Chapter 10 - Echocardiographic Evaluation of Preload Responsiveness


Video 10-1. Acute cor pulmonale (ACP) apical four-chamber view. Note dilated right ventricle (RV) is now an apex forming chamber.
Video 10-2. Acute cor pulmonale (ACP) parasternal short-axis view, note left ventricular (LV) compression by the dilated right ventricle (RV).
Video 10-3. Minimally invasive TEE short transgastric view of the LV. Note decrease LV diastolic area (LVDA). This patient appears hypovolemic and is likely to benefit from volume resuscitation. TEE, transesophageal echocardiography; LV, left ventricle.
Video 10-4. Same patient as in Video 10-3, but now adequately resuscitated. Notice decrease heart rate, absence of premature contractions, increased LVDA, and increased stroke volume. LVDA, LV diastolic area.
Video 10-5. Extreme ACP: note grossly dilated RV and right atrium (RA). LV is obviously compressed by RV resulting in decreased LV diastolic volume and stroke volume and thus hemodynamic instability, left atrium is compressed by the dilated RA further contributing to the lack of LV filling during diastole. This patient died from shock, resulting from hemodynamic consequences of the above, later that day. LV, left ventricle; RV, right ventricle; ACP, acute cor pulmonale.
Video 10-6. Subcostal view. Note normal respiratory collapse of the inferior vena cava (IVC). This patient is likely to be a volume responder.
Video 10-7. Subcostal view. Note lack of respiratory collapse and dilated IVC. This patient is unlikely to be a volume responder. IVC, inferior vena cava.
Video 10-8. Physiological explanation (basis) of the passive leg raising (PLR) maneuver.
Video 10-9. Common carotid artery flow prior to PLR in patient with septic shock. PLR, passive leg raising.
Video 10-10. Common carotid artery (CCA) flow after PLR in patient with septic shock. Note significant increase in CCA flow. Also note CCA diameter increased, likely due to flow mediated dilatation (FMD). This patient was judged to be a likely candidate to benefit from volume resuscitation and improved hemodynamically after infusion of 1500 mL of lactated ringer solution. FMD is indicative of the relative lack of endothelial dysfunction and thus the ability to respond to neuro-hormonal stimuli redirecting blood to vital organs.