title: Transesophageal Echocardiographic Measurement of Cardiac Index by the Prosthetic Mitral Valve Method Is Not Similar to the Continuous Thermodilution Method Via a Pulmonary Artery Catheter.
abstract: OBJECTIVE
  To compare the agreement of cardiac index measurements between transesophageal echocardiography across the prosthetic mitral valve and the continuous thermodilution method through a pulmonary artery catheter (PAC-TD) in patients undergoing double-valve replacement.
  
  
  METHODS
  Observational prospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twenty-five patients undergoing double-valve replacement (12 men and 13 women, age 25-78 years, ASA III-IV, NYHA II-III, LVEF≥45%). Patients were grouped according to their prosthesis (mechanical prosthesis v bioprosthesis).
  
  
  METHODS
  All patients underwent cardiac index assessment during double-valve replacement.
  
  
  RESULTS
  Cardiac index across the prosthetic mitral valve was measured simultaneously using transesophageal echocardiography (CI(MV)) and PAC-TD (CI(PAC)) at 15, 30, 45, and 60 minutes after weaning from cardiopulmonary bypass, and at 0, 15, and 30 minutes after incision closure. A correlation was present between CI(MV) and CI(PAC) in both groups (mechanical prosthesis: r = 0.47, p<0.01; bioprosthesis: r = 0.60, p<0.01). In the mechanical prosthesis group, the bias between techniques (CI(PAC) v CI(MV)) was-0.5 L/min/m(2) (95% CI:-1.97 to 0.97), and error was 55%. In the bioprosthesis group, the bias between both techniques was-1.3 L/min/m(2) (95% CI:-3.1 to 0.5), and error was 56%.
  
  
  CONCLUSIONS
  A relatively weak correlation and lack of agreement between values of CI(PAC) and CI(MV) were observed in patients undergoing double-valve replacement. Therefore, transesophageal echocardiography might not be interchangeable with PAC-TD for measuring cardiac output or cardiac index. A regression equation is needed to correct the probable value of CI(PAC). CI(MV) might be useful as a quantitative or semi-quantitative cardiac output measurement.
authors.affiliation: Department of Anesthesiology.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Anesthesiology.
authors.forename: Zhenhong
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Wei
authors.affiliation: Department of Anesthesiology.
authors.forename: Yali
authors.initials: Y
authors.lastname: Ge
authors.affiliation: Cardiothoracic and Vascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address: stevecx2@163.com.
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass; D002407:Catheterization, Swan-Ganz; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D013815:Thermodilution / Q000379:methods*
keywords: cardiac index; cardiac output; echocardiography; mitral valve; thermodilution; transesophageal