Changes in right ventricular longitudinal function: primary mitral and concomitant tricuspid valve repair

Abstract

Objectives: To evaluate the impact of concomitant tricuspid valve (TV) repair on the right ventricular (RV) function postoperatively and within the 6 months following degenerative mitral valve (MV) repair. Methods: The prospective study included 37 patients (mean age 57.32 ± 2.13 years) with severe MV regurgitation due to primary MV prolapse. Nineteen underwent successful MV repair (TV(−) group). Additional TV repair due to moderate-to-severe TV regurgitation was performed in 18 (TV(+) group). Two-dimensional (2D) speckle-tracking and tissue Doppler echocardiography was performed for all patients before surgery and 7 days and 6 months after surgery. Results: Preoperative dimensions and indices of RV longitudinal function did not differ between the groups (right ventricle end-diastolic diameter (RVEDD) was 33.53 ± 0.94 mm vs. 34.67 ± 1.72 mm, tricuspid annular systolic motion (S’) was 15.06 ± 0.85 cm/s vs. 16.0 ± 1.27 cm/s, tricuspid annular plane systolic excursion (TAPSE) was 24.02 ± 1.06 mm vs. 22.4 ± 1.36 mm, respectively; p>0.05). RVEDD decreased significantly and did not change within the follow-up in the TV(−) group. In the TV(+) group, RVEDD decreased early after surgery and more markedly six months later in comparison to the TV(−) group. Indices of RV systolic longitudinal function decreased early after surgery and had a tendency to increase after six months in both groups. Regional longitudinal strains of the lateral RV wall decreased early after surgery and improved within the six months in the TV(−) group and did not change significantly in the TV(+) group. Conclusions: Additional TV repair in degenerative MV repair more markedly reduces RV dimensions and does not have a negative impact on RV systolic function in comparison to an isolated MV repair although these conclusions are of limited value due to the lack of a control group.

Acute changes of global and longitudinal right ventricular function: an exploratory analysis in patients undergoing open-chest mitral valve surgery, percutaneous mitral valve repair and off-pump coronary artery bypass grafting

“…While long-term alterations in longitudinal RV function are increasingly being understood [ 27 ], the functional changes immediately after MVS employing cardiopulmonary bypass have not been investigated thoroughly. As a decrease in longitudinal RV function after MVS has been demonstrated [ 12 ], our results underline those changes as early as during the course of surgery. This phenomenon should be taken into consideration when RV failure appears to be clinically or hemodynamically unlikely, as longitudinal dysfunction might be compensated by increased circumferential shortening without prognostic implications [ 13 ].…”

“…Over the last few decades, there has been substantial debate regarding RV contraction patterns and their alterations during RV stress [ 23 ]. In the setting of cardiac surgery, various studies have focused on the adaptive mechanisms regarding RV contraction after sternotomy, pericardiotomy, cardioplegia and cardiopulmonary bypass [ 7 , 10 – 12 ]. Intraoperative TEE is known to have the potential to have a major impact on surgical decision-making [ 24 ].…”

“…In recent years, longitudinal RV functiondescribing the isolated contribution of baso-apical shortening to pressure generation and volume ejectionhas been identified as an essential contributor to RV function in various conditions [2][3][4][5][6]. To date, heterogeneous data regarding global and longitudinal RV function after adult cardiac surgery exist but the available data point to a change in the sense of maintaining global but decreasing longitudinal function [7][8][9][10][11][12][13]. Although two-dimensional (2D) echocardiography is widely used for these analyses, 3D echocardiography is advantageous considering the complex geometry and heterogeneous myocardial deformation patterns of the right ventricle when compared to cardiac magnetic resonance [14].…”

Changes of biventricular function after CABG surgery: does cardioplegia type matter?

“…During follow-up period RV function improved more in the second group due to pulmonary artery pressure reduction after TV repair. 20…”