European Journal of Echocardiography Advance Access published online on February 27, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep015
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Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study
1 Centro Cardiologico Monzino, I.R.C.C.S., Institute of Cardiology, University of Milan, Via Parea 4, 20138 Milan, Italy
2 Biomedical Engineering Department, Politecnico di Milano, Milan, Italy
Received 19 November 2008; accepted after revision 7 February 2009.
* Corresponding author. Tel: +39 2 580021; fax: +39 2 504667.E-mail address: gtamborini{at}cardiologicomonzino.it
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Abstract |
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Aims: 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.
Methods and results: 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).
Conclusion: 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.
Keywords: Three-dimensional echocardiography; Cardiac surgery; Right ventricular function; Mitral valve prolapse
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