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Assessment of ventricular function and prediction of ventricular assist device removal by transesophageal echocardiography

Assessment of ventricular function and prediction of ventricular assist device removal by transesophageal echocardiography

JAW Vol. 17. No. Z February I991:3§A of obstruction g2*37 at&l& Results were compared with TEE studies in 10 normal controls. TEE studies pro ed su...

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JAW Vol. 17. No. Z February I991:3§A

of

obstruction

g2*37 at&l& Results were compared with TEE studies in 10 normal controls. TEE studies pro ed superb anatomic detail of the mitral leaflets (ML), length and systolic anterior motion (SAW. : Pts. with obstructive HC ComeroPs with anterior le mm and posterior leaflet length of 20&4 mm s 15+> mm. In all cases there was anterior ML-septal contact. The mitral regurgitation (MR) was almost always directed posteriorly through a funnel created by incomplete mid ML coaptaeion ae the level of the bend in the anterior 2228 1226 5.592.7 2226 2.1k2.3 wl : Pts. with obstructive have longer ML Wi both leaflets but only terior leafleeseptal contact. TEE studies provide anatomic confirmation that the f!iR is due to lack of coaptaeion to an eccentric posteriorly dfreceed operatively with return of normal upp dimensions ehere is normalization of mier and marked reduction or abolition of the

ete~i~ed-compared & he corpe~ation (r) and agree

Pre-op Post-op

AL ECHO IN EJECTION Stephen J. Lenhoff, Blair MacPhail, Mike1 0. Smith, Oi Ling Kwan, David C. Booth, John C. Gurley, and Anthony N. DeMaria. University of Kentucky & VA Medical Cznters, Lexington, KY Recent advances in transesophageal echo (TEE) have allowed biplane imaging of the LV in orthogonal views. However, no data are available regarding the relative accuracy of estimating LV biplane diastolic (EDV) and systolic (ESV) volumes and ejection fraction (EF) by TEE. Therefore, we studied 13 pts with coronary artery disease who had TEE with biplane imaging and in whom LV volumes and EF were obtained by ventriculography (CINE). Biplane TEE was performed in apical &chamber (4CH) and P-chamber (2CH) equivalent views. TEE EDV and ESV were obtained by tracing endocardial borders from videotapes and applying a modified Simpson's rule algorithm. Biplane TEE volumes and EF were calculated as averages of 4CH and 2CH values. Single plane RAO CINE volumes were obtained using a calibrated grid. Correlations vs. CINE showed: EDV 4CH

2CH BP

r 80 :67 .76

ESV

SEE(ml1 21 20 19

r LF SEE

.66 .88

ii

86 :67 .87

8 12 7

TEE volumes underestimated CINE volumes in all cases (p c .02). Correiation of EDV, ESV and EF were higher for 4CH than 2CH views, possibly due to paoillary muscle encroachment or image foreshorteni,\g. Thus, TEE underestimates angiographic LV volumes and EF, perhaps due to foreshortening of the long axis. Biplane averaging of 4CH and 2CH views appears to offer no advantage over standard TEE 4CH slices in estimating LV volumes and EF.

itral

and 'r0.

ASSESSMENT OF VENTRICULAR VENTRICULAR ASSIST DEVICE ECHOCAPOIOGRAPHY

Victor

G. Oavila-Roman,

Thomas

H.

Washington

blareing,

Benico Nicholas

University,

FUNCTION AND PREDICTION OF REMOVAL BY TRANSESOPHAGEAL

St.

Barzilai,

T.

Mark

Eaton,

Kouchoukos.

Louis,

The use of ventricular assist devices (VAD) in the treatment of cardiogenic shock following cardiac surgery has steadily increased. The timing for the removal of these devices is critical, and is guided by hemodynamic parameters and techniques such as transthoracic nchocardiography and radionuclide imaging. Transesophageal echocardiography (TEE) has been found to be an effective technique for the real-time assessment of myocardial and valvular function. To deteni,ine the predictive value of TEE in the optimal timing for VAD withdrawal, we performed daily TEE at the bedside in 11 patients after insertion of VAD. Six left view (papillary

ventricular

segments

in

the

short

axis

muscle level) were analyzed. A wall motion score was assigned to each segment based on a semiquantitative assessment of wall motion (l=normal, 2=hypo, 3=akinetic, 4=dyskinetic). The scores were added and the initial and last studies were c~pared in those patients

weaned

(W) to those wh TEE LV Wall

re not weaned (PJW). on Score (mean I SD)

p value In:;i;l*S;u;y L;h pr;d; eaned (n=5) 1510 f 2:1 14:2 f 1:6 ot weaned (n=6) Results: l.The initia study mean score (W and N improvement in score comparable (p=NS); 2. had a greater than NW; 3.Timing of VAD removal was based on hemodynamic and TEE findings; 4,Localized pericardial thrombus seen by TEE was compr&nising VAD flow in 2 patients; this improved after clot decompression. Thus, TEE is useful of patients on ventricuiar assist for the assessment aning. and predicts successful dev ice support