Mitral stenosis, especially of Rheumatic origin usually has a slow progression and presents when there is an acute decompensation (for example the development of new atrial fibrillation).
Acute RV failure is seen with increasing frequency in ICU’s and is especially hard to treat when a patient with pre-existing pulmonary hypertension develops ARDS. Initial management should focus on determining the cause of Right Ventricular decompensation and reversing it. When reversal is not possible, a step-wise approach as mentioned above will help. Extracorporeal support is effective in restoring stability and can be attempted in patients who are expected to recover form the cause of RV failure or as a bridge to surgical interventions.
