Imran Khan - Senior Registrar, Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan
Ahmad Shahbaz - Associate Professor, Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan
Madeeha Iqbal - Senior Biostatistician, Department of Continuing Medical Education, Punjab Institute of Cardiology, Lahore, Pakistan
Abdul Khan - Medical Officer, Combined Military Hospital, Lahore, Pakistan
Waseem Riaz - Assistant Professor, Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan
Muhammad Sayyed - Medical Officer, Combined Military Hospital, Lahore, Pakistan
Kamran Khan - Senior Resident, Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan

BACKGROUND: Right ventricular (RV) function is a major determinant of clinical outcome, but its function indices have not been studied well in surgery for rheumatic valvular heart disease. The aim of this study was to determine the correlation of tricuspid annular plane systolic excursion (TAPSE) with outcome of rheumatic heart valve surgery.METHODS: A prospective comparative study was conducted including ۱۰۰ eligible patients who were divided into two groups based on RV function as assessed by TAPSE measured by two-dimensional (۲D) echocardiography preoperatively. Those with TAPSE less than ۱۵ mm were included in group ۱ and those with TAPSE of ۱۵ or more were included in group ۲.RESULTS: ۵۰ patients were included in group ۱ and ۵۰ patients in group ۲. Mean age of the patients was ۵۶.۷۸ ± ۱۵.۲۱ years in group ۱ and ۵۴.۴۶ ± ۱۵.۰۳ years in group ۲ (P = ۰.۴۴۴). ۳۴ (۳۴%) patients underwent aortic valve replacement (AVR), ۳۵ (۳۵%) underwent both aortic and mitral valves replacement, and ۳۱ (۳۱%) ones had mitral valve replacement (MVR). A significant difference was found between the duration of ventilation (۵.۱۵ ± ۲.۸۰ hours in group ۱ vs. ۳.۷۲ ± ۲.۷۱ hours in group ۲, P = ۰.۰۰۱), postoperative inotropic requirement [more than ۲۴ hours in ۱۸ (۳۶%) patients in group ۱ vs. ۷ (۱۴%) patients in group ۲, P = ۰.۰۰۳], total intensive care unit (ICU) stay (۸.۹۲ ± ۳.۶۲ days in group ۱ vs. ۵.۲۰ ± ۲.۰۶ days in group ۲, P = ۰.۰۰۱), and mortality [۷ (۱۴%) in group ۱ vs. ۲ (۴%) in group ۲, P = ۰.۰۳۸].CONCLUSION: TAPSE less than ۱۵ mm in patients undergoing surgical correction for rheumatic valvular heart disease leads to poor outcomes. These patients need special attention perioperatively. 

Rheumatic Heart Diseases, Right Ventricle, Cardiac Surgery