title: Assessment of right ventricular function by transthoracic echocardiography following aortic valve replacement.
abstract: 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.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David R
authors.initials: DR
authors.lastname: Okada
authors.forename: Hind W
authors.initials: HW
authors.lastname: Rahmouni
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: Paul R
authors.initials: PR
authors.lastname: Forfia
authors.forename: Yuchi
authors.initials: Y
authors.lastname: Han
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D015203:Reproducibility of Results; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: TAPSE; TAVR; aortic valve replacement; right ventricular function