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Right ventricular transverse displacement increases following cardiac surgery: possibly compensating loss in tricuspid annular plane systolic excursion (TAPSE)

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Abstract

Right Ventricular (RV) output mostly derives from longitudinal shortening in normal hearts. However, following even uncomplicated cardiac surgery with preserved RV function a significant and sustained decrease in longitudinal contraction has been observed. How the RV compensates and sustains output in this setting remains unsettled. The aim of this study was to evaluate the RV contraction pattern by speckle tracking echocardiography to elucidate possible compensatory mechanisms mitigating the reduced RV longitudinal contraction after cardiac surgery. Thirty patients with normal preoperative ejection fraction and no valvulopathy underwent coronary artery bypass grafting (CABG) with the use of cardiopulmonary bypass (CPB). RV dedicated speckle tracking software measuring longitudinal and transverse displacement, as well as strain, was employed on transesophageal echocardiographic (TEE) images as part of the Right Ventricular Echocardiography in cardiac SurgEry (ReVERSE) study. Data was recorded at baseline (after anesthesia induction), immediately after CPB and upon chest closure. Tricuspid Annulus Plane Systolic Excursion (TAPSE) was reduced from 2.0 [1.6–2.5 cm] to 0.8 [0.6–11 mm] from baseline to after chest closure. RV longitudinal displacement was reduced from 6.1 [3.4–8.8 mm] to 2.9 [0.4–5.4 mm] at the same time-points. RV speckle tracking revealed concomitantly that transverse displacement of the free wall increased significantly from 1.2 [0–2.7 mm] at baseline to 5.4 [3.6–7.2 mm] after chest closure. RV speckle tracking strain did not change significantly. Increased transverse displacement likely compensates for reduction in RV longitudinal contraction following cardiac surgery and maintains cardiac output. The sustained output from the right ventricle was not related to an increased contractility.

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Authors and Affiliations

  1. Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark

    André Korshin, Lars Grønlykke, Frederik Holmgaard, Jens Christian Nilsson & Hanne Berg Ravn

  2. Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

    Sven Morten Kjøller

  3. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

    Finn Gustafsson

  4. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Finn Gustafsson & Hanne Berg Ravn

Authors
  1. André Korshin
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  2. Lars Grønlykke
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  3. Frederik Holmgaard
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  4. Sven Morten Kjøller
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Correspondence to André Korshin.

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Supplementary file1—Video 1: Transesophageal echocardiographic loop in the mid-esophageal 4-chamber view with using speckle tracking software from TomTec 2D cardiac performance analysis applied (TomTec Imaging Systems GMBH, Unterschleissheim, Germany). (AVI 19573 kb)

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Korshin, A., Grønlykke, L., Holmgaard, F. et al. Right ventricular transverse displacement increases following cardiac surgery: possibly compensating loss in tricuspid annular plane systolic excursion (TAPSE). J Clin Monit Comput 34, 1139–1148 (2020). https://doi.org/10.1007/s10877-020-00466-2

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  • DOI: https://doi.org/10.1007/s10877-020-00466-2

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