Diagnosis of Left Ventricular Outflow Tract-Right Atrial Shunt Using Color Flow Doppler and Transesophageal Echocardiography

Background: Left ventricular (LV) outflow tract (LVOT) obstruction increases mortality in patients undergoing transcatheter mitral valve implantation (TMVI) in degenerated bioprostheses, annuloplasty rings, and native mitral valves. We aimed to evaluate the left ventricular outflow tract area after TMVI using 3-diensional (3D) transesophageal echocardiography (TEE) and to investigate the pre-procedural cardiac geometry affects the LVOT area after TMVI. Methods: We retrospectively reviewed echocardiography data in 43 patients who had TMVI. A change in pressure gradient across LVOT from before to after TMVI (∆PG) and post-procedure 3D cross sectional area (CSA) at the level of the most distal portion of the mitral valve stent that was closest to the LV apex were assessed as evidence of LVOT narrowing. Results: TMVI with the use of balloon-expandable valve system was performed for 24 bioprostheses, 7 annuloplasty rings, and 12 native valves. Compared to patients without increase in LVOT gradient (∆PG <10 mmHg; n=33), patients with increase in LVOT gradient (∆PG ≥10 mmHg; n=10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF) and smaller aorto-mitral (AM) angle. CSA at the valve stent distal edge showed strong association with ∆PG (r=-0.68, P<0.0001). Only small AM angle was associated with small CSA at the valve stent ventricular edge on multivariable analysis, independent of LVESV and LVEF. Conclusion: Pre-procedural AM angle as well as LVESV and LVEF were associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-in-ring, and valve-in-native valve implantation. These data may be useful for preprocedural planning.

Download Full-text

The Left Ventricular Outflow Tract Changes in Size and Shape From Pre- to Post-Cardiopulmonary Bypass: Three-Dimensional Transesophageal Echocardiography

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.10.026 ◽

2020 ◽

Cited By ~ 1

Author(s):

Caroline Hunter ◽

Tzonghuei Chen ◽

Michelle Gorgone ◽

Patricia Apruzzese ◽

Feroze Mahmood ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Transesophageal Echocardiography ◽

Left Ventricular Outflow Tract ◽

Three Dimensional ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Size And Shape ◽

Left Ventricular Outflow ◽

Post Cardiopulmonary Bypass

Download Full-text

Intraoperative Determination of Cardiac Output Using Multiplane Transesophageal Echocardiography

Anesthesiology ◽

10.1097/00000542-199808000-00010 ◽

1998 ◽

Vol 89 (2) ◽

pp. 350-357 ◽

Cited By ~ 128

Author(s):

Albert C. Perrino ◽

Stephen N. Harris ◽

Martha A. Luther

Keyword(s):

Cardiac Output ◽

Transesophageal Echocardiography ◽

Continuous Wave ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Continuous Wave Doppler ◽

Imaging Array ◽

Left Ventricular Outflow

Background Limitations in the imaging views that can be obtained with transesophageal echocardiography (TEE) have hindered development of a widely adopted Doppler method for cardiac output (CO) monitoring. The authors evaluated a CO technique that combines steerable continuous-wave Doppler with the imaging capabilities of two-dimensional multiplane TEE. Methods From the transverse plane transgastric, short-axis view of the left ventricle, the imaging array was rotated to view the left ventricular outflow tract (LVOT) and ascending aorta. Steerable continuous-wave Doppler was subsequently used to measure aortic blood flow velocities. Aortic valve area was determined using a triangular orifice model. Matched thermodilution and Doppler CO measurements were obtained serially during surgery. Results The left ventricular outflow tract was imaged in 32 of 33 patients (97%). Data analysis reveal a mean difference between techniques of -0.01 l/min, and a standard deviation of the differences of 0.56 l/min. Multiple regression showed a correlation of r = 0.98 between intrasubject changes in CO. Multiplane TEE correctly tracked the direction of 37 of 38 serial changes in thermodilution CO but with a modest 14% underestimation of the magnitude of these changes. Conclusions These results indicate that multiplane TEE can provide an alternative method for the intraoperative measurement of CO. The ability of the rotatable imaging array to align with the left ventricular outflow tract and the need for only minimal adjustments in probe position advance the utility of intraoperative TEE.

Download Full-text