Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic...

A reduction in tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity (PSV) of tricuspid annulus after cardiac surgery is a well-known phenomenon, even though its origin is not well established. Recently, a new three-dimensional (3D) echocardiographic software adapted for right ventricular (RV) analysis has been validated. Aims of this study were to evaluate RV function in patients with mitral valve prolapse undergoing surgical valvular repair and to compare and correlate 3D RV ejection fraction (RVEF) with TAPSE and PSV before and after surgery.

Forty patients were studied by transthoracic 2D and 3D echocardiography pre- and 3, 6, and 12 months post-surgery. TAPSE (15.5 +/- 3, 16.5 +/- 3, and 18.5 +/- 4 mm at 3, 6, and 12 months, respectively) and PSV (11.9 +/- 2, 12 +/- 2, and 12.8 +/- 3 cm/s at 3, 6, and 12 months, respectively) were significantly (P < 0.001) lower after surgery in comparison with pre-surgical values (TAPSE: 25.3 +/- 4 mm; PSV: 17.8 +/- 4 cm/s). On the contrary, pre-operative RVEF (58.4 +/- 4%) did not change after surgery (56.9 +/- 5, 59.5 +/- 5, and 58.5 +/- 5% at each step).

Despite the post-operative reduction of RV performance along the long axis suggested by TAPSE and PSV, the absence of a decrease in 3D RVEF leads to caution in the interpretation of these 2D and Doppler parameters after cardiac surgery, supporting the hypothesis of geometrical rather than functional changes in the right ventricle.