Evaluation of right ventricular performance in patients with postoperative congenital heart disease using Doppler tissue imaging and cardiopulmonary bypass indices: A prospective cohort study

Abstract

Background and aims: Postoperative cardiac outcomes after intracardiac repair (ICR) are determined by numerous factors whereas right ventricle (RV) dysfunction is considered essential for them, as only few studies attempted to evaluate it postsurgically. RV's function is supposed to be the strong prognostic factor for patients diagnosed with congenital heart defects; therefore, assessing it is the main objective of the study.

Methods: This is a prospective single-centered cohort study performed on 50 pediatric patients with congenital heart disease (CHD) who underwent ICR between January 2019 and January 2022. All patients underwent echocardiographic assessment of RV function via tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) at 1, 24, and 48 h. After surgery, where pre- and postoperative RV pressure, cardiopulmonary bypass (CPB), and aortic cross-clamp (ACC) time were assessed. Similarly ventilation intensive care unit (ICU) and hospital stay times and mediastinal drainage were also monitored.

Results: The mean ± standard deviation for pre- and postoperative RV pressure was 49.1 ± 16.12 and 42.7 ± 2.9 mmHg, respectively, whereas that for pre- and postoperative pulmonary artery pressure was 30.4 ± 2.6 and 24.2 ± 12.9 mmHg, with p value of <0.002 and <0.001, respectively. The mean ± standard deviation of CPB and ACC times was 120.92 ± 74.17 and 78.44 ± 50.5 min accordingly, while those for mean ± standard deviation of ventilation time, mediastinum chest drainage, ICU and hospital stays were 30.36 ± 54.04, 43.78 ± 46.7 min, 5.9 ± 4.01 h, were 30.36 ± 54.0, 43.78 ± 46.7 min, 5.9 ± 4.01 and 10.3 ± 4.83 h, respectively.

Conclusions: RV dysfunction plays the important role in longer recovery and intraoperative time, while its effect is mostly transient. The use of TAPSE and FAC methods is valuable in the evaluation of postoperative outcomes, and the former proved to be more effective.

Keywords: Doppler tissue imaging; cardiopulmonary bypass; congenital heart disease; intracardiac repair; ventricular performance.

Figure 1

The change of fractional area was calculated by delineating the RV endocardial border at the end‐diastole and end‐systole phases. The difference between the two areas was divided by the area at end‐diastole. However, this measure is a reproducible one that is unaffected by pericardiotomy. The normal change for adults is greater than 35%. In this example, it reduced to (26%), which refers to an RV dysfunction. RV, right ventricle/right ventricular.

Figure 2

TAPSE is determined by using 2D imaging (A, B) or placing the M‐mode cursor at the level of the tricuspid valve annulus (C). 2D, two‐dimensional; TAPSE, tricuspid annular plane systolic excursion.

Figure 3

Ratio of male to female patients (X‐axis–Gender; Y‐axis–Number of participants)

Figure 4

RV pressure (X‐axis–Preoperative and postoperative phase; Y‐axis–RV pressure in mmHg). RV, right ventricle/right ventricular.

Figure 5

MPA pressure (X‐axis–Preoperative and postoperative phase; Y‐axis–MPA pressure in mmHg).

Figure 6

ACC and CPB time correlation. ACC, aortic cross‐clamp; CPB, cardiopulmonary bypass.

Figure 7

Correlation of ventilation time and mediastinal drainage in hours

Figure 8

Correlation of ICU stay and hospital stay in days. ICU, intensive care unit.

Figure 9

TAPSE value at preoperative, after 1, 24, and 48 h. TAPSE, tricuspid annular planar systolic excursion.

Figure 10

FAC value at preoperative, after 1, 24, and 48 h. FAC, fractional area change.