Marked changes in right ventricular contractile pattern after cardiothoracic surgery: implications for post-surgical...

Area of Science:

• Cardiology
• Cardiac Surgery
• Echocardiography

Background:

• Longitudinal shortening is the primary contributor to right ventricular (RV) contraction in healthy individuals.
• Measures like tricuspid annular plane systolic excursion (TAPSE) correlate with global RV function.
• Cardiac surgery may significantly alter the RV contractile pattern.

Purpose of the Study:

• To investigate changes in the RV contractile pattern after cardiac surgery.
• To compare RV function and mechanics in cardiac surgical cohorts versus normal subjects.
• To assess the implications of these changes for RV function assessment.

Main Methods:

• Retrospective analysis of two cardiac surgical cohorts (orthotopic heart transplant [OHT] and coronary artery bypass grafting [CABG]) and a lung transplant cohort (OLT).
• Comparison of TAPSE, RV fractional area change (RVFAC), and relative changes in RV transverse and longitudinal areas.
• Data from 84 normal subjects used as a reference group.

Main Results:

• RVFAC was within the normal range but lower in surgical groups compared to controls.
• TAPSE and the relative contribution of longitudinal area change were significantly reduced in OHT and CABG patients.
• The ratio of TAPSE to RVFAC was markedly lower in OHT and CABG patients.
• OLT patients showed higher TAPSE and greater longitudinal area contribution than OHT and CABG patients.

Conclusions:

• Cardiac surgery alters the RV contractile pattern, characterized by reduced longitudinal shortening and increased transverse shortening.
• Despite these pattern changes, global RV function may remain within normal limits.
• Quantitative assessment of RV function post-surgery should consider these altered patterns, potentially favoring global measures and lower normative ranges for longitudinal assessments.