A. Maslow et al., PULSED WAVE DOPPLER MEASUREMENT OF CARDIAC-OUTPUT FROM THE RIGHT-VENTRICULAR OUTFLOW TRACT, Anesthesia and analgesia, 83(3), 1996, pp. 466-471
Doppler ultrasound can be used to measure cardiac output (CO). Intraop
erative Doppler cardiac output (DCO) by transesophageal echocardiograp
hy (TEE) has been studied using blood flow velocity from the left vent
ricular outflow tract (LVOT), the mitral valve (MV), and the main pulm
onary artery (MPA). The purpose of this study was to compare DCO, meas
ured from a relatively new TEE view of the right ventricular outflow t
ract (RVOT), with thermodilution cardiac output (TDCO). We also compar
ed changes in DCO from the RVOT to changes in TDCO. A 5.0/3.7 MHz mult
iplane TEE probe was placed in 45 adult cardiac surgical patients unde
rgoing general anesthesia. Patients were excluded if there was greater
than mild tricuspid valve insufficiency. From the transgastric view,
at approximately 110-140 degrees, the RVOT was imaged. DCO was calcula
ted from 1) the time-velocity integral (TVI) using pulse wave (PW) Dop
pler, 2) the area of the RVOT (measured in early systole using the dia
meter (pi(D/2)(2)) of the RVOT at the level of the PW Doppler sample v
olume), and 3) the heart rate. Simultaneous TDCO was performed by a se
parate examiner. The RVOT was imaged satisfactorily in 84% of patients
(38/45). The mean bias between DCO and TDCO was -0.01 L/min (2 SD +/-
0.45 L/min; n = 38). There was good correlation between DCO and TDCO
(R(2) = 0.97). Changes in TDCO and changes in DCO were compared in 15
patients. The mean bias between changes in DCO and changes in TDCO was
0.04 L/min (2 SD +/- 0.66 L/min). Analysis of the changes in DCO and
TDCO showed good correlation (R(2) = 0.96). We conclude that there is
a good correlation between DCO measured from the RVOT and TDCO. This t
echnique permits cardiac output measurement without the necessity of p
lacing a pulmonary artery catheter, and it also provides a method of e
valuating RVOT blood flow.