Comment on: “Assessment of Right Ventricle Function in Patients with Mitral Repair: Case Series”

Sir, In the January issue of Annals of Cardiac Anaesthesia; Amador, et al.[1] publish a retrospective case series, evaluating the echocardiographic pattern of right ventricle (RV) function in relation to outcomes in 30 patients undergoing mitral valve (MV) repair. Having comprehensively assessed a range of displacement and deformation echocardiographic parameters such as Tricuspid Annular Plane Systolic Excursion (TAPSE) and right ventricular longitudinal free wall strain (RVLS); the authors despite outlining a promising functional role of RVLS, happen to fall short of concurrently delineating an equally significant clinical role in their surgical cohort.[1-3] In this context, it is believed that the pulmonary artery systolic pressure (PASP) ought to have been presented for the participants, particularly when they manifested varying degrees of tricuspid regurgitation (TR) which is often utilized on echocardiography to estimate the former premised on the simplified Bernoulli equation, that is, PASP = right atrial pressure + 4 (vTR)2.[2,3] As an extension of the same, TAPSE/PASP or RVLS/PASP herein, could have served as relevant surrogates of ventriculo-arterial or RV-PA coupling.[2,3] Meanwhile Chehab, et al.[2] associate TAPSE/PASP ≤0.35 with mortality and length of hospital stay specifically in patients with mitral regurgitation (MR) undergoing MV surgery; independent researchers hint toward improved performance of RVLS/PASP over TAPSE/PASP, as far as the matter of RV-PA coupling is concerned.[3,4] Given Amador, et al.[1] also happened to include patients with MR subjected to mitral valve repair with/without concomitant tricuspid valve repair, the incorporation of component of RV afterload could have likely added an incremental value.[2-4] To add to it, the qualitative reporting on the need of vasopressors in the index case series merits attention, wherein an established hemodynamic support score, or the vasoactive inotropic score (VIS) would have served the purpose of correlation analysis more lucid, alongside being that much more informative.[1,5] Krishna, et al.[5] indeed highlight a significantly negative correlation between TAPSE-RVLS and mean postoperative VIS. The finding, albeit emanating from a post-tetralogy of Fallot subset; bespeaks of the importance of inclusion of quantitative reporting of vasopressor support when studied in close conjunction with the RV function, as was the case in the Amador, et al.[1] research endeavor. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.