Chronic Rightsided Heart Failure

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Chronic right-sided heart failure has a number of causes. The common ones include congenital pulmonary stenosis, Ebstein's anomaly, severe chronic obstructive pulmonary disease, and recurrent pulmonary thromboembolic disease. Diffusely decreased pulmonary vascularity with unusually lucent lungs is seen in patients with right-sided heart failure without pulmonary hypertension (see Fig. 12-7Q. Centralized PBF pattern is encountered when the right-sided heart failure is secondary to precapillary pulmonary hypertension (see Fig. 12-7A, B->;B; B). A cephalized flow pattern with unusually lucent lungs is found in patients with right-sided heart failure secondary to long-standing severe left-sided heart failure (see Fig. 12-7D). The degree of right-sided chamber enlargement is proportional to the severity of tricuspid regurgitation.

Combined

It is generally believed that right-sided heart failure is caused most often by severe left-sided heart failure. This is exemplified by patients with severe mitral stenosis leading to severe tricuspid regurgitation (see Fig. 12-7D). Other examples of bilateral heart failure are cardiac tamponade and constrictive pericarditis, when both sides of the heart are affected (Fig. 12-23).

Right Sided Heart Failure PatientRight Sided Heart Failure PatientRight Left Sided Heart Failure

Figure 12-23: Patient with calcific constrictive pericarditis. Typically there is only mild postcapillary pulmonary hypertension due to left-sided constriction. Severe pulmonary venous congestion is prevented by the concurrent right-sided constriction. A. Posteroanterior view shows moderate cardiomegaly and mildly cephalic pulmonary blood flow pattern. B. Lateral view shows heavy calcification of the pericardium (arrows) and left atrial enlargement deviating the barium-filled esophagus posteriorly.

Figure 12-23: Patient with calcific constrictive pericarditis. Typically there is only mild postcapillary pulmonary hypertension due to left-sided constriction. Severe pulmonary venous congestion is prevented by the concurrent right-sided constriction. A. Posteroanterior view shows moderate cardiomegaly and mildly cephalic pulmonary blood flow pattern. B. Lateral view shows heavy calcification of the pericardium (arrows) and left atrial enlargement deviating the barium-filled esophagus posteriorly.

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