title: Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential.
abstract: Assessment of right ventricular (RV) function is important in the management of various forms of cardiovascular disease. Accurately assessing RV volume and systolic function is a challenge in day-to-day clinical practice due to its complex geometry. Tricuspid annular plane systolic excursion (TAPSE) and systolic excursion velocity (S') have been reviewed to further assess their suitability and objectivity in evaluating RV function. Multiple studies have validated their diagnostic and prognostic values in numerous pathologic conditions. Diminished longitudinal contraction after cardiothoracic surgery is a well-known phenomenon, but it is not well validated. Despite significant reduction in RV performance along the long-axis assessed by TAPSE and S' after cardiac surgery, RV ejection fractions did not change as well as the left ventricular parameters and exercise capacity. RV contractile patterns were markedly altered with decreased longitudinal shortening and increased transverse shortening, which are likely resulted from the septal damage during cardiac surgery. The septum is essential for RV performance due to its oblique fiber orientation. This allows ventricular twisting, which is a vital mechanism against increased pulmonary vascular resistance. The septum function along with TAPSE and S' should be adequately assessed during cardiac surgery, and evidence of septal dysfunction should lead to reevaluation of myocardial protection methods.
authors.affiliation: Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, North Carolina.
authors.forename: Tin
authors.initials: T
authors.lastname: Nguyen
authors.forename: Long
authors.initials: L
authors.lastname: Cao
authors.forename: Assad
authors.initials: A
authors.lastname: Movahed
mesh_terms: D006348:Cardiac Surgical Procedures; D006346:Heart Septum / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D009200:Myocardial Contraction / Q000502:physiology*; D011182:Postoperative Care / Q000379:methods*; D014261:Tricuspid Valve / Q000000981:diagnostic imaging; D014463:Ultrasonography; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: cardiovascular surgery; helical ventricular myocardial band; myocardial protection; right ventricular systolic function; septum; systolic excursion velocity; tricuspid annular plane systolic excursion