The Role of Epicardial Echocardiography in the Measurement of Transvalvular Flow Velocities During Aortic Valve Replacement

Taneja, Ravi; Quaghebeur, Bert; Stitt, Larry W.; Quantz, Mackenzie A.; Guo, Lin R.; Kiaii, Bob; Bainbridge, Daniel T.

doi:10.1053/j.jvca.2009.01.007

« Previous Next »Journal of Cardiothoracic and Vascular Anesthesia
Volume 23, Issue 3 , Pages 292-297, June 2009

The Role of Epicardial Echocardiography in the Measurement of Transvalvular Flow Velocities During Aortic Valve Replacement

Presented at the American Society of Anesthesiologists Meeting, San Francisco, CA, October 14, 2007.

Ravi Taneja, FRCA
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
- Address reprint requests to Ravi Taneja, MBBS, MD, FFARCSI, FRCA, Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
Bert Quaghebeur, MD
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
Larry W. Stitt, MSc
- Department of Epidemiology and Biostatistics, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
Mackenzie A. Quantz, FRCSC
- Division of Cardiovascular and Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
Lin R. Guo, MD
- Division of Cardiovascular and Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
Bob Kiaii, FRCSC
- Division of Cardiovascular and Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
Daniel T. Bainbridge, FRCPC
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada

Objective

The purpose of this study was to compare transvalvular flow velocities obtained by transesophageal echocardiography and epicardial echocardiography (EE) during aortic valve replacement (AVR).

Design

Prospective observational study.

Setting

University hospital.

Participants

Patients undergoing AVR for aortic stenosis.

Interventions

After institutional review board approval, 17 patients undergoing AVR consented. Deep transgastric (deep TG LAX) and transgastric long-axis (TG LAX) views and epicardial aortic valve long-axis views (S8 probe) were obtained on a SONOS 5500 (Phillips Medical Systems, Bothell, WA) before and after AVR. Transvalvular flow velocity and velocity time integral (VTI) were recorded via each technique. Measurements were made offline by 2 independent reviewers. Agreement between measurements made by different views was evaluated by using Bland-Altman analysis.

Measurements and Main Results

The epicardial probe was well tolerated. Quality images were obtained in all patients with TEE and 30 of 34 studies via epicardial scanning. The mean bias for peak velocities derived through EE and deep TG LAX was 96.3 cm/s (95% confidence interval [CI], 51.1-141.4) before AVR and 58 cm/s (95% CI, 32.4-83.7) after AVR. The mean bias for peak velocities between EE and TG LAX was 70 cm/s (95% CI, 31.1-108.9) before and 84.7 cm/s (95% CI, 55.6-113.7) after AVR. Similar results were obtained for VTI.

Conclusions

Peak transaortic valve velocities and VTI measured with epicardial echocardiography are higher in comparison to measurements via TEE in patients undergoing AVR. The precise role of epicardial echocardiography in the comprehensive echocardiographic examination of patients undergoing aortic valve replacement needs further evaluation.

Key Words: transesophageal, epicardial, echocardiography, transvalvular velocities, aortic valve