OJAnes  Vol.3 No.4 , June 2013
Noninvasive Assessment of Cardiac Index with Transesophageal Echocardiography in Patients Undergoing Mitral Valve Replacement: A Comparison between Determinations at the Mitral Valve and the Ascending Aorta
Abstract: Methods: Sixteen patients with American Society of Anesthesiologists status (ASA) II-III, age ≤ 70 yr, male or female, preoperatively NYHA II-III and EF ≥ 45%, scheduled for mitral valve replacement (MVR) were studied. Complete intravenous general anesthesia was used for induction and anesthesia maintenance. After anesthesia induction we put the TEE probe into the esophagus. The cardiac index was determined at three periods following MVR: T1 30 minutes later following cessation of bypass, T2 60 minutes after cessation of bypass, T3 90 minutes after cessation of bypass. Statistical analysis was made with the Bland and Altman method. Results: Ninety-six measurements were compared. The cardiac index values at the level of prosthesis mitral valve (CIMV) ranged from 1.3 to 5.5 L·min-1·m-2 (mean 2.6 ± 0.9). The Values of cardiac index at aortic valve (CIAA) ranged from 2.7 to8.8 L·min-1·m-2 (mean 4.9 ± 1.7). Bias was -2.3 L·min-1·m-2 and limits of agreement -5.6 to 1.0 L·min-1·m-2. Conclusion: During mitral valve replacement, doubtful correlations were observed between values of cardiac index at the mitral valve and the ascending aorta using TEE.
Cite this paper: X. Hu, H. Shi, J. Yan, Y. Ge and H. Wei, "Noninvasive Assessment of Cardiac Index with Transesophageal Echocardiography in Patients Undergoing Mitral Valve Replacement: A Comparison between Determinations at the Mitral Valve and the Ascending Aorta," Open Journal of Anesthesiology, Vol. 3 No. 4, 2013, pp. 249-254. doi: 10.4236/ojanes.2013.34056.

[1]   E. D. Robin, “The Cult of the Swan-Ganz Catheter: Over- Use and Abuse of the Pulmonary Flow Catheters,” Annals of Internal Medicine, Vol. 103, No. 3, 1985, pp. 445-449. doi:10.7326/0003-4819-103-3-445

[2]   W. C. Shoemaker, “Use and Abuse of the Balloon Tip Pulmonary Artery (Swan-Ganz) Catheter: Are Patients Getting Their Money Worth?” Critical Care Medicine, Vol. 18, No. 11, 1990, pp. 1294-1296. doi:10.1097/00003246-199011000-00025

[3]   I. A. Muhiudeen, H. F. Kuecherer, E. Lee et al. “Intraoperative Estimation of Cardiac Output by Transesophageal Pulsed Doppler Echocardiography,” Anesthesiology, Vol. 74, No. 1, 1991, pp. 9-14. doi:10.1097/00000542-199101000-00003

[4]   M. C. Cabrera Schulmeyer, R. A. Vega Sepulveda and E. G. Santelices, “Cuevas Intraoperative Measurement of Cardiac Output by Transesophageal Echocardiography of Transmitral Flow,” Revista Espa?ola de Anestesiología y Reanimación, Vol. 51, No. 7, 2004, pp. 367-372.

[5]   M. A. Branthwaite and R. D. Pradley, “Measurement of Cardiac Output by Thermal Dilution in Man,” Journal of Applied Physiology, Vol. 24, No. 3, 1968, pp. 434-438.

[6]   A. J. Coats, “Doppler Ultrasonic Measurement of Cardiac Output: Reproducibility and Validation,” European Heart Journal, Vol. 11, No. 1, 1990, pp. 49-61. doi:10.1093/eurheartj/11.suppl_I.49

[7]   J. M. Bland and D. G. Altman, “Measuring Agreement in Method Comparison Studies,” Statistical Methods in Medical Research, Vol. 8, No. 2, 1999, pp. 135-160. doi:10.1191/096228099673819272

[8]   A. C. Perrino and S. T. Reeves, “A Practical Approach to Transesophageal Echocardiography,” 2nd Edtion, Lippincott Williams & Wilkins Ltd., Philadelphia, 2008, pp. 620-623.

[9]   S. J. Goldberg, D. F. Dickinson and N. Wolson “Evaluation of an Elliptical Area Technique for Calculating Mitral Blood Flow by Doppler Echocardiography,” British Heart Journal, Vol. 54, No. 1, 1985, pp. 68-75. doi:10.1136/hrt.54.1.68

[10]   R. A. Nishimura, F. A. Miller Jr., M. J. Callahan, et al., “Doppler Echocardiography: Theory, Instrumentation, Technique, and Application,” Mayo Clinic Proceedings, Vol. 60, No. 5, 1985, pp. 321-343. doi:10.1016/S0025-6196(12)60540-0

[11]   M. Balik, P. Plasil and J. Pazout, “Correlation of Cardiac Output Measurement with Transesophageal Echocardiography and Bolus Termodilution Technique in Patients with Various of Tricuspid Regurgitation,” Anaesthesiology Intensive Medicine, Vol. 15, 2004, pp. 204-208.

[12]   J. Brodka, L. Tulecki, M. Ciurysek, et al., “Thermodilution Stransesophageal Echocardiography for Cardiac Output Measurements in Patients with Good Left Ventricle Function,” Anaesthesiology Intensive Therapy, Vol. 42, No. 1, 2010, pp. 15-18.

[13]   R. De simone, R. Lange, A. Tanzeem, et al., “Adjustable Tricuspid Valve Annuloplasty Assisted by Intraoperative Transesophageal Color Doppler Echocardiography,” American Journal of Cardiology, Vol. 71, No. 11, 1993, pp. 926-931.

[14]   C. F. Royse, A. G. Royse, D. W. Blake, et al., ”Measurement of Cardiac Output by Transesophageal Echocardiography: A Comparison of Two Doppler Methods with Thermodilution,” Anaesth Intensive Care, Vol. 27, No. 6, 1999, pp. 586-590.

[15]   J. L. Fellahi, B. Valtier, J. P. Bourdarias, et al., “Does Positive End-Expiratory Pressure Ventilation Improve Left Ventricular Function? A Comparative Study by Transesophageal Echocardiography in Cardiac and Noncardiac Patients,” Chest, Vol. 114, No. 2, 1998, pp. 556-562. doi:10.1378/chest.114.2.556

[16]   J. L. Fellahi, V. Caille, C. Charron, et al., “Noninvasive Assessment of Cardiac Index in Healthy Volunteers: A Comparison between Thoracic Impedance Cardiography and Doppler Echocardiography,” International Anesthesia Research Society, Vol. 108, No. 5, 2009, pp. 1553- 1559.