Perioperative Changes of Right Ventricular Function in Cardiac Surgical Patients Assessed by Myocardial Deformation Analysis and 3-Dimensional Echocardiography

Abstract

Objectives: To test the hypothesis that longitudinal strain of the right ventricle (RV) is significantly reduced in patients undergoing cardiac surgery with extracorporeal circulation and cardioplegic cardiac arrest at the end of surgery, whereas RV ejection fraction remains unchanged. Design: Prospective observational cohort study. Setting: Single university hospital. Participants: Thirty patients with normal myocardial function undergoing coronary artery bypass grafting with cardioplegic cardiac arrest. Interventions: Right ventricular 3-dimensional echocardiography and strain analysis were performed preoperatively, intraoperatively, and postoperatively. Measurements and Main Results: Peak longitudinal systolic strain of the RV lateral and inferior wall, RV outflow tract, and interventricular septum was reduced significantly at the end of surgery after sternal closure compared to preoperatively (lateral: À16 § 5 v À22 § 4, p < 0.001; inferior: À12 § 4 v À19 § 5, p < 0.001; outflow tract, À11 § 5 v. À20 § 6, p < 0.001; septum: À9 § 3 v À14 § 4, p < 0.001), whereas peak circumferential systolic strain of the RV lateral wall had increased significantly (À16 § 4 v-12 § 5, p = 0.008). Right ventricular ejection fraction remained stable (51 § 6% v. 50 § 7%, p = 0.34). Conclusion: In patients undergoing coronary artery bypass grafting with cardioplegic cardiac arrest, the longitudinal contraction of the RV lateral and inferior wall, the RV outflow tract, and the interventricular septum is impaired at the end of surgery. This impairment is compensated by an increase in circumferential contraction without changes in RV ejection fraction.

Benefits of Myocardial Deformation Analysis in Cardiac Surgery

“…In the study by Donauer et al, STE revealed interesting changes in RV contractile function during and shortly after bypass surgery, which deserves particular consideration. 1 The authors found significant regional changes in the RV free wall and IVS deformation pattern, which might indicate both detrimental and adaptive changes in myocardial contraction and which, altogether, did not affect the RV global pump function adversely in their patients. These changes in myocardial deformation, and in particular the significant reduction of the LS, might be induced primarily by an increase in RV afterload (increase in pulmonary vascular resistance), which could be related to the use of norepinephrine in about 43% of the studied patients.…”

“…Thank you for publishing a review article on the important topic of perioperative visual loss in cardiac surgery. 1 Raphael et al did an excellent job describing the epidemiology, clinical manifestations, and treatment of perioperative visual loss in cardiac surgery. The review also includes a brief section on possible approaches to prevention.…”

“…Ultrasoundassisted vascular access can provide a safer and more efficient means of obtaining both peripheral and central venous access by reducing complications. [1][2][3] Several techniques have been used for the catheterization of the internal jugular vein (IJV). These include the oblique, central, anterior, and posterior approaches.…”

“…We read with interest the article by Donauer et al accepted for publication in the Journal of Cardiothoracic and Vascular Anesthesia. 1 Their study is of particular value, because it provides evidence that myocardial deformation analysis can improve substantially the diagnostic performance of echocardiography in cardiac surgery patients. By focusing their study mainly on the right ventricle (RV) and the interventricular septum (IVS), the authors also investigated an up-to-date topic, which in the past received less attention.…”

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

“…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].…”