Contrasting effect of different cardiothoracic operations on echocardiographic right ventricular long axis velocities, and implications for interpretation.

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Contrasting effect of different cardiothoracic operations on echocardiographic right ventricular long axis velocities, and implications for interpretation of post-operative values Beth Unsworth, Roberto P. Casula, Hemang Yadav, Resham Baruah, Alun D. Hughes, Jamil Mayet, Darrel P. Francis International Journal of Cardiology Volume 165, Issue 1, Pages 151-160 (April 2013) DOI: 10.1016/j.ijcard.2011.08.031 Copyright © 2011 Elsevier Ireland Ltd Terms and Conditions

Fig. 1 Changes in RV tissue Doppler S′, E′ and tricuspid annular plane systolic excursion (TAPSE) in the seven surgical procedure groups (110 patients) 1week before and 1month after surgery. The top four surgical groups involved full pericardial opening. The bottom three surgical groups required only a small pericardial incision or mediastinal surgery where the pericardium was left intact. The large reduction in RV post operative velocities and excursions was only seen in those surgical procedures where the pericardium was fully opened. International Journal of Cardiology 2013 165, 151-160DOI: (10.1016/j.ijcard.2011.08.031) Copyright © 2011 Elsevier Ireland Ltd Terms and Conditions

Fig. 2 Top panel: Time course data from one patient. Intraoperative TOE of RV tissue Doppler S′ velocities recorded during routine on-pump AVR using traditional full sternotomy access. The preoperative TTE velocities are reproduced intraoperatively using TOE and remain unchanged after sternal opening. Following pericardial incision there is an immediate reduction in RV tissue Doppler S′ velocity which remains depressed at the time of closure. Velocities one month later remain depressed. Bottom panel: Time course data from one patient. Intraoperative TOE of RV velocities during minimally invasive AVR. The velocities remain unchanged from the pre operative assessment and do not change throughout the entire operation, even after a small pericardium incision was made. TTE velocities one month later also remain unchanged from pre-operative values. International Journal of Cardiology 2013 165, 151-160DOI: (10.1016/j.ijcard.2011.08.031) Copyright © 2011 Elsevier Ireland Ltd Terms and Conditions

Fig. 3 Top panel: Time course data from one patient. Intraoperative TOE of RV tissue Doppler S′ velocities during routine off-pump CABG using traditional full sternotomy access. Bottom graph: Time course data from one patient. Intraoperative TOE of RV tissue Doppler S′ velocities during minimally invasive RCABG using a left-sided mediastinoscopy approach. International Journal of Cardiology 2013 165, 151-160DOI: (10.1016/j.ijcard.2011.08.031) Copyright © 2011 Elsevier Ireland Ltd Terms and Conditions

Fig. 4 Top panel: Time course data from one patient. Intraoperative TOE of RV tissue Doppler S′ velocities during surgical removal of a left atrial myxoma using a traditional full sternotomy approach. Bottom panel: Time course data from one patient. Intraoperative TOE of RV tissue Doppler S′ velocities during the excision of a left-sided mediastinal mass via thoracotomy only. International Journal of Cardiology 2013 165, 151-160DOI: (10.1016/j.ijcard.2011.08.031) Copyright © 2011 Elsevier Ireland Ltd Terms and Conditions

Fig. 5 Time course data from one patient. Intraoperative TEE of RV tissue Doppler S′ velocities recorded during a routine minimally invasive AVR surgery which required conversion to full sternotomy once after the patient was already on bypass. The preoperative TTE tissue Doppler velocities are reproduced intraoperatively using TEE and remain unchanged following administration of general anaesthesia, minimally-invasive sternal opening, minimally-invasive pericardial incision and even at the point of bypass cannulae insertion, at which point data acquisition was suspended. But once measurements of RV tissue Doppler velocities resumed following sternal conversion, full pericardial opening and successful aortic valve replacement velocities were found to be much lower, and did not improve. One month later, the velocities remain equally depressed. International Journal of Cardiology 2013 165, 151-160DOI: (10.1016/j.ijcard.2011.08.031) Copyright © 2011 Elsevier Ireland Ltd Terms and Conditions