Can Echocardiographic Right Ventricular Function Parameters Predict Vasoactive Support Requirement After Tetralogy of Fallot Repair?

Objective: To evaluate the role of echocardiographic right ventricular function parameters in predicting postoperative vasoactive inotrope requirement after tetralogy of Fallot repair.
Design: Prospective observational study.
Setting: A tertiary care hospital.
Participants: Fifty-two children undergoing elective intracardiac repair.
Interventions: Comprehensive transesophageal echocardiography was performed before and after surgery. Fractional shortening, fractional area change, tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index, tricuspid annular velocities (S', E', A'), and right ventricular global longitudinal strain and strain rate (RV Gls and RV Glsr) were measured. The ratio of peak systolic pressure of the right and left ventricles (P _rv/lv ) was measured directly from the surgical field pre- and post-repair. The inotrope requirement during first 24 postoperative hours was calculated using the mean Vasoactive-Inotropic Score (VIS). Pearson correlation analysis was used to study the relation between echocardiographic parameters and VIS as well as P _rv/lv and VIS. Receiver operating characteristic analysis was used to study the predictive strength of parameters.
Measurements and Main Results: Among the measured parameters, both pre- and post-repair TAPSE had significant negative correlation with the mean VIS (p < 0.05). Both pre- and post-repair right ventricular myocardial performance index and S', E', A', RV Gls, RV Glsr, P _rv/lv also had significant correlation with the mean VIS (p < 0.05). Of these, TAPSE, RV Gls, RV Glsr, and P _rv/lv had significant predictive strength (p < 0.05) and reasonable sensitivity and specificity (area under the curve > 0.6) for predicting high mean VIS (VIS > 20).
Conclusion: Tricuspid annular plane systolic excursion, RV Gls, RV Glsr, and P _rv/lv could predict a postoperative high mean VIS with significant strength and reasonable sensitivity and specificity.
(Copyright © 2019 Elsevier Inc. All rights reserved.)