Clinical Investigation
Three-Dimensional Echocardiography
Feasibility of Intraoperative Three-Dimensional Transesophageal Echocardiography in the Evaluation of Right Ventricular Volumes and Function in Patients Undergoing Cardiac Surgery

https://doi.org/10.1016/j.echo.2011.05.002Get rights and content

Background

The aim of this study was to test the feasibility of the assessment of right ventricular (RV) volumes and function using real-time three-dimensional (3D) transesophageal echocardiographic (TEE) imaging in patients undergoing cardiac surgery.

Methods

One hundred-fifty surgical patients were enrolled: 65 undergoing mitral valve repair, 10 undergoing mitral valve and tricuspid valve repair, four with congenital heart disease, two undergoing Jarvik implantation, 13 undergoing aortic valve surgical replacement, and 56 undergoing transcatheter aortic valve implantation. Real-time 3D TEE acquisition for RV evaluation was performed before and after the surgical procedure and compared with standard two-dimensional multiplane TEE measurements. In a subgroup of 81 patients, 3D transthoracic echocardiographic imaging was also performed. RV volumetric quantification was performed for all data using dedicated software.

Results

Three-dimensional RV analysis was feasible in 98.7% in the preoperative TEE data set and in 92.7% in the postoperative TEE data set. Agreement between 3D transthoracic and transesophageal echocardiography for end-diastolic volume (r = 0.98; 95% confidence interval [CI], −0.2 ± 13.6 mL), end-systolic volume (r = 0.97; 95% CI, −2.1 ± 10.2 mL), ejection fraction (r = 0.77; 95% CI, 1.8 ± 8.2%), and stroke volume (r = 0.91; 95% CI, 2.0 ± 12.9 mL) was significant. RV parameters were highly reproducible in patients with both normal and dilated RV volumes.

Conclusions

Intraoperative 3D TEE assessment of RV volumes and function is feasible in patients with normal and dilated right ventricles, with good correlation between 3D transthoracic echocardiographic and TEE RV parameters. These measurements could improve the quantitative evaluation of RV function during cardiac surgery.

Section snippets

Methods

The study population consisted of 150 nonconsecutive patients who underwent 2D TEE monitoring during cardiac surgery between June 2009 and January 2011: 65 undergoing mitral valve (MV) repair for prolapse, 10 undergoing MV and tricuspid valve (TV) repair, four with congenital heart diseases, two undergoing Jarvik implantation, 13 undergoing aortic valve surgical replacement (six with aortic regurgitation and seven with aortic valve stenosis), and 56 undergoing transcatheter aortic valve

Results

Clinical characteristics of the study population and the feasibility of 3D TEE RV volume assessment are shown in Table 1, separately for preoperative and postoperative TEE data. The reconstruction of the RV preoperative and postoperative TEE volumes was feasible in 98.7% (n = 148) and 92.7% (n = 139) of patients, respectively. The time required for each real-time 3D acquisition was about 38 ± 20 sec, whereas for each analysis, the time required was up to 5 min. The mean quality scores of

Discussion

The importance of RV function in cardiac surgery outcomes has been largely proven.1, 2, 3, 4 An accurate estimation of RV function may improve risk stratification in patients undergoing surgery and in those with postoperative hemodynamic instability, in whom acute RV failure is known to be a significant cause of morbidity and mortality in the perioperative period after valvular and congenital surgery, coronary artery bypass, or heart transplantation.5, 23

Over the past decades, 2D

Conclusions

Intraoperative TEE assessment of RV volumes and function is feasible and reproducible both in patients with normal RV function and in those with dilated right ventricles, without being excessively time consuming. The good correlations found between 3D TEE and TTE data, as well as between preoperative and postoperative TEE differences in EDV and EDA, demonstrate the reliability of this procedure for 3D RV quantification, which could improve the intraoperative evaluation of RV function.

References (32)

Cited by (53)

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