Impact of Septoplasty on Right Ventricular Mechanics Assessed by Three-dimensional Echocardiography, Myocardial Performance Index, and Strain Analysis

Background: Chronic nasal septum deviation (NSD) may cause persistent upper airway obstruction, intermittent hypoxia, and sympathetic overactivity, potentially leading to subtle alterations in right ventricular (RV) structure and function. Advanced echocardiographic techniques – including three-dimensional RV ejection fraction (3D-RVEF), myocardial performance index (Tei index), and RV longitudinal strain – enable detection of subclinical RV dysfunction associated with chronic hypoxic states and sleep-disordered breathing. Relief of airway obstruction may be associated with changes in cardiopulmonary physiology that could influence RV functional parameters. This study aimed to evaluate changes in RV mechanics following septoplasty using comprehensive conventional and advanced echocardiographic assessment. Methods: This prospective observational study included 30 consecutive adults undergoing elective septoplasty for symptomatic NSD. Comprehensive transthoracic echocardiography was performed preoperatively and 3 months postoperatively. Conventional RV functional parameters – tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), and pulmonary artery systolic pressure (PASP) – were measured together with advanced indices obtained from 3D echocardiography (3DE) and speckle-tracking analysis, including 3D-RVEF, RV myocardial performance index (Tei index), and RV free-wall longitudinal strain (FWLS). Paired statistical comparisons were conducted to assess postoperative changes in accordance with contemporary echocardiographic quantification standards. Results: Septoplasty was associated with significant improvement in both conventional and advanced RV functional parameters. TAPSE increased from 21.6 ± 2.7 mm to 23.4 ± 3.1 mm ( P = 0.002), RV FAC increased from 43% ± 6% to 47% ± 7% ( P = 0.008), and PASP decreased from 30 ± 6 mmHg to 25 ± 5 mmHg ( P = 0.001). Advanced echocardiographic analysis demonstrated a significant rise in 3D-RVEF (48% ± 5% to 53% ± 6%, P < 0.001), a reduction in Tei index (0.46 ± 0.08–0.38 ± 0.07, P = 0.002), and improvement in RV FWLS (−19.8% ± 3.2% to −23.1% ± 3.6%, P < 0.001). Left ventricular systolic function remained unchanged, and no perioperative cardiovascular complications occurred. Conclusion: Septoplasty is associated with measurable improvement in RV mechanics assessed by 3DE, myocardial performance index, and strain imaging. Relief of chronic upper airway obstruction may therefore contribute to favorable subclinical cardiopulmonary remodeling beyond symptomatic nasal improvement. These findings highlight the value of advanced echocardiographic assessment in detecting reversible RV dysfunction and warrant confirmation in larger controlled prospective studies.