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A 74-Year-Old Man With Refractory Hypotension After Spine Surgery

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Presentation on theme: "A 74-Year-Old Man With Refractory Hypotension After Spine Surgery"— Presentation transcript:

1 A 74-Year-Old Man With Refractory Hypotension After Spine Surgery
Eric Tesoriero, DO, Somnath Bose, MD, Achikam Oren-Grinberg, MD, Akiva Leibowitz, MD  CHEST  Volume 152, Issue 1, Pages e1-e5 (July 2017) DOI: /j.chest Copyright © 2017 American College of Chest Physicians Terms and Conditions

2 Figure 1 Apical four-chamber view. Still image that is directed posteriorly as the coronary sinus is seen. Although the left ventricle is foreshortened, dimensions of the right ventricle (×---×) and left ventricle (+---+) are recorded. CHEST  , e1-e5DOI: ( /j.chest ) Copyright © 2017 American College of Chest Physicians Terms and Conditions

3 Figure 2 Apical four-chamber view with M mode across the tricuspid annulus. The tricuspid annular plane systolic excursion is recorded and is 1.19 cm. CHEST  , e1-e5DOI: ( /j.chest ) Copyright © 2017 American College of Chest Physicians Terms and Conditions

4 Figure 3 Apical four-chamber view with continuous wave Doppler interrogation of tricuspid regurgitation. The pulmonary artery systolic pressure can be estimated by the velocity of the tricuspid regurgitation jet. The relationship 4v2 + right atrial pressure (central venous pressure), which is the right ventricular systolic pressure, is equal to the pulmonary artery systolic pressure as long as there is no pulmonic stenosis or right ventricular outflow tract obstruction. CHEST  , e1-e5DOI: ( /j.chest ) Copyright © 2017 American College of Chest Physicians Terms and Conditions

5 Figure 4 CT angiogram of the chest. A, CT evidence of right ventricular strain, showing a right ventricular diameter greater than the left ventricular diameter and abnormal septal position. B, Bilateral proximal pulmonary emboli are demonstrated. CHEST  , e1-e5DOI: ( /j.chest ) Copyright © 2017 American College of Chest Physicians Terms and Conditions

6 Figure 5 Pulmonary artery angiogram. A, Filling defects in right pulmonary artery. B, Improved perfusion of right middle and lower lobar arteries following mechanical embolectomy. CHEST  , e1-e5DOI: ( /j.chest ) Copyright © 2017 American College of Chest Physicians Terms and Conditions


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