COMPARATIVE STUDY
JOURNAL ARTICLE

Transesophageal echocardiographic area and Doppler flow velocity measurements: comparison with hemodynamic changes in coronary artery bypass surgery

D Schmidlin, R Jenni, E R Schmid
Journal of Cardiothoracic and Vascular Anesthesia 1999, 13 (2): 143-9
10230946

OBJECTIVE: Changes in transesophageal echocardiography (TEE)-derived Doppler flow velocities through the mitral valve and pulmonary veins occur after cardiopulmonary bypass and are believed to reflect left ventricular (LV) diastolic functional impairment. The aim of this study was to determine the time-coincidence between these Doppler flow velocity parameters, LV two-dimensional (2D) short-axis area measurements, and hemodynamic parameters in patients after coronary artery bypass grafting.

DESIGN: Prospective clinical study.

SETTING: University hospital.

PARTICIPANTS: Twenty patients with normal ejection fraction undergoing elective cardiac surgery.

INTERVENTIONS: At multiple intervals during surgery and 6 hours postoperatively, mitral inflow velocity and pulmonary venous flow velocity were measured with pulsed Doppler TEE. LV short-axis area by echocardiography and cardiac output by thermodilution were simultaneously obtained.

MEASUREMENTS AND MAIN RESULTS: Time-coincidence was found in the immediate postbypass period between a decreased E/A ratio from 1.16 (95% confidence interval, 1.0 to 1.31) to 0.64 (95% confidence interval, 0.47 to 0.81, p < 0.01), a decreased E-wave deceleration time, and a significantly increased heart rate (HR) and cardiac index. End-diastolic area (EDA) and stroke volume index (SVI) decreased after sternal closure. HR, E-wave deceleration time, and SVI remained altered until 6 hours postoperatively. No change was found in pulmonary venous flow velocity parameters and systolic LV function.

CONCLUSION: In patients with normal systolic ventricular function and no inotropic support, Doppler flow velocity patterns alone did not sufficiently reflect hemodynamic changes, whereas 2D LV area, especially EDA measurements, provided useful information about hemodynamically significant LV filling impairment.

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