Echocardiography, Transesophageal, Ventricular Function, Right
Conditions
Brief summary
Transesophageal echocardiography (TEE) is becoming a more prevalent method of monitoring and diagnosis in the perioperative setting for critically ill patients and patients undergoing cardiac surgery. Many TEE measurements are extrapolated from transthoracic echocardiography (TTE) data and have not validated by transesophageal means. The aim of this study is to validate TEE assessment of right ventricular function by comparing them to simultaneously measured TTE measurements. Likewise, there are currently no agreed upon values for RV free wall strain. Therefore, the investigators will attempt to define a range of normal values of RV free wall strain as compared to the other measures of RV function.
Detailed description
Traditionally, all echocardiographic measurements have been studied utilizing TTE. Therefore the normal values and ranges for pathology findings have been defined by transthoracic means alone. TEE offers different images planes when compared to TTE, which may make the measurements obtained differ from those obtained by TTE. In the operating room environment the vast majority of echocardiography is completed by transesophageal means for many reasons; largely access to the patient and the continuous use of TEE as a hemodynamic monitor. However, given the fact that most echocardiographic measurements have only been validated by TTE, there remains a question as to the validity or precision of TEE-derived measurements.
Interventions
DIAGNOSTIC_TESTTransesophageal Echocardiography
TEE measures of right ventricular function
DIAGNOSTIC_TESTTransthoracic Echocardiography
TTE measures of right ventricular function
Sponsors
Milton S. Hershey Medical Center
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients undergoing elective cardiac surgery requiring TEE
Exclusion criteria
* Patient who do not wish to consent * Patients with contraindications to TEE * Urgent or emergent cardiac surgery * Patients with preexisting open chest * Patients with intrathoracic hardware (VAD, thoracostomy tube, etc) * Non-English speaking subjects * Cognitively impaired adults * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tricuspid annular plane systolic excursion (TAPSE) | Immediately following the induction of anesthesia and TEE probe placement | Tricuspid annular plane systolic excursion (TAPSE) will be measured using both TTE and TEE. |
| RV annular systolic velocity (S') | Immediately following the induction of anesthesia and TEE probe placement | RV annular systolic velocity (S') will be measured using both TTE and TEE. |
| RV free wall longitudinal strain | Immediately following the induction of anesthesia and TEE probe placement | RV free wall longitudinal strain will be measured using both TTE and TEE. |
| Right ventricular index of myocardial performance (RIMP) | Immediately following the induction of anesthesia and TEE probe placement | Right ventricular index of myocardial performance (RIMP) will be measured using both TTE and TEE. |
| Right ventricular fractional area change (FAC) | Immediately following the induction of anesthesia and TEE probe placement | Right ventricular fractional area change (FAC) will be measured using both TTE and TEE. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Define values for normal right ventricular free wall strain | Through study completion, an estimate of 1 year | The data collected will be used to define normal values for right ventricular free wall strain |
| Ease of obtaining appropriate TEE measures of right ventricular function | Within 15 minutes following anesthesia induction | Ease of acquisition will be assessed by the echocardiographers |
Countries
United States
Outcome results
None listed