Right ventricular pulsus alternans during acute increase in afterload during balloon pulmonic valvuloplasty

Pulsus alternans is characterized by a regular rhythm with alternation of strong and weak contractions. It is a phenomenon generally ascribed to severe myocardial dysfunction and occurs most commonly in patients with heart failure secondary to increased resistance to left ventricular ejection. It has also been described in coronary artery disease and in idiopathic dilated cardiomyopathy. Although pulsus alternans has more often been described in advanced myocardial disease, it has also been described in acute, transient ischemia. 1 Right ventricular (RV) alternans has been described previously, but usually in patients with congestive heart failure or severe RV dysfunction, or both. 2,3 The present report describes RV pulsus alternans that occurred acutely during balloon pulmonary valvotomy.