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The Reduction in Right Ventricular Longitudinal Contraction Parameters Is Not Accompanied by a Reduction in General
Inge T Bootsma1, Thomas W L Scheeren2, Fellery de Lange1
1Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Journal of Cardiothoracic and Vascular Anesthesia
|March 7, 2020
Summary
Post-cardiothoracic surgery, longitudinal right ventricular (RV) function parameters like TAPSE and S' decrease significantly. However, global RV performance, measured by MPI and RVEF, remains stable, indicating complex RV adaptation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Cardiothoracic surgery, particularly aortic valve replacement, can impact right ventricular (RV) function.
- Longitudinal parameters such as tricuspid annular systolic plane excursion (TAPSE) and systolic excursion velocity (S") are commonly used to assess RV contractility.
Purpose of the Study:
- To investigate whether decreased longitudinal RV parameters after cardiothoracic surgery correlate with reduced global RV performance.
- To evaluate the adequacy of single RV parameters in assessing global RV function post-surgery.
Main Methods:
- Prospective, observational, single-center study involving 20 patients undergoing aortic valve replacement.
- Simultaneous measurements of RV function using pulmonary artery catheter and transesophageal echocardiography (TEE) before and after surgery.
Main Results:
- Significant reductions in TAPSE and S" were observed immediately after surgery (p < 0.001 and p = 0.041, respectively).
- Global RV performance, assessed by TEE-derived myocardial performance index (MPI) and pulmonary artery catheter-derived RV ejection fraction (RVEF), remained statistically unchanged post-surgery (p = 0.278 and p = 0.294, respectively).
Conclusions:
- Reduced longitudinal RV contractility parameters (TAPSE, S") post-cardiothoracic surgery do not necessarily indicate a decrease in global RV performance (MPI, RVEF).
- Relying on single RV parameters may be insufficient for a comprehensive assessment of the right ventricle's adaptation to aortic valve replacement.
Keywords:
cardiac surgerypulmonary artery catheterright ventricleright ventricular ejection fractionright ventricular functionsystolic excursion velocitytransesophageal echocardiographytricuspid annular systolic plane excursionMore Related Videos
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