Detection of Right Ventricular Dysfunction by Portal Vein Doppler After Cardiac Surgery (DVDDP)

Right ventricular (RV) failure after cardiac surgery is associated with morbidity and mortality, but is hard to diagnose with conventional echocardiographic means. RV dysfunction may be associated with hepatic congestion, which may have an effect on portal veinous flow, but this has not been extensively. The investigators aimed determine whether an increased pulsatility in the portal venous flow was associated with RV dysfunction, after cardiac surgery at risk of RV dysfunction: mitral and tricuspid valve procedures.

In cardiac surgical patients, RV dysfunction is associated with organ hypoperfusion and venous congestion leading to increased morbidity and mortality. Non-invasive methods used to assess RV function are 2D-echocardiographic measurement of tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (EF), RV fractional area change (FAC), 3D assessment of RV function, tissue Doppler assessment of velocities, and magnetic resonance imaging (MRI). Though MRI is the gold standard method to assess RV function, it cannot be used in the perioperative period. In the present prospective observational study, The investigators investigated the association between the pattern of portal venous flow and RV function as assessed by echocardiography in the postoperative period.

Cardiac surgery, Echocardiography, Right ventricular dysfunction, Doppler, Portal vein Doppler, Ventricular function

systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) RV fractional area change below 35% End-diastole diameter ratio between RV and left ventricle > 0.6 Ratio between S and D wave or inverse D wave in supra-hepatic veins

flow pulsatility is assessed with the formula = 100 x (Vmax-Vmin)/Vmax. Time frame: First 24 hours post cardiac surgery

Feasability of all measurements (RV failure with the 4 criteria: systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) RV fractional area change below 35% End-diastole diameter ratio between RV and left ventricle > 0.6 Ratio between S and D wave or inverse D wave in supra-hepatic veins)

Concordance of repeated measurements of the venous portal flow Time frame: First 24 hours post cardiac surgery

Concordance of repeated measurements of : systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) RV fractional area change below 35% End-diastole diameter ratio between RV and left ventricle > 0.6 Ratio between S and D wave or inverse D wave in supra-hepatic veins

As defined systolic dysfunction (TAPSE below 16 mm or S wave below 9.5 cm/s) RV fractional area change below 35% End-diastole diameter ratio between RV and left ventricle > 0.6 Ratio between S and D wave or inverse D wave in supra-hepatic veins

defined by KDIGO criteria as creatininemia elevation above > 26 micromol/L during the first 48 hours or +50% during the first week, oliguria with urine output less than 0.5 mL/kg/h during 6 hours.

Inclusion Criteria: More than 18 years old Ability to provide an informed consent Planned mitral and / or tricuspid valve surgery under cardiopulmonary bypass. Exclusion Criteria: Insufficient echogenicity

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