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Intraoperative assessment of right ventricular volume and function
Raffaele De Simone1, Ivo Wolf, Sibylle Mottl-Link
1Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. r.de.simone@urz.uni-heidelberg.de
Summary
Three-dimensional echocardiography offers a novel, non-invasive method for assessing right ventricular function during surgery. This technique accurately measures right ventricular ejection fraction, providing crucial data for patient management.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiac Surgery
Background:
- Right ventricular function is critical for overall cardiac performance and patient outcomes post-cardiac surgery.
- Assessing right ventricular function is challenging due to its complex geometry.
- Existing methods for intraoperative assessment have limitations.
Purpose of the Study:
- To evaluate a new transesophageal 3D-echocardiography technique for intraoperative right ventricle assessment.
- To compare this novel technique against volumetric thermodilution using advanced pulmonary artery catheters.
Main Methods:
- Simultaneous intraoperative measurements using 3D-echocardiography and thermodilution in 25 coronary artery disease patients.
- Analysis of right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV), and ejection fraction (RVEF).
- Segmentation of right ventricular volumes using the 'Coons-Patches' technique within the EchoAnalyzer system.
Main Results:
- 3D-echocardiography and thermodilution showed poor correlation for RVEDV and RVESV, with thermodilution overestimating volumes.
- Strong correlation found between RVEF measured by 3D-echocardiography and thermodilution (r=0.93).
- Bland-Altmann analysis indicated thermodilution systematically underestimates RVEF by 15.6% (precision +/-4.3%). Patients with impaired left ventricular function had significantly lower RVEF.
Conclusions:
- 3D-echocardiography is a valuable non-invasive tool for intraoperative and serial assessment of right ventricular function.
- This technique overcomes limitations of prior methods, offering new insights into managing patients with cardiac dysfunction.
- The findings support the use of 3D-echocardiography for improved patient care and outcome prediction.