Snejana Hyllén1, Shahab Nozohoor2, Annika Ingvarsson3, Carl Meurling3, Per Wierup2, Johan Sjögren2. 1. Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden; Lund University, Department of Clinical Sciences, Lund, Cardiothoracic Surgery, Lund, Sweden. Electronic address: snejana.hyllen@med.lu.se. 2. Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden; Lund University, Department of Clinical Sciences, Lund, Cardiothoracic Surgery, Lund, Sweden. 3. Department of Heart Failure and Valvular Disease, Skane University Hospital, Lund, Sweden; Lund University, Department of Clinical Sciences, Lund, Cardiology, Lund, Sweden.
Abstract
BACKGROUND: Our aim was to assess right ventricular (RV) performance after mitral valve repair by use of RV focused echocardiography and to evaluate the influence of elevated pulmonary artery systolic pressure (PASP) on RV recovery. METHODS: Forty consecutive patients undergoing mitral valve repair were prospectively investigated with RV focused echocardiography, including two-dimensional speckle tracking-derived longitudinal strain and measurement of N-terminal protype-B natriuretic peptide levels performed on the day before operation and 6 months postoperatively. RESULTS: The 30-day mortality was 0%. Overall survival was 97.5% ± 2.5% at 6-month follow-up, and the prevalence of postoperative RV dysfunction was 61% (n = 22). Conventional longitudinal indices of RV function decreased significantly after operation (n = 36): tricuspid annular plane systolic excursion (mean 24 ± 5 mm vs mean 15 ± 3 mm, p < 0.001), systolic peak velocity (mean 14 ± 3 cm/s vs mean 10 ± 2 cm/s, p < 0.001), isovolumic acceleration time (mean 2.5 ± 1.0 cm/s(2) vs mean 2.1 ± 0.7 cm/s(2), p = 0.022), but the RV free wall, septal, and global strain did not change significantly. Patients with preoperative PASP above 50 mm Hg showed a significant change in postoperative RV global strain compared with those whose PASP was 50 mm Hg or below (mean difference 10% ± 30% vs -17% ± 23%, p = 0.033). CONCLUSIONS: RV dysfunction was common at 6-month follow-up. Pulmonary hypertension, although reversible after operation, had a negative effect on RV function. Speckle tracking-derived RV strain may assist in the prioritization of surgical referrals to avoid biventricular impairment.
BACKGROUND: Our aim was to assess right ventricular (RV) performance after mitral valve repair by use of RV focused echocardiography and to evaluate the influence of elevated pulmonary artery systolic pressure (PASP) on RV recovery. METHODS: Forty consecutive patients undergoing mitral valve repair were prospectively investigated with RV focused echocardiography, including two-dimensional speckle tracking-derived longitudinal strain and measurement of N-terminal protype-B natriuretic peptide levels performed on the day before operation and 6 months postoperatively. RESULTS: The 30-day mortality was 0%. Overall survival was 97.5% ± 2.5% at 6-month follow-up, and the prevalence of postoperative RV dysfunction was 61% (n = 22). Conventional longitudinal indices of RV function decreased significantly after operation (n = 36): tricuspid annular plane systolic excursion (mean 24 ± 5 mm vs mean 15 ± 3 mm, p < 0.001), systolic peak velocity (mean 14 ± 3 cm/s vs mean 10 ± 2 cm/s, p < 0.001), isovolumic acceleration time (mean 2.5 ± 1.0 cm/s(2) vs mean 2.1 ± 0.7 cm/s(2), p = 0.022), but the RV free wall, septal, and global strain did not change significantly. Patients with preoperative PASP above 50 mm Hg showed a significant change in postoperative RV global strain compared with those whose PASP was 50 mm Hg or below (mean difference 10% ± 30% vs -17% ± 23%, p = 0.033). CONCLUSIONS: RV dysfunction was common at 6-month follow-up. Pulmonary hypertension, although reversible after operation, had a negative effect on RV function. Speckle tracking-derived RV strain may assist in the prioritization of surgical referrals to avoid biventricular impairment.
Authors: Stephen J Huang; Marek Nalos; Louise Smith; Arvind Rajamani; Anthony S McLean Journal: Intensive Care Med Date: 2018-05-22 Impact factor: 17.440
Authors: Magd A Kotb; Inas Abd El Satar; Ahmed M Badr; Nancy H Anis; Hoda Abd El Rahman Ismail; Alaa F Hamza; Hesham M Abdelkader Journal: J Adv Res Date: 2017-07-27 Impact factor: 10.479
Authors: Márton Tokodi; Endre Németh; Bálint K Lakatos; Erika Kispál; Zoltán Tősér; Levente Staub; Kristóf Rácz; Ádám Soltész; Szabolcs Szigeti; Tamás Varga; János Gál; Béla Merkely; Attila Kovács Journal: ESC Heart Fail Date: 2020-03-26