CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 2, March 2012
66
AFRICA
This study has some important limitations. The sample size
was relatively small. Only one site of the tricuspid annulus was
studied. In clinical practice, recording of other tricuspid annu-
lar sites might not be feasible in all patients. In addition, no
method was included to assess the global RV function. In fact,
there is no consensus regarding the echocardiographic assess-
ment of global RV function aside from the gold-standard MRI.
Two-dimensional echocardiography using the ellipsoidal shell
model for right ventricular volumetry provides usable results
for clinical practice, and it has been reported that it yielded data
on right ventricular function comparable to those from MRI.
19,20
On the other hand, a non-invasive perfusion study could have
been utilised to assess the significance of the reduced tricuspid
annular velocities.
Conclusions
In general clinical practice, two-dimensional echocardiography
can still be used to assess right ventricular dysfunction. Both
systolic and diastolic RV functions are very important param-
eters in the peri- and postoperative period after CABG. Reducing
right ventricular diastolic dysfunction via selecting the sequen-
tial, not individual, bypass technique for revascularisation of
the RCA could help patients recover more rapidly and possibly
improve their prognosis. Large-scale and randomised studies
are still needed for assessment of the effect of this technique on
long-term morbidity and survival.
References
1.
Oz BS, Iyem H, Akay HK,
et al.
Mid-term angiographic comparison of
sequential and individual anastomosis techniques for diagonal artery.
J
Card Surg
2006;
21
: 471–474.
2.
Flemma RJ, Johnson WD, Lepley D Jr. Triple aorto-coronary bypass as
treatment for coronary insuffiency.
Arch Surg
1971: 103–182.
3.
Bartley TD, Bigelow JC, Page US. Aortocoronary bypass grafting with
multiple sequential anastomoses to a single vein.
Arch Surg
1972:
105–115.
4.
Meeter K, Veldkamp R, Tijssen JGP,
et al.
Clinical outcome of single
versus sequential grafts in coronary bypass operations at ten years
follow-up.
J Thorac Cardiovasc Surg
1991;
101
: 1076–1081.
5.
Grondin CM, Limet R. Sequential anastomoses in coronary artery
grafting: Technical aspects and early and late angiographic results.
Ann
Thorac Surg
1977;
23
: 1–8.
6.
Keiser TM, FitzGibbon GM, Keon WJ. Sequential coronary bypass
grafts: Long-term follow-up.
J Thorac Cardiovasc Surg
1986;
91
:
767–772.
7.
Vural KM, Sener E, Tasdemir O. Long-term patency of sequential and
individual saphenous vein coronary bypass grafts.
Eur J Cardiothorac
Surg
2001;
19
: 140–144.
8.
Sewell WH, Sewell KV. Technique for the coronary snake graft opera-
tion.
Ann Thorac Surg
1976;
22
: 58–65.
9.
O’Neill MJ Jr, Wolf PD, O’Neill TK,
et al
. A rationale for the use of
sequential coronary artery bypass grafts.
J Thorac Cardiovasc Surg
1981;
81
: 686–690.
10. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R,
Feigenbaum H,
et al
. Recommendations for quantitation of the leftven-
tricle by two-dimensional echocardiography. American Society of
Echocardiography Committee on Standards. Subcommittee on quan-
titation oftwo-dimensional echocardiography
. J Am Soc Echocardiogr
1989;
2
: 358–367.
11. Currie PJ, Seward JB, han KL,
et al
. Continuous wave doppler determi-
nation of right ventricular pressure: a simultaneous doppler catheteriza-
tion study in 127 patients.
J Am Coll Cardiol
1985;
6
: 750–756.
12. Baker BJ, Wilen MM, Boyd CM, Dinh H, Francisa JA. Relation of
right ventricular ejection fraction to exercise capacity of patients with
chronic left ventricular failure.
Am J Cardiol
1984;
54
: 596–599.
13. Burger W, Brinkies C, Illert S, Teupe C, Kneissl GD, Schrader R. Right
ventricular function before and after percutaneous balloon mitral valvu-
loplasty.
Int J Cardiol
1997;
58
: 7–15.
14. Saricam E, Ozbakır C, Yildirim N,
et al.
Evaluation of the relationship
between functional capacity and right ventricular diastolic function in
patients with isolated mitral stenosis and sinus rhythm: a tissue Doppler
study.
Echocardiography
2007;
24
(2): 134–139.
15. Brookes CI, White PA, Bishop AJ,
et al
. Validation of a new intraopera-
tive technique to evaluate load-independent indices of right ventricular
performance in patients undergoing cardiac operations.
J Thorac
Cardiovasc Surg
1998;
116
: 468–476.
16. Mishra M, Swaminathan M, Malhorta R,
et al
. Evaluation of right
ventricular function during CABG: transesophageal echocardiographic
assessment of hepatic venous flow versus conventional right ventricular
performance indices.
Echocardiography
1998;
15
: 51–58.
17. Alam M, Hedman A, Nordlande R, Samad B. Right ventricular func-
tion before and after an uncomplicated coronary artery bypass graft
as assessed by pulsed wave Doppler tissue imaging of the tricuspid
annulus.
Am Heart J
2003;
146
: 520–526.
18. Meluzin J, Spinarova L, Bakala J,
et al
. Pulsed Doppler tissue imaging
of the velocity of tricuspid annular systolic motion.
Eur Heart J
2001;
22
: 340–348.
19. Kovalova S, Necas J, Cerbak R, Malik P, Vespalec J. Echocardiographic
volumetry of the right ventricle.
Eur J Echocardiogr
2005;
6
(1): 15–23.
20. Denslow S, Wiles HB, McKellar LF, Wright NA, Gillette PC. Right
ventricular volume estimation with an ellipsoidal shell model and two-
plane magnetic resonance imaging.
Am Heart J
1995;
129
: 782–790.
