Evaluation of the Clinical Utility of Transesophageal Echocardiography and Invasive Monitoring to Assess Right Ventricular Function During and After Pulmonary Endarterectomy

Right Ventricular Assessment: Are Regional Longitudinal Measurements of Value?

“…We are still left with the question as to whether longitudinal measures reflect global RV function for cardiac surgical patients. [17][18][19][20] Similar to the results presented by Bootsma et al, in other studies involving different cardiac surgical patients (coronary artery bypass grafting, mitral or aortic valve surgery, and patients undergoing pulmonary endarterectomy) TAPSE and S 0 decreased by approximately 50% from the start of the case to its end. [19][20][21][22][23] In these investigations, longitudinal measures did not correlate with RV performance, measured by cardiac index, SV, RVFAC, and responses to therapies.…”

“…[17][18][19][20] Similar to the results presented by Bootsma et al, in other studies involving different cardiac surgical patients (coronary artery bypass grafting, mitral or aortic valve surgery, and patients undergoing pulmonary endarterectomy) TAPSE and S 0 decreased by approximately 50% from the start of the case to its end. [19][20][21][22][23] In these investigations, longitudinal measures did not correlate with RV performance, measured by cardiac index, SV, RVFAC, and responses to therapies. [19][20][21][22][23] Interestingly, the decreases in TAPSE and S 0 occurred immediately after pericardial incision and persisted for 1 to 6 months after surgery.…”

“…[19][20][21][22][23] In these investigations, longitudinal measures did not correlate with RV performance, measured by cardiac index, SV, RVFAC, and responses to therapies. [19][20][21][22][23] Interestingly, the decreases in TAPSE and S 0 occurred immediately after pericardial incision and persisted for 1 to 6 months after surgery. 19,22 Bootsma et al also reported a decline in TAPSE after pericardial incision that continued throughout the study.…”

“…[19][20][21][22][23] Interestingly, the decreases in TAPSE and S 0 occurred immediately after pericardial incision and persisted for 1 to 6 months after surgery. 19,22 Bootsma et al also reported a decline in TAPSE after pericardial incision that continued throughout the study. One study did not find any benefit in repairing the pericardium prior to chest closure, but it did note that the longitudinal measures were correlated with changes in right atrial function, perhaps suggesting changes in right atrial and annular mechanics after pericardial incision.…”

TAPSE: A Red Herring After Cardiac Surgery

“…In this issue of the Journal, Sullivan et al set out to evaluate commonly used echocardiographic parameters of RV function, TAPSE and RV FAC, the postulated echocardiographic PVRsurrogate parameter, pulmonary artery acceleration time, and pulmonary artery catheter (PAC) measurements pre-and post-PTE. 5 Additionally, variables were evaluated against a functional outcome, the 6-minute walk test. Despite a declining role of the PAC in other clinical venues, the PAC remains the clinical gold standard for determining a successful PTE operation, specifically the calculation of a reduced PVR postoperatively.…”