The Right ventricle and cardiac surgery - more resilient than thought: multiparametric quantification shows altered rather than reduced function

Abstract

Background: Right ventricular (RV) function appears to declines following cardiac surgery, particularly long axis function. Three principal speculated causes are suggested: a) loss of constraint when pericardium is opened, b) intra-operative ischemia, c) post-operative tethering. The relative contributions are unknown. Similarly, the impact on different aspects of RV function (AV plane descent, apical movement towards the AV plane) is obscure. The length and complexity of cardiac operations is also thought to contribute to RV impairment. We sought to untangle these relative contributions by comparing pre- and post-surgery RV function changes in a cohort of patients where all had aortic valve replacement (AVR) but 1/3 had in addition grafting (CABG). Different measures of RV function were used and paired pre and post. Methods: Eighty-one patients were scanned at 1.5T (Siemens Avanto) prior to, and 1 year following AVR (n = 59) or combined AVR and CABG (n = 22), with full pericardial opening. RV volumes and function were calculated using standard techniques. RV longitudinal function was assessed using different measures, Figure 1(a). A - Tricuspid annular displacement - the distance measured between tricuspid annulus in diastole and systole. (Figure Presented).