CHANGES IN RIGHT VENTRICLE AND RIGHT ATRIUM FUNCTION FOLLOWING MITRAL VALVE REPAIR FOR PRIMARY MITRAL REGURGITATION

Background:
The assessment of right heart function following cardiac surgery remains a challenge.

Aims:
To assess changes in echocardiographic measures of the right ventricle (RV) and right atrium after mitral valve surgery.

Methods:
A total of 255 patients undergoing surgery for primary mitral regurgitation were included. Measurements were compared before and immediately after surgery (pre-discharge), and included tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV longitudinal (RVLS) and free wall (RVFWLS) strains, and right atrial volume index and reservoir strain.

Results:
As compared to baseline values, TAPSE (23 vs 11 mm; p <0.001), RVLS (-19.8 vs -15.3 %; p <0.001) and RVFWLS (-23.9 vs -16.7 %; p <0.001) significantly decreased after surgery, while FAC did not show a significant change (41% vs 42%; p = 0.22). Right atrial reservoir strain also showed a significant decrease after surgery (29.9 vs 9.5%; p <0.001). Patients who received concomitant tricuspid valve repair (n = 115; 45%) experienced significantly higher drop in TAPSE (p = 0.04) but significantly lower drop in right atrial strain (p <0.001). Right atrial volume index decreased only in patients who received tricuspid valve repair (38 vs 25 ml/m2; p <0.001).

Conclusions:
Following surgery for primary mitral regurgitation, all parameters of RV function showed a significant decrease except for FAC. Similarly, right atrial function, as measured by strain, decreased significantly after surgery.