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      A study of right ventricular function in pre- and post-valvular surgeries

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          Abstract

          Aims

          The aim of this study is to compare tricuspid annular plane systolic excursion (TAPSE) in pre- and postoperative valvular heart surgery patients using M-mode imaging, to determine changes in tissue Doppler parameters among patients undergoing valvular heart surgery, and to analyze tissue deformation parameters of right ventricle (RV) and RV strain in pre- and postoperative patients.

          Materials and methods

          This was an observational, cross-sectional, single-center study that included 24 patients who underwent echocardiographic assessment prior to surgery, after surgery, and at 1-month follow-up. Assessment of left and right ventricles by M-mode echocardiography, evaluation of RV by 2D Doppler echocardiography, tissue Doppler imaging, and strain imaging were performed.

          Results

          The TAPSE was significantly reduced immediately after surgery (14.8 ± 0.37 vs. 10.9 ± 0.26 mm), which was then improved on follow-up assessment (17.8 ± 34 mm) ( p = 0.001). Tricuspid valve diastolic velocity was increased after surgery and then gradually declined at 1-month follow-up ( p = 0.003). Presurgery RV free wall strain was found to be reduced, which was then improved during post-procedure analysis as well as on follow-up ( p = 0.001).

          Conclusions

          After cardiac valvular surgery, RV myocardial deformation showed a gradual improvement after 1 month, although there was an immediate decline in RV function postsurgery. The pattern of RV contraction, as showed by RV strain, varied postsurgery, which was remarkably increased in postoperative patients at the time of follow-up. Tissue deformation imaging being an emerging technique helps in the assessment of minute, subtle changes that occur in the RV myocardial function in cardiac patients undergoing valve surgery.

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          Most cited references23

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          Assessing right ventricular function: the role of echocardiography and complementary technologies.

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            Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study.

            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. 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). 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.
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              The right ventricle in cardiac surgery, a perioperative perspective: I. Anatomy, physiology, and assessment.

              The importance of right ventricular (RV) function in cardiovascular disease and cardiac surgery has been recognized for several years. RV dysfunction has been shown to be a significant prognostic factor in heart failure, congenital heart disease, valvular disease, and cardiac surgery. In the first of our two articles, we will review key features of RV anatomy, physiology, and assessment. In the first article, the main discussion will be centered on the echographic assessment of RV structure and function. In the second review article, pathophysiology, clinical importance, and management of RV failure in cardiac surgery will be discussed.
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                Author and article information

                Journal
                imas
                IMAS
                Interventional Medicine and Applied Science
                IMAS
                Akadémiai Kiadó (Budapest )
                2061-1617
                2061-5094
                24 July 2018
                September 2018
                : 10
                : 3
                : 137-144
                Affiliations
                [ 1 ]Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University , Manipal, India
                [ 2 ]Department of Cardiology, Kasturba Hospital, Kasturba Medical College, Manipal University , Manipal, India
                Author notes
                [* ]Corresponding author: Dr. Hashir Kareem, Associate Professor; Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India; Phone: +91 9880964858; Fax: +91 8202922750; E-mail: hashirkareem@ 123456gmail.com
                Article
                10.1556/1646.10.2018.31
                6343576
                4ad31251-8c3f-4ab5-b562-fdb01508b47b
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                : 11 October 2017
                : 18 May 2018
                : 19 May 2018
                Page count
                Figures: 5, Tables: 5, Equations: 1, References: 17, Pages: 8
                Funding
                Funding sources: No financial support was received for this study.
                Categories
                ORIGINAL PAPER

                Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
                surgery,heart valve,echocardiography,right ventricle,tissue Doppler imaging

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