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670 Right Ventricular Dysfunction Following Cardiac Surgery Assessed by Transthoracic Echocardiography
S353
Abstracts
670 RIGHT VENTRICULAR DYSFUNCTION FOLLOWING CARDIAC SURGERY ASSESSED BY TRANSTHORACIC ECHOCARDIOGRAPHY L Boileau, K Serri Montréal, Québec BACKGROUND: Right ventricular (RV) dysfunction is common following cardiac surgery. Recent guidelines emphasize the importance of RV function assessment using recent echocardiographic parameters, which have not been studied in the postoperative setting. Our objective was to evaluate RV function using these parameters, and to evaluate their feasibility immediately postoperatively. METHODS: Thirty-two patients had a transthoracic echocardiography (TTE) before and the day after surgery. Baseline demographic and standard echocardiographic data were collected. Various parameters of RV function were analyzed such as RV fractional area change (RV FAC), tricuspid annular motion (TAM), tricuspid annulus pulsed and tissue Doppler peak velocities (pulsed S’ and tissue S’), pulsed and tissue Doppler RV index of myocardial performance (pulsed RIMP and tissue RIMP), RV dP/dt, tissue Doppler myocardial acceleration during isovolumetric contraction (IVA), and speckle-tracking longitudinal strain of the 3 RV free wall segments (base, mid and apex). Continuous variables were expressed as means⫾SD and postoperative values were compared to preoperative values using Student’s t test. Statistical significance was set at p ⬍ 0.05.
11⫾3mm after cardiac surgery (p⬍0.0001), pulsed S’ decreased from 12⫾2m/s to 8⫾2m/s (p⬍0.0001), tissue S’ decreased from 10⫾2m/s to 6⫾2m/s (p⬍0.0001), pulsed RIMP increased from 0.37⫾0.16 to 0.44⫾0.25 (p⫽ 0.006), tissue RIMP increased from 0.41⫾0.10 to 0.51⫾0.10 (p⬍0.0001), RV FAC decreased from 0.48⫾0.07 to 0.42⫾0.09 (p⫽ 0.01), IVA decreased from 1.5⫾0.7m/s2 to 0.8⫾0.5m/s2 (p⬍0.0001). Basal strain increased from ⫺30.2⫾6.8% to ⫺21.5⫾6.0% (p⫽0.0001), mid-ventricular strain from ⫺28.2⫾5.1% to ⫺17.0⫾5.0% (p⬍0.0001) and apical strain from -26.9⫾5.5% to ⫺17.0⫾5.4% (p⬍0.0001). Postoperative decrease of RV function parameters is illustrated in figure 1. Postoperative feasibility of most parameters was excellent: 100% for TAM, 97% for pulsed and tissue S’, 94% for IVA, 84% for RV FAC, but only 51% for strain. CONCLUSION: RV dysfunction is common following cardiac surgery according to various parameters of RV function. Among these, TAM, pulsed and tissue S’, and IVA are highly feasible even in the setting of recent cardiac surgery. Feasibility was not as good for speckle-tracking strain and its additive value has yet to be demonstrated.
671 A NEW METHOD FOR THE ASSESSMENT OF VORTEX FORMATION DURING LV FILLING: MEASUREMENT OF THE INTRACARDIAC VORTICITY BY DOPPLER VORTOGRAPHY F Mehregan, S Muth, F Tournoux, D Garcia Montréal, Québec
Baseline and surgical characteristics are outlined in table 1. All patients survived to discharge from the intensive care unit (ICU) and average stay in ICU was 1.5⫾1.6 day. All measured TTE RV function parameters were concordant and demonstrated a highly significant deterioration in RV function postoperatively. TAM decreased from 22⫾4mm at baseline to
RESULTS:
BACKGROUND: A vortex is defined as a rapid rotary motion of fluid. The natural swirling flow that occurs in the healthy left ventricle during LV filling is known to be optimized in terms of energy dissipation. In vivo findings, however, revealed the formation of additional counterrotating vortices in patients with cardiac disease. Such unnatural vortices may significantly impair the LV function due to important kinetic dissipation.
Abstracts
670 RIGHT VENTRICULAR DYSFUNCTION FOLLOWING CARDIAC SURGERY ASSESSED BY TRANSTHORACIC ECHOCARDIOGRAPHY L Boileau, K Serri Montréal, Québec BACKGROUND: Right ventricular (RV) dysfunction is common following cardiac surgery. Recent guidelines emphasize the importance of RV function assessment using recent echocardiographic parameters, which have not been studied in the postoperative setting. Our objective was to evaluate RV function using these parameters, and to evaluate their feasibility immediately postoperatively. METHODS: Thirty-two patients had a transthoracic echocardiography (TTE) before and the day after surgery. Baseline demographic and standard echocardiographic data were collected. Various parameters of RV function were analyzed such as RV fractional area change (RV FAC), tricuspid annular motion (TAM), tricuspid annulus pulsed and tissue Doppler peak velocities (pulsed S’ and tissue S’), pulsed and tissue Doppler RV index of myocardial performance (pulsed RIMP and tissue RIMP), RV dP/dt, tissue Doppler myocardial acceleration during isovolumetric contraction (IVA), and speckle-tracking longitudinal strain of the 3 RV free wall segments (base, mid and apex). Continuous variables were expressed as means⫾SD and postoperative values were compared to preoperative values using Student’s t test. Statistical significance was set at p ⬍ 0.05.
11⫾3mm after cardiac surgery (p⬍0.0001), pulsed S’ decreased from 12⫾2m/s to 8⫾2m/s (p⬍0.0001), tissue S’ decreased from 10⫾2m/s to 6⫾2m/s (p⬍0.0001), pulsed RIMP increased from 0.37⫾0.16 to 0.44⫾0.25 (p⫽ 0.006), tissue RIMP increased from 0.41⫾0.10 to 0.51⫾0.10 (p⬍0.0001), RV FAC decreased from 0.48⫾0.07 to 0.42⫾0.09 (p⫽ 0.01), IVA decreased from 1.5⫾0.7m/s2 to 0.8⫾0.5m/s2 (p⬍0.0001). Basal strain increased from ⫺30.2⫾6.8% to ⫺21.5⫾6.0% (p⫽0.0001), mid-ventricular strain from ⫺28.2⫾5.1% to ⫺17.0⫾5.0% (p⬍0.0001) and apical strain from -26.9⫾5.5% to ⫺17.0⫾5.4% (p⬍0.0001). Postoperative decrease of RV function parameters is illustrated in figure 1. Postoperative feasibility of most parameters was excellent: 100% for TAM, 97% for pulsed and tissue S’, 94% for IVA, 84% for RV FAC, but only 51% for strain. CONCLUSION: RV dysfunction is common following cardiac surgery according to various parameters of RV function. Among these, TAM, pulsed and tissue S’, and IVA are highly feasible even in the setting of recent cardiac surgery. Feasibility was not as good for speckle-tracking strain and its additive value has yet to be demonstrated.
671 A NEW METHOD FOR THE ASSESSMENT OF VORTEX FORMATION DURING LV FILLING: MEASUREMENT OF THE INTRACARDIAC VORTICITY BY DOPPLER VORTOGRAPHY F Mehregan, S Muth, F Tournoux, D Garcia Montréal, Québec
Baseline and surgical characteristics are outlined in table 1. All patients survived to discharge from the intensive care unit (ICU) and average stay in ICU was 1.5⫾1.6 day. All measured TTE RV function parameters were concordant and demonstrated a highly significant deterioration in RV function postoperatively. TAM decreased from 22⫾4mm at baseline to
RESULTS:
BACKGROUND: A vortex is defined as a rapid rotary motion of fluid. The natural swirling flow that occurs in the healthy left ventricle during LV filling is known to be optimized in terms of energy dissipation. In vivo findings, however, revealed the formation of additional counterrotating vortices in patients with cardiac disease. Such unnatural vortices may significantly impair the LV function due to important kinetic dissipation.