Tricuspid annular velocity in patients undergoing cardiac operation using transesophageal echocardiography

The complex geometry of the right ventricle (RV) and poor endocardial definition make quantitative assessment of RV function difficult. Doppler tissue imaging may be helpful in quantifying RV function through measurement of tricuspid annular velocity (TAV). This prospective study assessed the feasibility of using color Doppler tissue imaging to measure TAV using a novel transgastric RV inflow view in patients undergoing cardiac surgery.

We used the transgastric RV inflow view and measured the TAV using Doppler tissue imaging and quantitative analysis software. We also measured left ventricular fractional area of contraction and hemodynamic variables. We compared values before and after cardiopulmonary bypass in patients undergoing coronary artery bypass graft.

TAV could be measured in 19 of 23 patients (83%) undergoing coronary artery bypass graft. There was a significant decrease postbypass in TAV: isovolumic acceleration was 1.71 +/- 0.59 versus 1.32 +/- 0.66 m/s2, isovolumic velocity was 4.34 +/- 1.19 versus 3.13 +/- 1.35 cm/s, and systolic annular descent velocity was 5.15 +/- 1.15 versus 3.77 +/- 1.18 cm/s. There was a significant change in heart rate and cardiac index without any change in stroke volume index. There was no change in left ventricular function (fractional area of contraction: 54 +/- 10 vs 52 +/- 10%).

Determination of TAV using the transgastric RV inflow view is feasible and may provide quantitative information on systolic RV function in patients undergoing coronary artery bypass graft. We found a decrease in systolic TAV after cardiopulmonary bypass without a significant change in stroke volume index.