Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post-operative...

Area of Science:

• Cardiovascular Surgery
• Cardiac Mechanics
• Echocardiography

Background:

• Mitral valve replacement/repair (MVR) can impact right ventricular (RV) function.
• Understanding pre-operative RV mechanics is crucial for predicting post-operative outcomes.
• Alterations in RV contraction patterns following MVR require detailed investigation.

Purpose of the Study:

• To investigate changes in the RV contraction pattern after MVR.
• To explore the relationship between pre-operative RV mechanics and early post-operative RV dysfunction (RVD).
• To identify predictors of RVD in patients undergoing MVR.

Main Methods:

• Prospective study of 42 patients undergoing open-heart MVR.
• Pre-operative, post-operative, and 6-month follow-up 3D echocardiography to assess RV ejection fraction (RVEF), longitudinal ejection fraction (LEF), and radial ejection fraction (REF).
• Pulmonary artery catheterization to monitor RV stroke work index (RVSWi).

Main Results:

• RV contraction pattern significantly shifted post-MVR, with radial motion becoming dominant compared to pre-operative longitudinal shortening.
• This shift was temporary, with longitudinal and radial contributions becoming equal at 6 months post-surgery.
• Pre-operative LEF was an independent predictor of early post-operative RVD (RVSWi < 300 mmHg·mL/m²).

Conclusions:

• MVR induces a significant and temporary shift in the RV mechanical contraction pattern.
• Advanced RV mechanics indices, particularly pre-operative LEF, are associated with invasively measured RV contractility.
• Pre-operative RV mechanics assessment may aid in predicting post-operative RVD.