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Clinically Evident Right Ventricular Strain and Fractional Area Change During Routine Cesarean Section
Abstract Number: O-04
Abstract Type: Original Research
Clinically detectable right ventricular (RV) strain and troponin leak during the peri-cesarean section (C-section) period may be present in the otherwise healthy parturient. Causes may include intermittent embolic events (air, amniotic fluid) or changes in loading conditions during the delivery period. The identification of these etiologies may be seen on transthoracic echocardiography (TTE). The aim of this study is to quantify and correlate RV strain, cardiac biomarker leak and the presence of RV or LV dysfunction during this period.
Patients undergoing scheduled cesarean underwent bedside transthoracic echocardiographic examination intra-operatively, during uterotomy and delivery, and postoperatively immediately after leaving the operating room. Cardiac biomarkers (troponin, CPK-MB, BNP) were collected pre- and post-operatively. Transthoracic measures included RV and LV ejection fraction, percentage RV fractional area change (FAC) and myocardial strain, which was calculated using 2D-speckle tracking.
30 patients’ images were analyzed for this study. There was no significant change in the RV strain from pre- to post-delivery (mean -5.28 vs. -5.72; p = 0.69). FAC decreased by a mean of 4.1% from pre- to post- delivery (p<0.014). FAC was also abnormal pre- and post- delivery indicating at least moderate dysfunction in most patients. Left ventricular (LV) circumferential strain increase was significant (-6.43 vs. -18.53; p =0.002). Cardiac troponin was significantly increased in 1 patient who also showed decreased LV strain. Difference in BNP over all patients was not significantly increased (p=0.09) neither was CK-MB (p=0.50). Only one patient demonstrated imaging consistent with significant intra-delivery embolism.
Our analysis shows that it is possible to image parturients during cesarean and quantify right ventricular dysfunction as assessed by longitudinal strain and FAC. Though strain is a sensitive marker, current literature is mixed on the applicability t right heart dysfunction. The presence of worsened FAC% indicates the presence of dysfunction despite lack of change in RV strain. The LV responds well to increased preload conditions, which was demonstrated by and more negative circumferential strain value. No evidence of increased BNP, CK-MB, troponin or significant emboli was seen with continuous TTE imaging in this cohort.