title: Transcatheter aortic valve implantation and intraoperative left ventricular function: a myocardial tissue Doppler imaging study.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation in patients turned down for surgical aortic valve replacement is a high-risk procedure. Severe aortic stenosis is associated with impaired left ventricular longitudinal motion, and myocardial peak systolic velocity is a measure of left ventricular function in these patients. The present study aimed to quantify the acute changes in left ventricular function during the procedure by using myocardial tissue Doppler imaging and transthoracic cardiac output measurements.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  40 patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation.
  
  
  METHODS
  Transesophageal 4-chamber and 2-chamber echocardiograms were performed immediately before and ~15 minutes after valve implantation. Longitudinal myocardial peak systolic velocity was obtained by tissue Doppler imaging from 8 basal segments and averaged. Cardiac output was measured by the lithium dilution method, and systemic vascular resistance index and stroke volume were calculated.
  
  
  RESULTS
  Longitudinal myocardial peak systolic velocity improved immediately after valve implantation, from -2.3±0.8 to -3.0±1.1 cm/sec (p<0.001); this represented an average increase of 31%±33%. Cardiac output increased from 3.2±0.8 L/min to 3.6±0.9 L/min (15%±33%; p = 0.04). This was due to increased heart rate (59±9 beats/min to 72±12 beats/min; p<0.001) and not to an improved stroke volume. Systemic vascular resistance index was reduced from 2,937±984 dynes*sec/cm(5)/m(2) to 2,436±730 dynes*sec/cm(5)/m(2) (p = 0.003).
  
  
  CONCLUSIONS
  Intraoperative echocardiography tissue Doppler imaging detected immediate improvement in left ventricular long-axis motion after transcatheter aortic valve implantation. The method provided detailed information not obtainable by routine hemodynamic monitoring.
authors.affiliation: The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway. Electronic address: jeidet@ous-hf.no.
authors.forename: Jo
authors.initials: J
authors.lastname: Eidet
authors.affiliation: Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Gry
authors.initials: G
authors.lastname: Dahle
authors.affiliation: Department of Anesthesiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Bugge
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Bendz
authors.affiliation: Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Kjell A
authors.initials: KA
authors.lastname: Rein
authors.affiliation: The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Fosse
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.affiliation: The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Per S
authors.initials: PS
authors.lastname: Halvorsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016277:Ventricular Function, Left / Q000502:physiology
keywords: aortic stenosis; intraoperative monitoring; left ventricular function; tissue Doppler imaging; transcatheter aortic valve implantation; transesophageal echocardiography