CLINICAL DETERMINATIONS OF VOLUMES OF NORMAL AND ANEURYSMATIC LEFT-VENTRICLES BY 3-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Biplane methods of determining Left ventricular volumes are inaccurate in. the presence of aneurysmal distortions. Multiplane transesophagea l echocardiography, which provides multiple, unobstructed cross-sectio nal views of the heart from a single, stable position has the potentia l for more accurate determinations of volumes of irregular cavity form s than the biplane methods. The aim of the study was to determine the feasibility of three-dimensional measurements of ventricular volumes i n patients with normal and aneurysmatic left ventricles by using multi plane transesophageal echocardiography. With the echotransducer in the mid-esophageal (transesophageal) position, nine echo cross-sectional images of the left ventricle in similar to 20 degrees angular incremen ts were obtained from each of 29 patients with coronary artery disease who had undergone biplane ventriculography during diagnostic cardiac catheterization. In 17 of these 29 patients, echo cross-sectional imag es of the left ventricle with the echotransducer in transgastric posit ion were also obtained. End-diastolic volume, end-systolic volume, and ejection fraction were determined from multiplane transesophageal ech ocardiographic images and biplane ventriculographic images by the disc -summation method and compared with each other. In another ten. patien ts with indwelling pulmonary artery catheters, stroke volumes calculat ed from multiplane transesophageal echocardiographic images were compa red with those derived fi om thermodilution. cardiac output measuremen ts. Correlations between biplane ventriculographic and multiplane tran sesophageal echocardiographic measurements were higher in the ten pati ents with normal ventricular shape [for end-diastolic volumes, r = 0.9 1, SEE = 19 ml; for end-systolic volumes, r = 0.98, SEE = 9.3 mi; for ejection fractions (EFs), r = 0.91, SEE = 5.4%] than in the 19 patient s with ventricular aneurysms (for end-diastolic volumes, r = 0.61, SEE = 31.5 ml; for end-systolic volumes, r = 0.66, SEE = 32.5 ml; for EFs , r = 0.79, SEE = 8%). Correlations between echocardiographic volumes from the transesophageal and transgastric transducer positions were hi gh independent of left ventricular geometry (for end-diastolic volumes , r = 0.84, SEE = 13.1 mi; for end-systolic volumes, r = 0.98 SEE = 9. 6 ml; for EFs, r = 0.97, SEE = 3.4%). In 12 observations (4 normal and 8 aneurysmal) from the ten, patients with indwelling pulmonary artery catheters, correlation between stroke volumes determined from thermod ilution cardiac output measurements and those derived from multiplane transesophageal echocardiographic images was high (r = 0.91, SEE = 6 m i). The results indicate that three-dimensional measurements of volume s of irregular and distorted left ventricles are feasible with multipl ane transesophageal echocardiography. This method may be more accurate than. biplane methods, especially in the presence of Left ventricular aneurysms.