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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery. J Vis Exp 2018 11 28(141)

Date

12/26/2018

Pubmed ID

30582607

DOI

10.3791/58374

Scopus ID

2-s2.0-85058138415

Abstract

Trans-mitral blood flow produces a three-dimensional rotational body of fluid, known as a vortex ring, that enhances the efficiency of left ventricular (LV) filling compared with a continuous linear jet. Vortex ring development is most often quantified with vortex formation time (VFT), a dimensionless parameter based on fluid ejection from a rigid tube. Our group is interested in factors that affect LV filling efficiency during cardiac surgery. In this report, we describe how to use standard two-dimensional (2D) and Doppler transesophageal echocardiography (TEE) to noninvasively derive the variables needed to calculate VFT. We calculate atrial filling fraction (β) from velocity-time integrals of trans-mitral early LV filling and atrial systole blood flow velocity waveforms measured in the mid-esophageal four-chamber TEE view. Stroke volume (SV) is calculated as the product of the diameter of the LV outflow track measured in the mid-esophageal long axis TEE view and the velocity-time integral of blood flow through the outflow track determined in the deep transgastric view using pulse-wave Doppler. Finally, mitral valve diameter (D) is determined as the average of major and minor axis lengths measured in orthogonal mid-esophageal bicommissural and long axis imaging planes, respectively. VFT is then calculated as 4 × (1-β) × SV/(πD). We have used this technique to analyze VFT in several groups of patients with differing cardiac abnormalities. We discuss our application of this technique and its potential limitations and also review our results to date. Noninvasive measurement of VFT using TEE is straightforward in anesthetized patients undergoing cardiac surgery. The technique may allow cardiac anesthesiologists and surgeons to assess the impact of pathological conditions and surgical interventions on LV filling efficiency in real time.

Author List

Pagel PS, Dye L 3rd, Hill GED, Vega JL, Tawil JN, De Vry DJ, Chandrashekarappa K, Iqbal Z, Boettcher BT, Freed JK

Authors

Brent Boettcher DO Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
Julie K. Freed MD, PhD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
Paul S. Pagel MD, PhD Professor in the Anesthesiology department at Medical College of Wisconsin
Justin N. Tawil MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Blood Flow Velocity
Cardiac Surgical Procedures
Echocardiography, Doppler
Echocardiography, Transesophageal
Female
Heart Diseases
Heart Rate
Heart Ventricles
Hemodynamics
Humans
Male
Middle Aged
Mitral Valve
Monitoring, Intraoperative
Stroke Volume
Time Factors
Ventricular Function, Left
jenkins-FCD Prod-409 d1e206b0be345926047b0d9c353c78a4cce4058b