Treatment of Right Heart Enlargement

Diagnosis and Evaluation

Comprehensive echocardiography is the diagnostic test of choice to document the severity of right-sided cardiac enlargement, right ventricular dysfunction, and tricuspid regurgitation, as recommended by the American College of Cardiology 2
ECG may show characteristic findings including right axis deviation, tall P waves, and right bundle branch block pattern, according to the American College of Cardiology 2
Chest X-ray typically shows right atrial enlargement with a "globular" cardiac contour and clear lung fields, as noted by the American College of Cardiology 2
Advanced imaging with cardiac MRI or CT may provide additional information about cardiac structure and function, as suggested by the American College of Cardiology 2, 3

The American College of Cardiology recommends transcatheter or surgical closure for secundum ASDs causing right atrial/ventricular enlargement with significant left-to-right shunt, provided pulmonary artery pressure is less than 50% of systemic pressure 4
Surgical repair is indicated for primum ASD, sinus venosus defect, or coronary sinus defect with similar hemodynamic criteria, as recommended by the American College of Cardiology 4

Treatment should be directed at the underlying cause of pulmonary hypertension, according to the American College of Chest Physicians 5
Specific pulmonary vasodilator therapies may be indicated depending on the classification and severity of pulmonary hypertension, as suggested by the American College of Chest Physicians 5
Right heart catheterization is essential for accurate diagnosis and to guide therapy in suspected pulmonary hypertension, as recommended by the American College of Chest Physicians 5

Tricuspid regurgitation that requires surgery is most often secondary to annular dilation with right-sided heart enlargement, as noted by the American Heart Association 6
The American Heart Association recommends tricuspid valve repair over replacement when feasible 6
Intraoperative transesophageal echocardiography should be used to evaluate the results of tricuspid valve repair immediately after cardiopulmonary bypass, as suggested by the American Heart Association 6

The American Heart Association recommends percutaneous balloon valvuloplasty as the treatment of choice for valvular pulmonary stenosis with right ventricular enlargement 7
Follow-up echocardiography-Doppler is recommended every 2 to 5 years in asymptomatic patients with a peak instantaneous valvular gradient by Doppler greater than 30 mm Hg, as suggested by the American Heart Association 7

Management should focus on optimizing preload, enhancing contractility, and reducing afterload, according to the American Heart Association 8
Diuretics should be used judiciously to reduce right-sided congestion while avoiding excessive preload reduction, as recommended by the American Heart Association 8
In acute right heart failure, inotropic support may be necessary to improve right ventricular contractility, as suggested by the American Heart Association 8
Mechanical circulatory support may be considered in refractory cases, as recommended by the American Heart Association 8

In patients with univentricular hearts and right heart enlargement, careful hemodynamic assessment is needed to determine the potential for definitive palliation, as noted by the American College of Cardiology 9, 10

Regular follow-up with clinical assessment and echocardiography is essential to monitor progression of disease and response to therapy, as recommended by the American Heart Association 1, 2
Patients with congenital heart disease should have regular follow-up in a center specialized in adult congenital heart disease, as suggested by the American College of Cardiology 2
Holter monitoring may be indicated in patients at risk for arrhythmias, as recommended by the American College of Cardiology 2, 3

The prognosis of right heart enlargement depends on the underlying etiology, severity of right ventricular dysfunction, and response to treatment, according to the American Heart Association 8
Chronic right heart failure is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output, progressive end-organ damage, and cachexia, as noted by the American Heart Association 8