Three-Dimensional Transesophageal Echocardiography for Perioperative Right Ventricular Assessment

• Published in: The Annals of thoracic surgery Vol. 94; no. 2; pp. 468 - 474
• Main Authors: Karhausen, Joern, MD, Dudaryk, Roman, MD, Phillips-Bute, Barbara, PhD, Rivera, J. Daniel, RCS, de Lange, Fellery, MD, PhD, Milano, Carmelo A., MD, Swaminathan, Madhav, MD, Mackensen, G. Burkhard, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2012; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Surgical Procedures; Cardiology. Vascular system; Cardiothoracic Surgery; Cardiovascular system; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal - methods; Female; Heart Ventricles - diagnostic imaging; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pneumology; Preoperative Care; Retrospective Studies; Surgery; Ultrasonic investigative techniques; 1; 18; Sonography; Perioperative; Echocardiography; Right ventricle; Anesthesia; Tridimensional image; Circulatory system; Cardiology
• DOI: 10.1016/j.athoracsur.2012.03.073
• ISSN: 0003-4975

Background In high-risk cardiac procedures, dynamic analysis of right ventricular (RV) performance is desirable, but the geometric complexity of the RV limits the applicability of current two-dimensional echocardiographic imaging techniques. This study aimed to evaluate the utility of three-dimensional transesophageal echocardiography (TEE) for the perioperative assessment of RV function and dimensions. Methods Patients undergoing cardiac surgical procedures with complete TEE examinations were identified and reviewed according to current guidelines to exclude patients with significant coexisting valvular regurgitation. Full-volume, three-dimensional datasets were analyzed by two independent investigators using stand-alone software, and left ventricular and RV dimensions were recorded. Results Datasets from 50 patients undergoing cardiac surgical procedures were evaluated for this study. The mean RV volume was 111.7 mL (range, 37.5 to 349.7 mL) at end diastole and 67.6 mL (range, 25.5 to 274.4 mL) at end systole. Intraobserver reliability was 0.93 and 0.90 for end diastolic and 0.77 and 0.87 for end systolic volumes. The interobserver reliability for RV volumes was 0.83 at end diastole and 0.86 at end systole. The mean stroke volume was 43.6 mL (range, 12 to 111.2 mL) for the RV and 49.1 mL (range, 19.9 to 102.8 mL) for the left ventricle; the correlation coefficient between the two was 0.85. Conclusions Three-dimensional TEE volumetric measurements were reproducible across a wide range of RV dimensions. As postulated by the continuity principle, stroke volume measurements between both ventricles correlated well, supporting the validity of this approach. Therefore, our work provides preliminary evidence that three-dimensional TEE offers reproducible information about RV function and size in the dynamic and complex perioperative setting of cardiac surgical procedures.