Successful Use of Pulmonary Vasodilators in Acute Chest Syndrome Complicated by Persistent Right Ventricular Failure

Figure 1

Apical four-chamber views and abbreviated echocardiogram reports from the baseline, acute chest syndrome (ACS), and follow-up. (a) Baseline echocardiogram. Twenty-two months prior to ACS. Left ventricular ejection fraction 55-60%. Moderately enlarged right ventricular chamber with mildly reduced systolic function. Mild right atrial enlargement. Moderate tricuspid regurgitation. Pulmonary artery systolic pressure 60 mmHg plus central venous pressure. Inferior vena cava small and collapses with inspiration. (b) Echocardiogram during ACS. Left ventricular ejection fraction 60-65%. Severely enlarged right ventricular chamber with moderately reduced systolic function. Severe right atrial enlargement. Severe tricuspid regurgitation. Pulmonary artery systolic pressure 132 mmHg plus central venous pressure. Inferior vena cava dilated. (c) Follow-up echocardiogram. Ten months after ACS. Left ventricular ejection fraction 55-60%. Moderately enlarged right ventricular chamber with moderately reduced systolic function. Moderate right atrial enlargement. Moderate tricuspid regurgitation. Pulmonary artery systolic pressure 45 mmHg plus central venous pressure. Inferior vena cava normal in caliber and collapses with inspiration.

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