Right ventricular function in patients undergoing surgical or transcatheter aortic valve replacement

We read with great interest the article ‘Right ventricular function after aortic valve replacement: a pilot study comparing surgical and transcatheter procedures using 3D echocardiography’ written by Keyl et al . [ 1 ]. They aimed to investigate the effects of surgical and transcatheter aortic replacement procedures on right ventricular (RV) function using standard Doppler echocardiographic parameters and 3D echocardiography. They found that RV longitudinal contraction decreased after surgical aortic replacement, whereas RV transverse contraction increased, but these parameters did not change after transcatheter aortic replacement. We believe that these findings will act as a guide for further studies regarding echocardiographic evaluation of left and RV functions in patients undergoing surgical and transcatheter aortic replacement. RV myocardial performance has exceptional importance in different disease states and RV dysfunction has prognostic importance in heart failure, pulmonary hypertension, pulmonary embolism, congenital heart disease and myocardial infarction [ 2 ]. RV systolic performance is a reflection of contractility, preload and afterload. Echocardiography can provide objective and quantitative assessment of RV function. Transcatheter aortic valve implantation is increasingly known as a preferred therapeutic option for patients with severe, symptomatic aortic stenosis, which can lead to RV dysfunction, and who are at high risk for conventional surgery. In high-risk patients, transcatheter aortic valve implantation could be favoured over surgical aortic replacement with regard to RV dysfunction [ 3 , 4 ]. The authors assessed RV systolic function using tricuspid annular plane systolic excursion (TAPSE), the peak systolic velocity of the lateral tricuspid annulus (RV S′) and fractional shortening of the transverse RV diameter (RV FS) in the current study [ 1 ]. According to current guidelines, RV FS is not a recommended parameter for the evaluation of RV systolic function [ 5 ]. Surgical aortic valve replacement led to a significant decrease in TAPSE but did not result in right ventricular fractional area change (RV FAC). Thus, RV FAC can be a preferable method for assessing RV function in the postoperative patient [ 6 ]. For these reasons, it would be better if they also evaluated RV function using other parameters including right ventricular index of myocardial performance (RV MPI), myocardial acceleration during isovolumic contraction (RV IVA) and RV FAC because these quantitative measurements are simple and reproducible, and they do not require sophisticated equipment or prolonged image analysis.