Right ventricular transverse displacement increases following cardiac surgery: possibly compensating loss in tricuspid a
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ORIGINAL RESEARCH
Right ventricular transverse displacement increases following cardiac surgery: possibly compensating loss in tricuspid annular plane systolic excursion (TAPSE) André Korshin1 · Lars Grønlykke1 · Frederik Holmgaard1 · Sven Morten Kjøller2 · Finn Gustafsson3,4 · Jens Christian Nilsson1 · Hanne Berg Ravn1,4 Received: 8 July 2019 / Accepted: 21 January 2020 © Springer Nature B.V. 2020
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. Keywords Echocardiography · Peri-operative · Transesophageal echocardiography · Speckletracking · Cardiac surgery · TAPSE · CABG
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10877-020-00466-2) contains supplementary material, which is available to authorized users. * André Korshin [email protected] 1
Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Blegdamsvej 9, Rigshospitalet, 2100 Copenhagen, Denmark
2
Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
3
Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
4
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
1 Introduct
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