INTRAOPERATIVE DOPPLER MEASUREMENT OF HEPATIC VEIN FLOW BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY DOES NOT PREDICT RIGHT ATRIAL PRESSURE

Abstract

S86 INTRODUCTION: The evaluation of left atrial pressure by TEE has been extensively studied. A smaller amount of data exists on the non-invasive measurement of right atrial pressure (RAP). Currently, validated echocardiographic indicators of RAP include inferior vena cava collapse during spontaneous inspiration and hepatic vein flow patterns. IVC dynamics have not been studied in TEE, and have limited value in mechanically ventilated patients. TEE could offer a quick and non-invasive way to determine central venous pressure in acutely hypotensive patients who do not have central venous catheters. We hypothesized that Doppler parameters of hepatic vein flow measured by TEE would correlate well with RAP in intraoperative patients. METHODS: We prospectively studied 47 patients undergoing routine TEE during cardiac surgery. With the chest closed, we measured the central venous pressure (CVP) and recorded pulsed wave Doppler tracings of hepatic vein flow. A blinded observer then made off-line measurements of peak systolic (Vs) peak diastolic (Vd) and peak atrial (Va) velocity, velocity-time integrals of the systolic (VTIs), diastolic (VTId) and atrial (VTIa) waves, and Vs/Vd, Vs/(Vs+Vd), and VTIs/(VTIs+VTId). RESULTS: Of all the measurements made, four parameters correlated weakly with the CVP: Vd (r=0.40, P<0.005) Vs/Vd (r=0.29, P=0.04) Vs/Vs+Vd (r=0.43, P=0.002) and VTIs/VTIs+VTId (r=0.33, P=0.02). All other parameters did not correlate with CVP. CONCLUSION: We conclude that Doppler parameters of hepatic vein flow measured by TEE are poor predictors of CVP in ventilated patients intraoperatively.