Thorac Cardiovasc Surg 2014; 62(03): 231-235
DOI: 10.1055/s-0033-1342941
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Echocardiographic Assessment of Right Ventricular Function Before and After Surgery in Patients with Pectus Excavatum and Right Ventricular Compression

Ufuk Gürkan
1   Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
,
Bülent Aydemir
2   Department of Thoracic Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
,
Sukru Aksoy
1   Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
,
Haldun Akgöz
1   Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
,
Aydın Rodi Tosu
1   Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
,
Dilaver Öz
1   Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
,
Barış Güngör
1   Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
,
Hale Yılmaz
1   Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
,
Osman Bolca
1   Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

01 November 2012

05 March 2013

Publication Date:
25 April 2013 (online)

Abstract

Background We aimed to evaluate the effect of surgical repair on right ventricular (RV) function in patients with pectus excavatum (PE) and RV compression by Doppler echocardiography.

Materials and Methods Twenty-three patients who were admitted to our hospital for surgical correction of PE between 2009 and 2012 were included in the study. After transthoracic echocardiographic evaluation, 16 patients with RV compression were enrolled. All patients were males (100%) with a mean age of 20.5 ± 5.6 years. Transthoracic echocardiography was repeated 1 month after surgery. Echocardiographic evaluation included the assessment of RV diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), pulsed tissue Doppler systolic velocity (S′), RV isovolumic acceleration (RV IVA), systolic pulmonary artery pressure, left ventricular (LV) ejection fraction, and myocardial performance indexes of both the right and the left ventricles (Tei index).

Results Following the surgery, the RV end-diastolic diameter, TAPSE, S′, and RV IVA were found to be significantly increased in patients with PE. In addition, RV and LV Tei index significantly improved after surgical correction.

Conclusions RV function significantly improved after corrective surgery. Quantitative echocardiographic examination provides accurate estimation when deciding for corrective surgery and also should be used in the assessment of postoperative improvement.

 
  • References

  • 1 Molik KA, Engum SA, Rescorla FJ, West KW, Scherer LR, Grosfeld JL. Pectus excavatum repair: experience with standard and minimal invasive techniques. J Pediatr Surg 2001; 36 (2) 324-328
  • 2 Kelly Jr RE. Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg 2008; 17 (3) 181-193
  • 3 Creswick HA, Stacey MW, Kelly Jr RE , et al. Family study of the inheritance of pectus excavatum. J Pediatr Surg 2006; 41 (10) 1699-1703
  • 4 Malek MH, Fonkalsrud EW, Cooper CB. Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest 2003; 124 (3) 870-882
  • 5 Ravitch MM. Pectus excavatum and heart failure. Surgery 1951; 30 (1) 178-194
  • 6 Haller Jr JA, Loughlin GM. Cardiorespiratory function is significantly improved following corrective surgery for severe pectus excavatum. Proposed treatment guidelines. J Cardiovasc Surg (Torino) 2000; 41 (1) 125-130
  • 7 Beiser GD, Epstein SE, Stampfer M, Goldstein RE, Noland SP, Levitsky S. Impairment of cardiac function in patients with pectus excavatum, with improvement after operative correction. N Engl J Med 1972; 287 (6) 267-272
  • 8 Malek MH, Berger DE, Housh TJ, Marelich WD, Coburn JW, Beck TW. Cardiovascular function following surgical repair of pectus excavatum: a metaanalysis. Chest 2006; 130 (2) 506-516
  • 9 Malek MH, Berger DE, Marelich WD, Coburn JW, Beck TW, Housh TJ. Pulmonary function following surgical repair of pectus excavatum: a meta-analysis. Eur J Cardiothorac Surg 2006; 30 (4) 637-643
  • 10 Guntheroth WG, Spiers PS. Cardiac function before and after surgery for pectus excavatum. Am J Cardiol 2007; 99 (12) 1762-1764
  • 11 Rudski LG, Lai WW, Afilalo J , et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23 (7) 685-713 , quiz 786–788
  • 12 Tamborini G, Pepi M, Galli CA , et al. Feasibility and accuracy of a routine echocardiographic assessment of right ventricular function. Int J Cardiol 2007; 115 (1) 86-89
  • 13 Lindqvist P, Waldenström A, Henein M, Mörner S, Kazzam E. Regional and global right ventricular function in healthy individuals aged 20-90 years: a pulsed Doppler tissue imaging study: Umeå General Population Heart Study. Echocardiography 2005; 22 (4) 305-314
  • 14 Anavekar NS, Mirza A, Skali H , et al; Survival and Ventricular Enlargement (SAVE) Investigators. Risk assessment in patients with depressed left ventricular function after myocardial infarction using the myocardial performance index—Survival and Ventricular Enlargement (SAVE) experience. J Am Soc Echocardiogr 2006; 19 (1) 28-33
  • 15 Tei C, Dujardin KS, Hodge DO , et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 1996; 9 (6) 838-847
  • 16 Jaroszewski D, Notrica D, McMahon L, Steidley DE, Deschamps C. Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med 2010; 23 (2) 230-239
  • 17 Krueger T, Chassot PG, Christodoulou M, Cheng C, Ris HB, Magnusson L. Cardiac function assessed by transesophageal echocardiography during pectus excavatum repair. Ann Thorac Surg 2010; 89 (1) 240-243
  • 18 Kaul S, Tei C, Hopkins JM, Shah PM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 1984; 107 (3) 526-531
  • 19 López-Candales A, Dohi K, Rajagopalan N, Edelman K, Gulyasy B, Bazaz R. Defining normal variables of right ventricular size and function in pulmonary hypertension: an echocardiographic study. Postgrad Med J 2008; 84 (987) 40-45
  • 20 Miller D, Farah MG, Liner A, Fox K, Schluchter M, Hoit BD. The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance. J Am Soc Echocardiogr 2004; 17 (5) 443-447
  • 21 Meluzín J, Spinarová L, Dusek L, Toman J, Hude P, Krejcí J. Prognostic importance of the right ventricular function assessed by Doppler tissue imaging. Eur J Echocardiogr 2003; 4 (4) 262-271
  • 22 Kjærgaard J. Assessment of right ventricular systolic function by tissue Doppler echocardiography. Dan Med J 2012; 59 (3) B4409
  • 23 Toyono M, Harada K, Tamura M, Yamamoto F, Takada G. Myocardial acceleration during isovolumic contraction as a new index of right ventricular contractile function and its relation to pulmonary regurgitation in patients after repair of tetralogy of Fallot. J Am Soc Echocardiogr 2004; 17 (4) 332-337
  • 24 Tugcu A, Yildirimtürk O, Tayyareci Y, Demiroglu C, Aytekin S. Evaluation of subclinical right ventricular dysfunction in obstructive sleep apnea patients using velocity vector imaging. Circ J 2010; 74 (2) 312-319
  • 25 Narayan RL, Vaishnava P, Castellano JM, Fuster V. Quantitative assessment of right ventricular function in pectus excavatum. J Thorac Cardiovasc Surg 2012; 143 (5) e41-e42
  • 26 Karatzis EN, Giannakopoulou AT, Papadakis JE, Karazachos AV, Nearchou NS. Myocardial performance index (Tei index): evaluating its application to myocardial infarction. Hellenic J Cardiol 2009; 50 (1) 60-65
  • 27 Yakabe K, Ikeda S, Urata J , et al. Significance of Tei-index alterations induced by acute preload reduction with hemodialysis. Clin Nephrol 2008; 70: 41-47