Volume 32, Issue 12 pp. 1809-1820
Original Investigation

Changes in Right Ventricular Shape and Deformation Following Coronary Artery Bypass Surgery—Insights from Echocardiography with Strain Rate and Magnetic Resonance Imaging

Assami Rösner M.D., Ph.D.

Assami Rösner M.D., Ph.D.

University Hospital North Norway, Tromsø, Harstad, Norway

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Derk Avenarius M.D.

Derk Avenarius M.D.

University Hospital North Norway, Tromsø, Harstad, Norway

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Siri Malm M.D., Ph.D.

Siri Malm M.D., Ph.D.

University Hospital North Norway, Tromsø, Harstad, Norway

Department of Clinical Medicine, University of Tromsø, Tromsø, Norway

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Amjid Iqbal M.D., Ph.D.

Amjid Iqbal M.D., Ph.D.

University Hospital North Norway, Tromsø, Harstad, Norway

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Henrik Schirmer M.D., Ph.D.

Henrik Schirmer M.D., Ph.D.

University Hospital North Norway, Tromsø, Harstad, Norway

Department of Clinical Medicine, University of Tromsø, Tromsø, Norway

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Bart Bijnens Ph.D.

Bart Bijnens Ph.D.

Pompeu Fabra, Barcelona University, Spain

The Catholic University Leuven, Leuven, Belgium

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Truls Myrmel M.D., Ph.D.

Corresponding Author

Truls Myrmel M.D., Ph.D.

University Hospital North Norway, Tromsø, Harstad, Norway

Department of Clinical Medicine, University of Tromsø, Tromsø, Norway

Address for correspondence and reprint requests: Truls Myrmel, M.D., Ph.D., Department of Cardiothoracic and Vascular Surgery, The Heart and Lung Clinic, University Hospital of North Norway, 9038 Tromsø, Norway.

Fax: +47 77628298;

E-mail: [email protected]; [email protected]

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First published: 25 May 2015
Citations: 34

Abstract

Background

This study was designed to assess whether altered RV geometry and deformation parameters persisted well into the recovery period after presumably uncomplicated coronary artery bypass grafting (CABG). It was our hypothesis that the altered geometry of and load in the RV following pericardial opening would change both regional and global deformation indices for an extensive period postoperatively.

Methods and Results

Fifty-seven patients scheduled for CABG underwent preoperative and 8–10 months postoperative magnetic resonance imaging (MRI) for RV volume measurements, and resting echocardiography with assessment of geometry and RV mechanical function determined by tissue Doppler imaging (TDI) based longitudinal strain. Both MRI and echocardiography revealed postoperative dilatation of the RV apex, shortened longitudinal RV length but unchanged RV ejection fraction. Echocardiography parameters associated with filling of the right atrium showed signs of constraint with a reduced systolic filling fraction and increased right atrial size. Right ventricular segmental strain (−20 ± 13% vs. −29 ± 20% preoperatively; mean ±SD, P < 0.0001) was reduced postoperatively in parallel with TAPSE (1.3 ± 0.3 cm vs. 2.2 ± 0.4 cm; P < 0.0001).

Conclusion

Post-CABG longitudinal motion of the RV lateral wall is reduced after uneventful CABG despite preserved RV ejection fraction and stroke volume. The discrepancy in various RV systolic performance indicators results from increased sphericity of the RV following opening the pericardium during surgery. Therefore, longitudinal functional parameters may underestimate RV systolic function for at least 8–10 months post-CABG. Changes in deformation parameters should thus always be interpreted in relation to changes in geometry.

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