Right Ventricular Dysfunction after Coronary Artery Bypass Grafting Is a Reality of Unknown Cause and Significance
DOI:
https://doi.org/10.1532/HSF98.20111142Abstract
Objective: To evaluate the impact of coronary bypass surgery on the function of the right ventricle (RV) in patients with a pre-operative ejection fraction ? 35% who did not have any perioperative myocardial infarction.
Method: We performed a prospective study of 30 patients who underwent uneventful isolated coronary artery bypass grafting (CABG). All patients had echocardiography prior to surgery and 3 months postoperatively. Myocardial tissue Doppler velocities were used to measure left and right ventricular function. The right ventricular myocardial performance index (Tei) and the ratio between the velocities of the RV and left ventricle (LV) were also calculated.
Results: There was a significant improvement in left ventricular ejection fraction before and after CABG (P = .046). The tissue Doppler imaging (TDI) velocities from the LV remained unchanged, but highly significant reductions in right ventricular TDI velocities were observed (P <.001). The TDI peak systolic (S), early diastolic (E), and late diastolic (A) velocities had a reduction of 30%, 34.5%, and 20%, respectively. Similarly, a fall in RV to LV ratios of various TDI velocities was also observed. This was also accompanied by a significant rise in the RV Tei index. All of these findings are suggestive of significant RV dysfunction.
Conclusion: There is a marked impairment of RV function after CABG.
References
Alam M, Wardell J, Andersson E, Samad BA, Nordlander R. 1999. Characteristics of mitral and tricuspid annular velocities determined by pulsed wave Doppler tissue imaging in healthy subjects. J Am Soc Echocardiogr 12:618-28.nAlam M, Wardell J, Andersson E, Samad BA, Nordlander R. 2000. Right ventricular function in patients with first inferior myocardial infarction: assessment by tricuspid annular motion and tricuspid annular velocity. Am Heart J 139:710-5.nAlam M, Hedman A, Nordlander R, Samad B. 2003. Right ventricular function before and after an uncomplicated coronary artery bypass graft as assessed by pulsed wave Doppler tissue imaging of the tricuspid annulus. Am Heart J 146:520-6.nAllen BS, Winkelmann JW, Hanafy H, et al. 1995. Retrograde cardioplegia does not adequately perfuse the right ventricle. J Thorac Cardiovasc Surg 109:1116-24.nBrookes CI, White PA, Bishop AJ, Oldershaw PJ, Redington AN, Moat NE. 1998. Validation of a new intra-operative technique to evaluate load-independent indices of right ventricular performance in patients undergoing cardiac operations. J Thorac Cardiovasc Surg 116:468-76.nChristakis GT, Fremes SE, Weisel RD, et al. 1985. Right ventricular dysfunction following cold potassium cardioplegia. J Thorac Cardiovasc Surg 90:243-50.nChristakis GT, Buth KJ, Weisel RD, et al. 1996. Randomized study of right ventricular function with intermittent warm or cold cardioplegia. Ann Thorac Surg 61:128-34.nDiller GP, Wasan BS, Kyriacou A, et al. 2008. Effect of coronary artery bypass surgery on myocardial function as assessed by tissue Doppler echocardiography. Eur J Cardiothorac Surg 34:995-9.nGondi S, Dokainish H. 2007. Right ventricular tissue Doppler and strain imaging: ready for clinical use? Echocardiography 24:522-32.nHannan EL, Racz MJ, Walford G, et al. 2005. Long-term outcomes of coronary-artery bypass grafting versus stent implantation. N Engl J Med 352:2174-83.nHedman A, Alam M, Zuber E, Nordlander R, Samad BA. 2004. Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: a tricuspid annular motion-based study. J Am Soc Echocardiogr 17:126-31.nHedman A, Samad BA, Larsson T, Zuber E, Nordlander R, Alam M. 2005. Improvement in diastolic left ventricular function after coronary artery bypass grafting as assessed by recordings of mitral annular velocity using Doppler tissue imaging. Eur J Echocardiogr 6:202-9.nYadav H, Unsworth B, Fontana M, et al. 2010. Selective right ventricular impairment following coronary artery bypass graft surgery. Eur J Cardiothorac Surg 37:393-8.nLindström L, Wigström L, Dahlin LG, Arén C, Wranne B. 2000. Lack of effect of synthetic pericardial substitute on right ventricular function after coronary artery bypass surgery. An echocardiographic and magnetic resonance imaging study. Scand Cardiovasc J 34:331-8.nMeluzín J, Spinarová L, Bakala J, et al. 2001. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur Heart J 22:340-8.nMeluzín J, Spinarová L, Hude P, et al. 2005. Prognostic importance of various echocardiographic right ventricular functional parameters in patients with symptomatic heart failure. J Am Soc Echocardiogr 18:435-44.nPeqq TJ, Selvanayaqam JB, Karamitsos TD, et al. 2008. Effects of offpump versus on-pump coronary artery bypass grafting on early and late right ventricular function. Circulation 117:2202-10.nRighetti A, Crawford MH, O'Rourke RA, Schelbert H, Daily PO, Ross J. 1977. Interventricular septal motion and left ventricular function after coronary bypass surgery: evaluation with echocardiography and radionuclide angiography. Am J Cardiol 39:372-7.nWranne B, Pinto FJ, Hammarstrm E, St Goar FG, Puryear J, Popp RL. 1991. Abnormal right heart filling after cardiac surgery: time course and mechanisms. Br Heart J 66:435-42.n
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