title: Early recovery of tricuspid annular isovolumic acceleration after mitral valve surgery - an observational study.
abstract: OBJECTIVE
  Patients undergoing mitral valve surgery are at risk for right ventricular (RV) dysfunction resulting from increased left atrial pressure and increased pulmonary artery impedance. Measures of longitudinal measures of RV function, such as displacement, are commonly performed but have been shown to be depressed after cardiac surgery despite good patient recovery. The aim of this observational study was to assess the early perioperative time course of longitudinal transthoracic echocardiographic (TTE) markers of RV function in a patient population undergoing mitral valve surgery.
  
  
  METHODS
  Twenty patients undergoing mitral valve surgery were enrolled in this observational study. Right ventricular longitudinal measurements (tricuspid annular plane systolic excursion [TAPSE], strain, annular velocity [S'], and isovolumic acceleration [IVA]) were performed using TTE and colour Doppler imaging preoperatively (day 1) and postoperatively (days 2 and 6). Comparisons were made between the preoperative and postoperative measurements.
  
  
  RESULTS
  Adequate echocardiographic imaging was obtained for all 20 patients. The TAPSE, strain, and S' measures remained depressed for up to one week (i.e., day 6) after surgery compared to preoperative values. The IVA was depressed on the first postoperative day (P > 0.001), but by day 6 it was no different from the preoperative value (P = 0.37). The median [interquartile range] time to discharge from hospital was 7 [6-9] days.
  
  
  CONCLUSIONS
  Persistent, significant depression of longitudinal markers of RV function despite functional improvement (discharge from hospital) make it difficult to assess recovery during the early perioperative period. Isovolumic acceleration, a load-independent measure of contractility, might be a more reliable measure of early recovery in RV function in this patient population.
authors.affiliation: Department of Anesthesia, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. jordan.vanorman@mail.utoronto.ca.
authors.forename: Jordan R
authors.initials: JR
authors.lastname: Van Orman
authors.affiliation: Keenan Research Center for Biomedical Science, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Connelly
authors.affiliation: Department of Cardiology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Zakariya
authors.initials: Z
authors.lastname: Albinmousa
authors.affiliation: Department of Anesthesia, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors.forename: Claude
authors.initials: C
authors.lastname: Tousignant
mesh_terms: D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011184:Postoperative Period; D013997:Time Factors; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000502:physiology; D016278:Ventricular Function, Right / Q000502:physiology*