Effect of pericardial repair after aortic valve replacement on septal and right ventricular function
Introduction
Open heart surgery results in reversed septal motion and reduced right ventricular (RV) free wall long axis function [1], [2], [3]. Over the years, a number of potential mechanisms have been proposed to explain such phenomenon including inadequate intra-operative RV myocardial perfusion preservation, right atrial (RA) damage or post-operative epicardial contusion caused by the consistent friction of the RV against the inner sternal surface, in patients left with opened pericardium [1], [4]. None of these potential mechanisms has proved satisfactory enough to alter clinical practice in a way that could preserve RV function. Recently similar findings were interpreted using MRI, in a group of patients who underwent coronary artery bypass graft surgery, on the basis of RV adhesions as a potential mechanism for the restricted tricuspid annular motion and disturbed RV long axis function [5]. On the other hand, other studies have shown recovery of RV function after cardiopulmonary by-pass technique [6], [7].
The aim of this study was therefore to assess in detail the effect of pericardial repair on septal and right ventricular function in a group of patients undergoing isolated aortic valve replacement (AVR) for aortic stenosis. Patients were assessed blinded to their randomization to open or repaired pericardium.
Section snippets
Methods
We studied 30 consecutive symptomatic patients (mean age 62 ± 11 years, 18 males) with severe aortic stenosis based on a peak trans-valvular pressure drop (gradient) ≥ 70 mm Hg and/or aortic valve area < 1.0 cm2 who were referred to the Umeå University Hospital Heart Centre for surgical aortic valve replacement (AVR). Patients were examined the day before, one week after and 6 months after surgery using Doppler echocardiography including tissue Doppler imaging (TDI). All patients had undergone cardiac
Results
Anthropometric data are shown in Table 1. No patient developed significant tricuspid regurgitation or severe pericardial fluid collection after AVR. 11 patients developed atrial fibrillation after AVR but all those were back in sinus rhythm before discharge. Of the 11 patients with atrial fibrillation after AVR, 7 had the pericardial sack closed.
Findings
The findings of this study show that surgical AVR results in significant changes in both left (LV) and right ventricular (RV) function. The interventricular septal motion reversed making it functioning as part of the RV and correlating with RV long axis amplitude. RV systolic long axis amplitude fell as did its free wall systolic and diastolic velocities but in contrast SR was maintained throughout the post-operative period, up to 6 months afterwards. RA SR significantly fell but right heart
Acknowledgements
This study was supported by the Swedish Heart and Lung Foundation, and the Heart Foundation of Northern Sweden. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [20].
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