Right Ventricular Function Change After PCI to Right Coronary Artery
Right Ventricular Function Change After PCI to Right Coronary Artery
Proximal RCA occlusions were very often found among men with fatal pre-hospital MI; whereas
 left-sided coronary occlusions were significantly more frequent in hospital-admitted
 survivors of MI. Left-sided coronary occlusions may be associated with a more favorable
 pre-hospital phase of acute MI compared to proximal RCA occlusions. Proximal RCA occlusion
 increases the risk of arrhythmia and shock leading to increase the mortality. Sinus
 bradycardia and cardiogenic shock accounts for the majorities of the mortalities of RCA
 occlusion
Myocardial infarction is a common presentation of coronary artery disease. The World Health
 Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart
 disease; with it being the leading cause of death in high- or middle-income countries and
 second only to lower respiratory infections in lower-income countries. Worldwide, more than 3
 million people have STEMIs and 4 million have NSTEMIs a year . STEMIs occur about twice as
 often in men as women .

 Myocardial infarction means that the tissue ischemia caused tissue death, as a result of
 diminished blood supply to a part of the heart muscles. The blood supply of the heart is
 coronary arteries (right and left). Proximal RCA occlusions were very often found among men
 with fatal pre-hospital MI; whereas left-sided coronary occlusions were significantly more
 frequent in hospital-admitted survivors of MI. Left-sided coronary occlusions may be
 associated with a more favorable pre-hospital phase of acute MI compared to proximal RCA
 occlusions .

 The right coronary artery (RCA) supplies the right ventricle, 25% to 35% of the left
 ventricle and SA node in 60% of people. Proximal RCA occlusion increases the risk of
 arrhythmia and shock leading to increase the mortality. Sinus bradycardia and cardiogenic
 shock accounts for the majorities of the mortalities of RCA occlusion.

 Sinus bradycardia is more frequent when the infarct-related artery is the RCA than other
 arteries involvement. Proximal occlusions of the RCA presented sinus bradycardia more than
 medial and distal occlusions.

 Mortality of cardiogenic shock due to right ventricular infarction (55%) was comparable to
 that due to left ventricular infarction (59%) in spite of patients being younger and a
 greater incidence of single vessel disease. The worse prognosis in patients with RV
 myocardial involvement may be related to the increased risk of life-threatening ventricular
 arrhythmias in these patients.

 Approximately one half of patients who present with signs and symptoms of acute inferior
 myocardial infarction have proximal occlusion of the dominant right coronary artery (RCA) and
 also show ECG signs of RV wall ischemia or infarction. Occlusion sufficiently proximal to
 cause RV free wall injury also frequently compromises the blood supply to the sinoatrial
 node, atrium and atrioventricular (AV) node, producing such effects as sinus bradycardia,
 atrial infarction, atrial fibrillation and AV block.

 The transthoracic echocardiography is the most common method to assess the function of the
 right ventricular function as it non-invasive, inexpensive and available in most of the
 hospitals. The presence of RV dysfunction on early echocardiography is an important predictor
 of an adverse prognosis, both short-and long-term, in STEMI patients.

 The Tissue Doppler Imaging method depicts myocardial motion (measured as tissue velocity) at
 specific locations in the heart. Tissue velocity indicates the rate at which a particular
 point in the myocardium moves toward or away from the transducer. Integration of velocity
 over time yields displacement or the absolute distance moved by that point.

 Evaluation of right ventricular function by echocardiography is challenging and often ignored
 in clinical practice. Tricuspid annular velocity correlates with right ventricular ejection
 fraction . Tricuspid annular excursion (tricuspid displacement) predicted 2-year survival in
 patients with pulmonary hypertension . Isovolumic acceleration, derived from tissue velocity,
 is a load-independent measure of contractility and correlates with right ventricular
 end-systolic elastance. This correlation is less pronounced in clinical studies . More recent
 experimental data suggest a weak relationship between isovolumic acceleration and regional
 contractility. Systolic velocity and strain best correlated with invasively determined right
 ventricular stroke volume and dynamically tracked changes in right ventricular function
 during vasodilator infusion. Strain rates and strain quantitate regional right ventricular
 systolic function in various pathologies
Inclusion Criteria:

 -  Patients subjected to elective PCI due to right coronary artery occlusion. Patients
 between 40 and 75 years old from the both genders

 Exclusion Criteria:

 1. History of chronic respiratory condition and PHTN

 2. Patients with previous percutaneous coronary intervention (PCI) or coronary artery
 bypass graft surgery (CABG).

 3. History of valvular surgery.

 4. Patients with significant rheumatic vavular heart disease.

 5. Presence of persistant arrythemia

 6. Patients with End stage renal disease.

 7. Patients with End stage liver disease.

 8. Haemodynamically unstable patients.

 9. Patients with previous Myocardial infarction.

 10. Patients with Ischemic Dilated Cardiomyopathy.

 11. Patients with pericardial disease.

 12. Patients with congenital intra-cardiac shunt.