04 February 2019 by Rajarajan Ganesan

Peri-operative right heart echocardiography changes in pulmonary hypertension associated with congenital heart disease

Introduction

Right heart circulation undergoes significant changes during corrective surgery in patients with pulmonary hypertension associated with congenital heart disease.Right ventricle dysfunction and pulmonary hypertension can occur to a varying extent. Our study objective was to describe the echocardiographic changes occurring in this period.

Methods

We enrolled 30 consecutive patients with suspected or confirmed pulmonary hypertension associated with congenital heart disease in the study. Pre-operative transthoracic echo (TTE) and transesophageal echo(TEE) ,post-operative TEE, and TTE after 48 hours of ICU admission were performed. Study parameters collected include Right ventricle Fractional Area change (RVFAC), Right ventricle outflow tract velocity time integral (RVOTVTI), Pulmonary artery acceleration time (PAAT) and ratio of PAAT to RV ejection time (PAAT/ET).p<0.05 was considered statistically significant.

Results

Age of the patients were 2[0.9,8] (median[IQR]) years and diagnoses included atrial septal defect(ASD)(n=9), ventricular septal defect(n=13), Total Anomalous pulmonary venous return (n=4), ASD+VSD(n=2) and Atrioventricular canal defect(n=2).Right ventricle outflow tract waveform could not be traced in 8 patents because of spectral broadening. Postoperative TTE measured RVFAC, RVOTVTI z score and PAAT/ET were statistically significantly lower than preoperative measured values (33[23,42]%,-1.3[-2.5,0.09],0.4[0.33,0.46] vs 40[28,47]%,1.5[-0.15,3.6], 0.37[0.31,0.43] respectively). Correlation was obtained between TTE and TEE measured RVOTVTI (r= 0.559) and PAAT/ET (r=0.756), but not for RVFAC (p=0.83).There was statistically significant difference between TEE measured preoperative and postoperative RVFAC and RVOTVTI z score (37.4[32,44]% vs 25[18.4,34]%, and 3.2[0.7,4] vs -1[-2.2,-0.15],respectively), but not for PAAT/ET (0.4[0.3,0.45] vs 0.34[0.3,0.44] respectively, p=0.26).

Conclusion

RVFAC, RVOTVTI and PAAT/ET are lower in the postoperative period of corrective repair in congenital heart disease with pulmonary hypertension.

 

About the author


profile picture of Rajarajan Ganesan

Rajarajan Ganesan

Cardiac anesthetist

Post Graduate Institute of Medical Education and Research, Chandigarh

India

Key Contributors

Rajarajan Ganesan,1 Goverdhan Dutt Puri 2 : 1- Fellow, Cardiac Anesthesia 2- Professor and Head, Anaesthesia and Intensive Care Post Graduate Institute of Medical Education and Research, Chandigarh, India


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