Intraoperative determination of cardiac output using multiplane transesophageal echocardiography: a comparison to thermodilution.
BACKGROUND
Limitations in the imaging views that can be obtained with transesophageal echocardiography (TEE) have hindered development of a widely adopted Doppler method for cardiac output (CO) monitoring. The authors evaluated a CO technique that combines steerable continuous-wave Doppler with the imaging capabilities of two-dimensional multiplane TEE.


METHODS
From the transverse plane transgastric, short-axis view of the left ventricle, the imaging array was rotated to view the left ventricular outflow tract (LVOT) and ascending aorta. Steerable continuous-wave Doppler was subsequently used to measure aortic blood flow velocities. Aortic valve area was determined using a triangular orifice model. Matched thermodilution and Doppler CO measurements were obtained serially during surgery.


RESULTS
The left ventricular outflow tract was imaged in 32 of 33 patients (97%). Data analysis reveal a mean difference between techniques of -0.01 l/min, and a standard deviation of the differences of 0.56 l/min. Multiple regression showed a correlation of r = 0.98 between intrasubject changes in CO. Multiplane TEE correctly tracked the direction of 37 of 38 serial changes in thermodilution CO but with a modest 14% underestimation of the magnitude of these changes.


CONCLUSIONS
These results indicate that multiplane TEE can provide an alternative method for the intraoperative measurement of CO. The ability of the rotatable imaging array to align with the left ventricular outflow tract and the need for only minimal adjustments in probe position advance the utility of intraoperative TEE.
Department of Anesthesiology, Yale University School of Medicine and VA Connecticut Healthcare System, West Haven Campus, New Haven, Connecticut 06520-8051, USA. 76467.727@Compuserve.com
A C
AC
Perrino
S N
SN
Harris
M A
MA
Luther
D002302:Cardiac Output / Q000502:physiology*; D003326:Coronary Circulation / Q000502:physiology; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008991:Monitoring, Physiologic; D012044:Regression Analysis; D013815:Thermodilution