Why TAPSE and FAC fall short: RVEF remains the gold standard for assessing RV function after cardiac surgery in children

Background Tricuspid annular plane systolic excursion (TAPSE) and right ventricular (RV) fractional area change (FAC) are often used as surrogate measurements of RV systolic function. However, their reliability in children following cardiac surgery involving pericardiotomy remains unclear. The goal of this study was to evaluate whether TAPSE and FAC are valid surrogate markers of global RV systolic function in paediatric patients with and without prior pericardiotomy. Methods We retrospectively analysed 120 paediatric patients who underwent ferumoxytol-enhanced, motion-resolved five-dimensional whole-heart cardiac MRI between 2020 and 2024. Patients were divided into two groups: those who had previous pericardiotomy (n=85) and those who had no previous surgery (n=35). TAPSE z-scores, RV FAC and RV ejection fraction (RVEF) were measured and compared between the two groups and correlation analyses were performed. Results In the post-pericardiotomy group, TAPSE z-score was significantly decreased (−5.32±2) and did not correlate with RVEF (r=0.04), while RV FAC was preserved (41.3%) but correlated only weakly with RVEF (r=0.39). In patients without previous cardiac surgery, TAPSE z-score was within the normal range (0.17±1.48) but demonstrated a weak correlation with RVEF (r=0.28), while RV FAC was moderately correlated with RVEF (r=0.57). Differences in the correlation strengths between the two groups were not statistically significant. Conclusions TAPSE and RV FAC showed limited reliability as surrogate markers of global RV systolic function in paediatric patients especially following surgery involving pericardiotomy. Only RVEF, measured by cardiac MRI, should be used to evaluate true RV systolic function after paediatric cardiac surgery.