This observational study aims to assess correlation of right atrial strain measured by two-dimensional speckle tracking echocardiography with intraoperatively measured pulmonary artery pressures, other indices of right ventricular function and short term postoperative outcome.
Study Type
OBSERVATIONAL
Enrollment
50
After induction of anaesthesia and stabilization of hemodynamics, transthoracic echocardiography will be done on a GE Vivid e9 workstation (GE Vingmed, Horton, Norway) with MS5 transthoracic probe with synchronized ECG. From TTE the following views and measurements will be acquired : * Apical four chamber (A4C) view * Apical two chamber view (A2C) view * Right ventricle (RV) focused A4C view * Right ventricular systolic pressure (RVSP) * Pulmonary arterial acceleration time (PAAT), * Tricuspid annular plane systolic excursion (TAPSE), * Tricuspid annular plane systolic velocity (s'), * Right ventricular fractional area change (RV FAC) * RV free wall strain, * RV myocardial performance index (MPI), * RV isovolumic relaxation time (IVRT), * RV isovolumic acceleration time (IVA) Invasive PA pressure measurement will be done after surgical exposure with a fine needle and a zeroed transducer by the Surgeon.
Postgraduate Institute of Medical Education & Research
Chandigarh, India
RECRUITINGCorrelation of right atrial strain measured by two-dimensional speckle tracking echocardiography with intraoperatively measured systolic pulmonary artery pressures.
RA strain estimation will be done from the TTE images in RV focused A4C view, tracing the endocardial border from tricuspid annulus to tricuspid annulus along RA lateral wall to roof to septal wall. After optimizing the region of interest and automated speckle tracking for longitudinal strain and the following parameters will be measured : * RA reservoir strain : difference of the strain value at tricuspid valve opening minus ventricular end-diastole (positive value). * RA conduit strain : difference of the strain value at the onset of atrial contraction minus tricuspid valve opening (negative value). * RA contractile strain : difference of the strain value at ventricular end- diastole minus onset of atrial contraction (negative value).
Time frame: For RA strain : after induction of anesthesia, before CPB institution. For pulmonary artery pressures, after induction of anesthesia, before CPB institution, and 10 min after separation from CPB, before sternal closure.
Correlation of right atrial strain measured by two-dimensional speckle tracking echocardiography with other indices of right ventricular function.
From TTE the following views and measurements will be acquired : Apical four chamber (A4C) view Apical two chamber view (A2C) view Right ventricle (RV) focused A4C view Right ventricular systolic pressure (RVSP) Pulmonary arterial acceleration time (PAAT), Tricuspid annular plane systolic excursion (TAPSE), Tricuspid annular plane systolic velocity (s'), Right ventricular fractional area change (RV FAC) RV free wall strain, RV myocardial performance index (MPI), RV isovolumic relaxation time (IVRT), RV isovolumic acceleration time (IVA)
Time frame: For RA strain and RV function : after induction of anesthesia, before CPB institution.
Correlation of right atrial strain measured by two-dimensional speckle tracking echocardiography with short term postoperative outcome as defined by duration of mechanical ventilation and duration of ICU stay.
Duration of mechanical ventilation will be measured from time of shifting out from the operating room to first extubation. Similarly, ICU stay will be measured from the date of surgery to shifting to general ward.
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Time frame: Preoperative (post induction, pre-CPB) RA reservoir, conduit and contractile strain will be correlated with duration of mechanical ventilation, and duration of ICU stay, measured on 30 days post-operative follow up.