Cor Pulmonale

RV failure is the third most common cardiac Dx after age 50 y.

Of all CHF admissions, 10–20% have some aspect of right heart failure.

Gender predominance is male > female.

Increased risk for respiratory failure, severe right heart failure (≥10% if cor pulmonale Dx made preop)

Risk of prolonged postop ventilatory support

Increased PVR may cause systemic hypotension due to RV dysfunction, resulting in decreased LV filling

Hypoxia, hypoxemia, hypercarbia, and acidosis intraop or in early postop period, which increase PVR

Underlying CAD and LV dysfunction

Alteration in RV structure (hypertrophy) and function (decreased)

Most common cause: Long-standing LV dysfunction leading to RV failure, with other common causes including chronic pulmonary emboli and end-stage COPD resulting in increased PVR (secondary to chronic hypoxia and structural changes)

Any disease that increases PVR chronically, which can induce RV changes, including idiopathic and toxin-induced pulm Htn, pulm fibrosis, severe obstructive sleep apnea, CHD with chronic RV overload, or RV outflow obstruction

Prognosis: Favorable for those who can maintain a near-normal PaO ₂ ; unfavorable for those with structural changes

LV heart failure

COPD: Smoking or severe asthma

Long-standing untreated OSA

Acute or chronic pulm embolus

CHD with RV volume overload (L-to-R shunt and long-standing pulmonic insufficiency) or afterload increase (pulm outflow obstruction)

Primary pulm Htn or severe pulm fibrosis