Echocardiographic Assessment After Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension: Which Parameters Reflect Improved Right Ventricular Function?

Dany Tager, Patrick Collier, Emmanuel O. Akintoye, Yifan Wang, Xiaofeng Wang, Alice Goyanes, Haytham Elgharably, Michael Tong, Anand Mehta, Gustavo A. Heresi

https://doi.org/10.1002/pul2.70261 

Abstract

Traditional echocardiographic measures of right ventricular (RV) function, such as tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity at the tricuspid annulus (S’), may be unreliable after cardiac surgery due to changes in loading conditions and myocardial mechanics. This study aimed to evaluate RV function following pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH) and to identify alternative echocardiographic indices that better reflect postoperative RV recovery. This retrospective, single-center study included CTEPH patients who underwent PTE at Cleveland Clinic between January 2020 and March 2021. Echocardiographic evaluations were performed preoperatively and within 3 months postoperatively. Parameters assessed included RV size, function, volumes, pulmonary pressures, and tricuspid regurgitation (TR) severity. TAPSE and RV S’ significantly decreased postoperatively (mean changes −0.75 cm and −2.8 cm/s, respectively; p < 0.001). RV systolic pressure, end-diastolic volume (RVEDV), and end-systolic volume (RVESV) also declined (p < 0.05). RV diameter decreased (mean 4.57 cm; p = 0.012), and 2D RV ejection fraction (RVEF) increased significantly (mean change +7%; p = 0.003). TR severity improved, with 97.1% of patients showing only mild TR (p = 0.003). Fractional area change (FAC) did not change significantly. After PTE, RV size, volume, RVEF, and TR severity are more reliable indicators of RV recovery than TAPSE or S’. These findings reflect reverse RV remodeling due to reduced afterload and underscore the limitations of traditional longitudinal RV function metrics in the postoperative setting.

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