Interv Akut Kardiol. 2014;13(4):184-189

The pitfalls in the assessment of right ventricular systolic function after cardiac surgery

Tomáš Paleček^1,2, Jana Podzimková², Petr Kuchynka^1,2, Martin Mašek³

¹ II. interní klinika kardiologie a angiologie VFN, 1. LF UK v Praze

² Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně

³ Radiodiagnostická klinika VFN, 1. LF UK v Praze

The assessment of right ventricular systolic function is extremely important in all patients undergoing cardiothoracic surgery in both

perioperative period and in long term follow up. The gold standard for routine assessment of right ventricle (RV) remains transthoracic

echocardiography. Contraction of the RV is predominantly determined by longitudinal myocardial fibres of the ventricular wall, particularly

by those present in the inflow tract. Therefore parameters reflecting longitudinal shortening of the RV free wall, namely tricuspid

annular plane systolic excursion (TAPSE) and peak systolic velocity of tricuspid annulus (St), are recommended parameters for evaluation

of RV systolic function; assessment of ventricular volumes and ejection fraction (EF) by 2D echocardiography do not seem convenient

for evaluation of RV function because of its morphology. Interestingly, following cardiothoracic surgery two phenomena tend to appear:

decline in TAPSE and St, respectively, and abnormal motion of the interventricular septum. However, these features do not result

into global RV systolic dysfunction. Therefore, in order to echocardiographically assess RV systolic function, other parameters need to

be evaluated: fractional area change (FAC) or RV volumes and EF using 3D echocardiography. Patients who are difficult to be examined

by transthoracic echocardiography should be referred to MRI for assessment of RV function. In case of contraindication to MRI, multislice

computed tomography may be used to evaluate RV volumes and EF, respectively.

Keywords: right ventricle, systolic function, echocardiography, magnetic resonance imaging, computed tomography

Published: December 1, 2014  Show citation