right ventricle was evaluated with serial determinations of right ventricular work. The RVAP was removed on the fifth postoperative day and the patient made a complete recovery. Postoperatively, gated radionuclide angiography demonstrated moderate recovery of right ventricular function. We suspect that the perioperative right ventricular failure was a result of unsatisfactory myocardial protection due to total occlusion of the proximal right coronary artery, which resulted in a maldistribution of the cardioplegic solution. This case demonstrates that right ventricular function can be restored following circulatory support with a mechanical assist device.