Interchangeability of transthoracic and transesophageal echocardiographic right heart measurements in the perioperative setting and correlation with hemodynamic parameters

Abstract

Purpose Reduction of right ventricular (RV) function after cardiac surgery has been shown to impact outcomes. Conventional indices for right ventricular dysfunction are validated using transthoracic echocardiogram (TTE) which has limited use compared to transesophageal echocardiogram (TEE) in the perioperative settings.The aim of this study was to assess the agreement of RV systolic function assessment with TEE compared to TTE and assess the association of echocardiographic parameter with hemodynamic indices of RV dysfunction.Method This was a single center prospective observational study in an academic institution. Fifty adult patients undergoing elective cardiac surgery were included. TTE, TEE and stroke volume measurements pre-cardiopulmonary bypass (CPB) and post-CPB were performed. The variables of interest were anatomical M-mode tricuspid annular plane systolic excursion (AMM-TAPSE), fractional area change (FAC), tricuspid annular velocity (S') and myocardial performance index (MPI).Results FAC and AMM-TAPSE measured at the mid-esophageal 4 chamber view had substantial agreement with the TTE acquired parameters (Lin's concordance correlation coe cient (CCC) = 0.76, 95%CI 0.59-0.86 and CCC = 0.85, 95%CI 0.76-0.91). S' was signi cantly underestimated by TEE (CCC = 0.07, 95%CI -0.04-0.19) and MPI showed moderate agreement (CCC = 0.45 95%CI 0.19-0.65). Despite the signi cant changes in echocardiographic parameters, there were no corresponding changes in stroke volume (SV) or pulmonary artery pulsatility index at the post-CPB period.Conclusions TEE acquired FAC and AMM-TAPSE had substantial agreement with pre-operative TTE values and no signi cant differences between the pre-CPB and post-CPB period. Systolic RV echocardiographic parameters decreased post-CPB but this was not accompanied by signi cant hemodynamic changes.

Multimodality Cardiovascular Imaging for Totally Video-Guided Thorascopic Cardiac Surgery

“…The coexistence of aortic insufficiency with an effective regurgitate orifice area (EROA 4.0 ) is a relative contraindication for TVTCS technique since adequate antegrade cardioplegia cannot be safely delivered to ensure optimal myocardial protection during aortic clamping. Specific parameters from TEE measurements after induction of anesthesia could further validate the diagnosis and more precisely evaluate the hemodynamic parameters such as tricuspid annular velocity [ 10 ]. For isolated tricuspid valve surgery, the severity of valve regurgitation is evaluated preop to help determine the type repair to be performed [ 11 ].…”