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Right ventricular function declines after cardiac surgery in adult patients with congenital heart disease.
- Source :
-
The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2012 Apr; Vol. 28 (4), pp. 755-62. Date of Electronic Publication: 2011 Jun 03. - Publication Year :
- 2012
-
Abstract
- Right ventricular function (RVF) is often selectively declined after coronary artery bypass graft surgery. In adult patients with congenital heart disease (CHD) the incidence and persistence of declined RVF after cardiac surgery is unknown. The current study aimed to describe RVF after cardiac surgery in these patients. Adult CHD patients operated between January 2008 and December 2009 in the Academic Medical Centre in Amsterdam were studied. Clinical characteristics, laboratory tests, surgical data and intensive care unit outcome were obtained from medical records. RVF was measured by trans-thoracic echocardiography (TTE) and expressed by tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (RV S') and myocardial performance index (MPI) pre-operatively and direct, at intermediate and late follow up. Of a total of 185 operated, 86 patients (mean age 39 ± 13 years, 54% male) had echo data available. There was a significant fall in RVF after cardiac surgery. TAPSE and RV S' were significantly higher and MPI was significantly lower pre-operatively compared to direct post-operative values (TAPSE 22 ± 5 versus 13 ± 3 mm (P < 0.01), RV S' 11 ± 4 versus 8 ± 2 cm/s (P < 0.01) and MPI 0.36 ± 0.14 vs 0.62 ± 0.25; P < 0.01). There were no significant differences in left ventricular function pre-operatively compared to post-operative values. Right-sided surgery was performed in 33, left-sided surgery in 37 and both sided surgery in 16 patients. Decline in RVF was equal for those groups. Patients with severe decline in RVF, were patients who underwent tricuspid valve surgery. Decline in RVF was associated with post-operative myocardial creatine kinase level and maximal troponin T level. There was no association between decline in RVF and clinical outcome on the intensive care unit. 18 months post-operatively, most RVF parameters had recovered to pre-operative values, but TAPSE which remained still lower (P < 0.01). CHD patients have a decline in RVF directly after cardiac surgery, regardless the side of surgery. Although a gradual improvement was observed, complete recovery was not seen 18 months post-operatively.
- Subjects :
- Academic Medical Centers
Adult
Biomarkers blood
Chi-Square Distribution
Creatine Kinase blood
Echocardiography, Doppler
Female
Humans
Linear Models
Male
Netherlands
Recovery of Function
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Troponin T blood
Ventricular Dysfunction, Right blood
Ventricular Dysfunction, Right diagnostic imaging
Ventricular Dysfunction, Right physiopathology
Young Adult
Cardiac Surgical Procedures adverse effects
Heart Defects, Congenital surgery
Ventricular Dysfunction, Right etiology
Ventricular Function, Right
Subjects
Details
- Language :
- English
- ISSN :
- 1875-8312
- Volume :
- 28
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The international journal of cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 21637982
- Full Text :
- https://doi.org/10.1007/s10554-011-9892-4