Does rheumatic valvular heart disease affect right ventricular performance?

Right ventricular (RV) function often determines clinical outcome in patients with valvular heart disease. Though difficult to assess by echocardiography, Tei index is useful in its assessment. The aims of the study were to evaluate global RV function using the Tei index in patients with rheumatic heart disease and to observe if such abnormalities in RV function were reversible post-operatively.

The study included patients with atrial septal defect (ASD, Group I, n = 15) and rheumatic valvular heart disease (RVHD, Group II, n = 18). Patients with atrial fibrillation were excluded from the study. Conventional 2-D echocardiography was performed preoperatively, immediate postoperative and in last follow-up.

ASD group had lower left LVES and LVED dimensions as compared to RHVD (p = 0.001) and better ejection fraction (EF) than RVHD group (p = 0.02). LV Tei in the ASD group was above the normal limit (> 0.5), while RV Tei was increased in the RHVD group. The median RVSP was similar in two groups (p = 0.9). The impaired LVMPI in the ASD group improved as early as 2 weeks following surgery (p = 0.09) while in patients with RHVD it deteriorated which mirrored the reduction in median LVEF (p = 0.04). Group II that had an abnormal RV Tei pre-operatively demonstrated improvement following surgery (p = 0.03).

RVHD is associated with impairment of RV function. Volume overload of RV in patients of ASD is associated with normal MPI. The abnormalities in RVMPI improved as early as 2 weeks after valve surgery with sustained improvement noted at follow up.