Skip to main content

Advertisement

Log in

The relation of right ventricular outflow tract measurements with in-hospital clinical outcomes after tricuspid valve surgery

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript
  • 1 Altmetric

Abstract

Right ventricular (RV) function is a determining factor for clinical outcomes in patients undergoing tricuspid valve surgery (TVS). Our aim was to investigate the importance of the function of the right ventricular outflow tract (RVOT), which is an important anatomical region of the RV, in patients underwent TVS. 104 patients who underwent TVS were analyzed retrospectively. Patients with previous cardiac surgery, congenital heart disease, or heart failure were excluded. The parasternal short-axis view at the level of the aortic root was used to measure RVOT dimensions and RVOT fractional shortening (RVOT-FS). The effect of RVOT diameter and function on major adverse cardiac events (MACE) after TVS was investigated. In our study, MACE, consisting of pacemaker implantation, acute kidney injury, postoperative atrial fibrillation and mortality, was developed at 44 (42.3%) patients.We compared the predictive performances of RVOT end-systolic (RVOTs) diameter, RVOT end-diastolic (RVOTd) diameter, RVOT-FS and RV diameters in prediction of MACE. The model including the RVOTs had higher AUC, R2 and likelihood ratio X2 values (0.775, 0.287 and 25.0, respectively) than RVOTd (0.770, 0.279 and 24.2, respectively) and RVOT-FS (0.750, 0.215 and 18.1, respectively). RVOT diameters showed better performance in predicting MACE than RV diameters. Moreover, there was statistically significant association between RVOTs, RVOTd and MACE (p value were 0.014 and 0.027, respectively), while no association between RVOT-FS and MACE (p value was 0.177). In summary, we determined that the RVOT diameters are important predictors for the in-hospital clinical outcomes of patients who underwent TVS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Amsallem M, Mercier O, Kobayashi Y, Moneghetti K, Haddad F (2018) Forgotten no more: a focused update on the right ventricle in Cardiovascular Disease. JACC: Heart Failure 6(11):891–903

    PubMed  Google Scholar 

  2. Wong W, Chen S, Chou A, Lee H, Cheng Y, Tsai F et al (2020) Late outcomes of Valve Repair Versus replacement in isolated and concomitant tricuspid valve surgery: a Nationwide Cohort Study. J Am Heart Association 9(8):e015637

    Article  Google Scholar 

  3. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al (2022) 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 43(7):561–632

    Article  PubMed  Google Scholar 

  4. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F et al (2021) 2020 ACC/AHA Guideline for the management of patients with Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 143(5):e72–227

    PubMed  Google Scholar 

  5. Algarni KD, Arafat A, Algarni AD, Alfonso JJ, Alhossan A, Elsayed A et al (2021) Degree of right ventricular dysfunction dictates outcomes after tricuspid valve repair concomitant with left-side valve surgery. Gen Thorac Cardiovasc Surg 69(6):911–918

    Article  PubMed  Google Scholar 

  6. Rao S, Tate DA, Stouffer GA (2013) Hemodynamic findings in severe tricuspid regurgitation. Catheter Cardiovasc Interv 81(1):162–169

    Article  CAS  PubMed  Google Scholar 

  7. Rana BS, Robinson S, Francis R, Toshner M, Swaans MJ, Agarwal S et al (2019) Tricuspid regurgitation and the right ventricle in risk stratification and timing of intervention. Echo Res Pract 6(1):R25–39

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dutta T, Aronow WS (2017) Echocardiographic evaluation of the right ventricle: clinical implications. Clin Cardiol 40(8):542–548

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dandel M, Hetzer R (2016) Echocardiographic assessment of the right ventricle: impact of the distinctly load dependency of its size, geometry and performance. Int J Cardiol 221:1132–1142

    Article  PubMed  Google Scholar 

  10. Torrado JF, Samidurai A (2016) Right ventricular outflow tract assessment: identification of right ventricle dysfunction in heart failure. Indian Heart J 68(Suppl 1):S5–7

    Article  PubMed  Google Scholar 

  11. Luo S, Li J, Yang D, Zhou Y, An Q, Chen Y (2017) Right ventricular outflow tract systolic function correlates with exercise capacity in patients with severe right ventricle dilatation after repair of tetralogy of Fallot. Interact Cardiovasc Thorac Surg 24(5):755–761

    Article  PubMed  Google Scholar 

  12. Asmer I, Adawi S, Ganaeem M, Shehadeh J, Shiran A (2012) Right ventricular outflow tract systolic excursion: a novel echocardiographic parameter of right ventricular function. Eur Heart J Cardiovasc Imaging 13(10):871–877

    Article  PubMed  Google Scholar 

  13. Addetia K, Miyoshi T, Citro R, Daimon M, Gutierrez Fajardo P, Kasliwal RR et al (2021) Two-dimensional echocardiographic right ventricular size and systolic function measurements stratified by sex, Age, and ethnicity: results of the World Alliance of Societies of Echocardiography Study. J Am Soc Echocardiogr 34(11):1148–1157

    Article  PubMed  Google Scholar 

  14. Lindqvist P, Henein M, Kazzam E (2003) Right ventricular outflow-tract fractional shortening: an applicable measure of right ventricular systolic function. Eur J Echocardiogr 4(1):29–35

    Article  CAS  PubMed  Google Scholar 

  15. Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120(4):c179–184

    Article  PubMed  Google Scholar 

  16. Mascherbauer J, Maurer G (2010) The forgotten valve: lessons to be learned in tricuspid regurgitation. Eur Heart J 31(23):2841–2843

    Article  PubMed  Google Scholar 

  17. Bulwer BE, Solomon SD, Janardhanan R (2007) Echocardiographic Assessment of Ventricular Systolic Function. In: Solomon SD, Bulwer B, editors. Essential Echocardiography: A Practical Handbook With DVD [Internet]. Totowa, NJ: Humana Press; [cited 2023 Feb 22]. p. 89–117. (Contemporary Cardiology). Available from: https://doi.org/10.1007/978-1-59259-977-6_5

  18. Allam LE, Onsy AM, Ghalib HA (2017) Right ventricular outflow tract systolic excursion and fractional shortening: can these echocardiographic parameters be used for the Assessment of right ventricular function? J Cardiovasc Echogr 27(2):52–58

    Article  PubMed  PubMed Central  Google Scholar 

  19. Alsoos F, Almobarak M, Shebli H (2014) Right ventricular outflow tract systolic excursion: a useful method for determining right ventricular systolic function. J Echocardiogr 12(4):151–158

    Article  PubMed  Google Scholar 

  20. Asmarats L, Taramasso M, Rodés-Cabau J (2019) Tricuspid valve disease: diagnosis, prognosis and management of a rapidly evolving field. Nat Rev Cardiol 16(9):538–554

    Article  PubMed  Google Scholar 

  21. Sung K, Park PW, Park KH, Jun TG, Lee YT, Yang JH et al (2009) Is tricuspid valve replacement a catastrophic operation? Eur J Cardiothorac Surg 36(5):825–829

    Article  PubMed  Google Scholar 

  22. Iscan ZH, Vural KM, Bahar I, Mavioglu L, Saritas A (2007) What to expect after tricuspid valve replacement? Long-term results. Eur J Cardiothorac Surg 32(2):296–300

    Article  PubMed  Google Scholar 

  23. Sun X, Zhang H, Aike B, Yang S, Yang Z, Dong L et al (2016) Tricuspid annular plane systolic excursion (TAPSE) can predict the outcome of isolated tricuspid valve surgery in patients with previous cardiac surgery? J Thorac Dis 8(3):369–374

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kim YJ, Kwon DA, Kim HK, Park JS, Hahn S, Kim KH et al (2009) Determinants of Surgical Outcome in patients with isolated tricuspid regurgitation. Circulation 120(17):1672–1678

    Article  PubMed  Google Scholar 

  25. Fukuda S, Gillinov AM, McCarthy PM, Stewart WJ, Song JM, Kihara T et al (2006) Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation 114(1supplement):I–582

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arda Guler.

Ethics declarations

Competing interests

The authors have no disclosures of funding. The authors have no conflict of interest. All authors have read and approved of the manuscript.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guler, A., Kahveci, G., Tanboga, I.H. et al. The relation of right ventricular outflow tract measurements with in-hospital clinical outcomes after tricuspid valve surgery. Int J Cardiovasc Imaging 39, 1897–1908 (2023). https://doi.org/10.1007/s10554-023-02923-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-023-02923-w

Keywords

Navigation