Assessment of right ventricular function postretrograde cardioplegia by transesophageal echocardiography

The impact of continuous retrograde cardioplegia (RCP) on right ventricular (RV) function was evaluated prospectively with intraoperative transesophag eal echocardiography (TEE) in 36 patients (23 males, 13 females) with a mea n age of 60.4 years (ages 24-82). Operative procedures included 12 aortic v alve replacements, 16 mitral valve repair/replacements, both with or withou t an associated cardiac operation, and 8 Ross procedures. Mean cardiopulmon ary bypass (CPB) time was 123.3 minutes (66-280 minutes) with an average cr oss-clamp time of 88.9 minutes (43-199 minutes). The amount of cold blood R CP ranged from 3160-18,500 mL (mean = 7382.5), and the average pulmonary ar tery pressure was 35/18 mmHg. The coronary sinus was distally snared in 11 patients. TEE documented biventricular global dysfunction in two patients a nd post-CPB with preservation of the left ventricular function in all other patients. Localized akinesis of the RV apex and outflow tract were noted i n three patients, and isolated worsening tricuspid insufficiency of moderat e to severe intensity in six patients. Two of the six patients with worseni ng tricuspid insufficiency belonged to the snared coronary sinus group (11 patients). All of the documented RV dysfunctions were new and showed no cor relation with the perfusion data. In conclusion: (1) RV apex, RV outflow tr act and tricuspid valve were particularly subject to important dysfunction post-RCP; (2) RCP did not protect RV adequately in 11 patients (31%); and ( 3) TEE is a convenient intraoperative technique in evaluating RV dysfunctio n.