Défaillance ventriculaire droite: Le rôle de l’échocardiographie lors de l’implantation d’une assistance ventriculaire gauche

Heart failure (HF) designes a clinical syndrome that appears when the heart does not succeed to maintain an enough level of function to supply the oxygen demand of the body. The prevalence of HF is estimated at 0.4% to 2% in general population in Switzerland and is up to 15% in the elderly population (>75 years old). In Europe, 2 to 10 millions of persons seems to be suffering from HF. Survival is 50% up to 4 years but this estimation falls to 1 year’s survival if the HF is considered as severe. Main etiologies of the HF are coronaries diseases (with or without infarct), valvular pathologies and arrhythmias. High blood pressures, diabetes, smoking, drinking alcohol and use of drugs are considered as risk factors for HF. The diagnostic of HF lays on the observation of typical symptoms (such as breathlessness, ankle swelling and fatigue) and eventually signs (e.g. elevated jugular venous pressure, pulmonary crackles and peripheral edema). HF is staged with the help of echocardiography. Indeed the classification of the severity of the HF is based on the Left Ventricular Ejection Fraction (LVEF). LVEF corresponds to the percentage of blood in the left ventricle that is ejected by it. A normal level of LVEF is around 60%. In the case of an HF disease, we can find 3 stages which are correlated to 3 levels of LVEF. HF with preserved ejection fraction (LVEF > 50%), HF with midrange ejection fraction (LVEF > 40-49%) and HF with reduced ejection fraction (LVEF < 40%). Treatments of HF is based on the type of etiology and the structural alteration in the myocardial muscle. We can find 4 types of HF: Left-sided HF, Right-sided HF, systolic HF, Diastolic HF