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In normal hearts, longitudinal shortening accounts for a greater portion of right ventricular (RV) contraction than transverse shortening, thus tricuspid annular plane systolic excursion (TAPSE) is a reasonable measure of RV function by transthoracic echocardiography. However, after cardiac surgery, the pattern of RV contraction is characterized by decreased longitudinal and increased transverse shortening, thus TAPSE may be diminished while RV systolic function may be unaffected. We examined pre- and post-operative TAPSE and RV fractional area change (FAC) in patients undergoing three different types of aortic valve replacement (AVR).
Thirty-seven patients enrolled in the Placement of AoRTic TraNscathetER Valve Trial were randomized to receive AVR by open surgery, trans-apical surgery, or transcatheter aortic valve implantation (TAVI). Each patient underwent transthoracic echocardiography before and after AVR. TAPSE was measured in M-mode and the 2D 4-chamber view. FAC was measured in the 2D 4-chamber view. Statistical significance was assessed using the Wilcoxon signed-rank test.
Thirty-seven patients (mean age 81 years, 19 males) underwent open AVR (n=15), trans-apical AVR (n=9), or TAVI (n=13). The median time from echocardiography to AVR was 31 days (interquartile 8-51.5 days). The median time to post AVR echocardiography was 7 days (interquartile 5-18.5 days). The mean change in M-mode TAPSE was −0.68 cm for open AVR (p=0.002), −0.20 cm for trans-apical AVR (p=0.26) and 0.10 cm for TAVI (p=0.65). The mean change in 2D TAPSE was −0.70 cm for open AVR (p=0.0008), −0.06 cm for trans-apical AVR (p=0.55) and −0.0004 cm for TAVI (p=0.66). The mean change in FAC was −0.7% for open AVR (p=0.92), 6.0% for trans-apical AVR (p=0.21) and 6.6% for TAVI (p=0.08).
The normal pattern of RV contraction was unchanged by TAVI, while open AVR led to a significant decrease in longitudinal RV shortening as measured by TAPSE. FAC is a preferable method for assessing RV function in the post-operative patient.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: Echo: RV Imaging
Abstract Category: 18. Imaging: Echo
Presentation Number: 1179-325
- 2013 American College of Cardiology Foundation