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Extra info for Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.: Proceedings of the 22st Postgraduate Course in Critical Medicine Venice-Mestre, Italy - November 9-11, 2007
In the transgastric view, either short and long-axis, the RV function and its size and septal motion can be evaluated. An abnormal movement of the interventricular septum is often the first signal of RV failure. The septum bellows to the LV and maintains a convex curve toward the RV. With the increase in RV volume, the septum flattens and assumes a paradoxical movement toward LV during the end-diastolic phase. In the case of pressure overload (pulmonary hypertension), this paradoxical movement is maximal during the end-systolic phase.
What is important is that this condition may require the discontinuation of inotropes in a hypotensive patient, so the diagnosis should be firmly established . Colour-flow mapping is a useful method for the detection of valvular regurgitation. However, since it may not be accurate enough for reliable quantification in some circumstances, a volumetric approach is preferable. In cases of massive mitral regurgitation (MR) or aortic regurgitation (AR), any measurement may be difficult. Aortic and mitral stenosis are satisfactorily assessed by the volumetric, continuous wave and pulsed wave Doppler methods .
Moreover, it has been shown that the respiratory variations in arterial pulse pressure are more predictive of response to volume expansion than the respiratory variations in systolic arterial pressure since systolic arterial pressure not only depends on respiration-induced changes in stroke volume, but also on respiration-induced changes in intrathoracic pressure. The main limitations of these indices are that they are invasive, technically challenging, or not widely available. Arterial catheters, which are mandatory for DPP calculation and monitoring, have been shown to be responsible for infections and thromboses and their use is limited to the operating room.