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Assessment of Right Ventricular Function by Transthoracic Echocardiography Following Aortic Valve Replacement
Author(s) -
Okada David R.,
Rahmouni Hind W.,
Herrmann Howard C.,
Bavaria Joseph E.,
Forfia Paul R.,
Han Yuchi
Publication year - 2014
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12421
Subject(s) - medicine , cardiology , ventricular function , valve replacement , aortic valve , aortic valve replacement , tricuspid valve , stenosis
Background Tricuspid annular plane systolic excursion ( TAPSE ) is a widely used clinical measure of right ventricular ( RV ) systolic performance. However, postsurgical changes in the pattern of RV contraction may limit the utility of TAPSE for assessing global RV function. We retrospectively examined pre‐ and postoperative TAPSE and RV fractional area change ( FAC ) in patients undergoing 3 different types of aortic valve replacement ( AVR ). Methods Fifty‐two patients enrolled in the Placement of AoRTic TraNscathetER Valve Trial at our institution were randomized to receive open AVR or transcatheter AVR ( TAVR ) by either the transapical or transfemoral access routes. Thirty‐seven of these patients had analyzable transthoracic echocardiography (TTE) before and after AVR . Using M‐mode echocardiography, TAPSE was measured in the apical four‐chamber view. Using two‐dimensional echocardiography, RV FAC was measured in the apical four‐chamber view. Results The mean change in TAPSE was −0.7 ± 0.6 cm for open AVR (P = 0.002), −0.2 ± 0.4 cm for transapical TAVR (P = 0.26), and 0.1 ± 0.5 cm for transfemoral TAVR (P = 0.64). The mean change in RV FAC was −1 ± 5% for open AVR (P = 0.91), 2 ± 4% for transapical TAVR (P = 0.37), and 7 ± 10% for transfemoral TAVR (P = 0.07). Conclusions The normal pattern of RV contraction was unchanged by transapical and transfemoral TAVR , while open AVR led to a significant decrease in TAPSE with preserved RV FAC . Thus, RV FAC is a preferable method for assessing RV function in the postoperative patient.