Background: RV dysfunction has been shown to be a significant prognostic factor in cardiac surgery. In clinical practice, 2D echocardiography is the mainstay of evaluation of RV structure and function. The commonly used indices of RV function are right ventricle fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and systolic annular TV velocity. Their accuracy is limited by the need of geometric assumptions because of the complexity of RV architecture. This factor is eliminated by using 3D echocardiogram. This study will compare the non-invasive quantitative methods of RV function assessment using RVFAC and TAPSE obtained by 2D echocardiography; systolic annular TV velocity obtained by doppler; and RVEF obtained by 3D echocardiography in predicting post-operative morbidity and mortality in patients with pulmonary hypertension undergoing valve and congenital corrective surgeries.
Methods: Patients 19 years old and above who fulfilled the inclusion/exclusion criteria were evaluated. Demographic as well as echocardiographic data were obtained. Patients were monitored for post-operative morbidity and mortality. Correlation between their occurrence with the mean RVEF obtained by 3D echocardiography; RVFAC and TAPSE obtained by 2D echocardiography; and systolic annular velocity of the TV obtained by doppler were determined and compared.
Results: A total of 62 patients were enrolled in this study. RVEF has a sensitivity in predicting outcome of 50%; specificity of 60%; PPV of 87%; and NPV of 19%. RVFAC, TAPSE, and systolic annular TV velocity have comparable sensitivity and specificity. RVFAC has high NPV of 88%.
Conclusion: In patients with valvular or congenital heart diseases with pulmonary hypertension undergoing valvular or congenital corrective surgeries, 2D echocardiographic assessment of RV function by RVFAC has the highest NPV; and RVEF by 3D echocardiogram has the highest PPV in predicting post-operative morbidity and mortality.