Impairment of Tricuspid Annular Plane Systolic Excursion and Tricuspid Annular Peak Systolic Velocity in Patients with Pectus Excavatum

We read with interest the article “Echocardiographic assessment of right ventricular function before and after surgery in patients with pectus excavatum and right ventricular compression” by Gürkan et al.[1] In our opinion, this is an interesting article describing an improvement of right ventricular (RV) function in adolescents and young adult patients with pectus excavatum (PE) after surgical correction. The authors found a reduced tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular peak systolic velocity (S′) in their PE patients compared with age-related normal values before surgical correction and found that RV systolic performance significantly increased after surgical correction. We completely agree with the findings of Gürkan et al[1] that this increase of RV systolic performance after surgical correction of PE is due to the beneficial effects of surgery in PE patients, a fact that is known to be discussed contradictory in the literature. For the convenience of the audience of the journal The Thoracic and Cardiothoracic Surgeon, we would like to mention that in our opinion, a comparison of TAPSE and S′ data from their PE patients below 18 years of age to available TAPSE and S′ pediatric normal values and Z-scores[2] [3] would have improved the statistical power of their analysis although we have to state that the normal values for these age groups are very close to adult normal values. Gürkan et al[1] nicely support the notion that the RV is highly susceptible to preoperative function impairment in patients with PE. We want to thank the authors for addressing the need for careful and systematic evaluation of the RV in patients with PE. We hope that with more interesting studies like this from Gürkan et al[1] quantification of systolic RV function will become a routine measurement in pre- and postoperative PE patients.

• References

• 1 Gürkan U, Aydemir B, Aksoy S , et al. Echocardiographic assessment of right ventricular function before and after surgery in patients with pectus excavatum and right ventricular compression. Thorac Cardiovasc Surg 2014; 62 (3) 231-235
• 2 Koestenberger M, Ravekes W, Everett AD , et al. Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr 2009; 22 (6) 715-719
• 3 Koestenberger M, Nagel B, Ravekes W , et al. Reference values of tricuspid annular peak systolic velocity in healthy pediatric patients, calculation of z score, and comparison to tricuspid annular plane systolic excursion. Am J Cardiol 2012; 109 (1) 116-121

• References

• 1 Gürkan U, Aydemir B, Aksoy S , et al. Echocardiographic assessment of right ventricular function before and after surgery in patients with pectus excavatum and right ventricular compression. Thorac Cardiovasc Surg 2013; (e-pub ahead of print). doi:10.1055/s-0033-1342941
• 2 Koestenberger M, Nagel B, Ravekes W , et al. Reference values of tricuspid annular peak systolic velocity in healthy pediatric patients, calculation of z score, and comparison to tricuspid annular plane systolic excursion. Am J Cardiol 2012; 109 (1) 116-121
• 3 Koestenberger M, Ravekes W, Everett AD , et al. Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr 2009; 22 (6) 715-719