CLINICAL ESTIMATION OF LEFT AND RIGHT-VENTRICULAR VOLUME WITH OPEN-CHEST COMPARED WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND FAST-RESPONSE THERMODILUTION

Objective: A clinical measure-inspection of the relation of the heart (acute margin) to the diaphragm-has shown a strong positive correlatio n to transesophageal echocardiographic (TEE) determination of left ven tricular end-diastolic area (LVEDA) during weaning from cardiopulmonar y bypass (CPB). She present study examines the correlation between rig ht ventricular end-diastolic volumes (RVEDV) before and after CPB when using the same clinical measure of left ventricular dimension. Design : Prospective study. Setting: Operating room, university hospital. Par ticipants: Patients scheduled for elective coronary artery bypass graf ting.Interventions: After induction of anesthesia and endotracheal int ubation, a transesophageal echo-probe was inserted. A pulmonary artery right ventricular ejection fraction/volumetric TD catheter was placed in the pulmonary artery. Measurements and Main Results: Before going on CPB, a mark was made with cautery at the line of contact between th e acute margin and the diaphragm, After CPB, the patients were transfu sed to the same level. At these two times, TEE recordings of the LVEDA and hemodynamic measurements including calculations of RVEDV were obt ained. The LVEDA before and after CPB showed a positive correlation, r = 0.81, p < 0.001. The RVEDV after CPB showed a weak correlation, r = 0.54, p < 0.05, to RVEDV before CPB. There were no significant change s in right ventricular (RV) wall tension calculated as right atrial pr essure x RVEDV and pulmonary artery systolic pressure x right ventricu lar end systolic volume products. The only significant change regardin g hemodynamic parameters was a decrease in mean arterial pressure. Con clusions: It is concluded that there is only a weak correlation regard ing RVEDV before and after OPE when the patient is transfused to the l ine of contact, whereas this clinical measure correlates well with LVE DA. (C) 1995 by W.B. Saunders Company