Document Type : Original Article(s)

Authors

1 Senior Registrar, Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan

2 Associate Professor, Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan

3 Senior Biostatistician, Department of Continuing Medical Education, Punjab Institute of Cardiology, Lahore, Pakistan

4 Medical Officer, Combined Military Hospital, Lahore, Pakistan

5 Assistant Professor, Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan

6 Senior Resident, Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan

Abstract

BACKGROUND: Right ventricular (RV) function is a major determinant of clinical outcome, but its function indices have not been studied well in surgery for rheumatic valvular heart disease. The aim of this study was to determine the correlation of tricuspid annular plane systolic excursion (TAPSE) with outcome of rheumatic heart valve surgery.METHODS: A prospective comparative study was conducted including 100 eligible patients who were divided into two groups based on RV function as assessed by TAPSE measured by two-dimensional (2D) echocardiography preoperatively. Those with TAPSE less than 15 mm were included in group 1 and those with TAPSE of 15 or more were included in group 2.RESULTS: 50 patients were included in group 1 and 50 patients in group 2. Mean age of the patients was 56.78 ± 15.21 years in group 1 and 54.46 ± 15.03 years in group 2 (P = 0.444). 34 (34%) patients underwent aortic valve replacement (AVR), 35 (35%) underwent both aortic and mitral valves replacement, and 31 (31%) ones had mitral valve replacement (MVR). A significant difference was found between the duration of ventilation (5.15 ± 2.80 hours in group 1 vs. 3.72 ± 2.71 hours in group 2, P = 0.001), postoperative inotropic requirement [more than 24 hours in 18 (36%) patients in group 1 vs. 7 (14%) patients in group 2, P = 0.003], total intensive care unit (ICU) stay (8.92 ± 3.62 days in group 1 vs. 5.20 ± 2.06 days in group 2, P = 0.001), and mortality [7 (14%) in group 1 vs. 2 (4%) in group 2, P = 0.038].CONCLUSION: TAPSE less than 15 mm in patients undergoing surgical correction for rheumatic valvular heart disease leads to poor outcomes. These patients need special attention perioperatively. 

Keywords

  1. Carapetis JR, Steer AC, Mulholland EK, Weber M.
  2. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5(11): 685-94.
  3. Pinzani A, de Gevigney G, Pinzani V, Ninet J, Milon H, Delahaye JP. Pre- and postoperative right cardiac insufficiency in patients with mitral or mitral-aortic valve diseases. Arch Mal Coeur Vaiss 1993; 86(1): 27-34.
  4. Pande S, Agarwal SK, Dhir U, Chaudhary A, Kumar S, Agarwal V. Pulmonary arterial hypertension in rheumatic mitral stenosis: Does it affect right ventricular function and outcome after mitral valve replacement? Interact Cardiovasc Thorac Surg 2009; 9(3): 421-5.
  5. McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Coll Cardiol 2009; 53(17): 1573-619.
  6. Mohammed SF, Hussain I, AbouEzzeddine OF, Takahama H, Kwon SH, Forfia P, et al. Right ventricular function in heart failure with preserved ejection fraction: A community-based study. Circulation 2014; 130(25): 2310-20.
  7. Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: Pathophysiology, clinical importance, and management of right ventricular failure. Circulation 2008; 117(13): 1717-31.
  8. Simon MA, Pinsky MR. Right ventricular dysfunction and failure in chronic pressure overload. Cardiol Res Pract 2011; 2011: 568095.
  9. Schindera ST, Mehwald PS, Sahn DJ, Kececioglu D. Accuracy of real-time three-dimensional echocardiography for quantifying right ventricular volume: Static and pulsatile flow studies in an anatomic in vitro model. J Ultrasound Med 2002; 21(10): 1069-75.
  10. van Wolferen SA, Marcus JT, Boonstra A, Marques KM, Bronzwaer JG, Spreeuwenberg MD, et al. Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J 2007; 28(10): 1250-7.
  11. Kaul S, Tei C, Hopkins JM, Shah PM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 1984; 107(3): 526-31.
  12. Schmid E, Hilberath JN, Blumenstock G, Shekar PS, Kling S, Shernan SK, et al. Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy. Heart Lung Vessel 2015; 7(2): 151-8.
  13. Tamborini G, Pepi M, Galli CA, Maltagliati A, Celeste F, Muratori M, et al. Feasibility and accuracy of a routine echocardiographic assessment of right ventricular function. Int J Cardiol 2007; 115(1): 86-9.
  14. Foale R, Nihoyannopoulos P, McKenna W, Kleinebenne A, Nadazdin A, Rowland E, et al. Echocardiographic measurement of the normal adult right ventricle. Br Heart J 1986; 56(1): 33-44.
  15. Horton KD, Meece RW, Hill JC. Assessment of the right ventricle by echocardiography: A primer for cardiac sonographers. J Am Soc Echocardiogr 2009; 22(7): 776-92.
  16. Kjaergaard J, Akkan D, Iversen KK, Kober L, Torp-Pedersen C, Hassager C. Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure. Eur J Heart Fail 2007; 9(6-7): 610-6.
  17. Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 2006; 174(9): 1034-41.
  18. Samad BA, Alam M, Jensen-Urstad K. Prognostic impact of right ventricular involvement as assessed by tricuspid annular motion in patients with acute myocardial infarction. Am J Cardiol 2002; 90(7): 778-81.
  19. Sun X, Ellis J, Kanda L, Corso PJ. The role of right ventricular function in mitral valve surgery. Heart Surg Forum 2013; 16(3): E170-E176.