Transit Time Ultrasound Research Articles

Analysing the Impact on Morbidity and Mortality of Eliminating Competitive Flow in Coronary Artery Bypass Grafts to Left Anterior Descending Artery Using Transit Time Ultrasound

Analysing the Impact on Morbidity and Mortality of Eliminating Competitive Flow in Coronary Artery Bypass Grafts to Left Anterior Descending Artery Using Transit Time Ultrasound

Transit time ultrasound perivascular flow probe technology is superior to MR imaging on hepatic blood flow measurement in a porcine model

BackgroundThe hepatic hemodynamics is an essential parameter in surgical planning as well as in various disease processes. The transit time ultrasound (TTUS) perivascular flow probe technology is widely used in clinical practice to evaluate the hepatic inflow, yet invasive. The phase-contrast-MRI (PC-MRI) is not invasive and potentially applicable in assessing the hepatic blood flow. In the present study, we compared the hepatic inflow rates using the PC-MRI and the TTUS probe, and evaluated their predictive value of post-hepatectomy adverse events. MethodsEighteen large white pigs were anaesthetized for PC-MRI and approximately 75% hepatic resection was performed under a unified protocol. The blood flow was measured in the hepatic artery (Qha), the portal vein (Qpv), and the aorta above the celiac trunk (Qca) using PC-MRI, and was compared to the TTUS probe. The Bland-Altman method was conducted and a partial least squares regression (PLS) model was implemented. ResultsThe mean Qpv measured in PC-MRI was 0.55 ± 0.12 L/min, and in the TTUS probe was 0.74 ± 0.17 L/min. Qca was 1.40 ± 0.47 L/min in the PC-MRI and 2.00 ± 0.60 L/min in the TTUS probe. Qha was 0.17 ± 0.10 L/min in the PC-MRI, and 0.13 ± 0.06 L/min in the TTUS probe. The Bland-Altman method revealed that the estimated bias of Qca in the PC-MRI was 32% (95% CI: −49% to 15%); Qha 17% (95% CI: −15% to 51%); and Qpv 40% (95% CI: −62% to 18%). The TTUS probe had a higher weight in predicting adverse outcomes after 75% resection compared to the PC-MRI (β= 0.35 and 0.43 vs β = 0.22 and 0.07, for tissue changes and premature death, respectively). ConclusionsThere is a tendency of the PC-MRI to underestimate the flow measured by the TTUS probes. The TTUS probe measures are more predictive of relevant post-hepatectomy outcomes.

Comparison of Two Devices for Intraoperative Portal Venous Flow Measurement in Living-Donor Liver Transplantation: Transit Time Ultrasound and Conventional Doppler Ultrasound

BackgroundIntraoperative portal venous flow measurement provides surgeons with instant guidance for portal flow modulation during living-donor liver transplantation (LDLT). In this study, we compared the agreement of portal flow measurement obtained by 2 devices: transit time ultrasound (TTU) and conventional Doppler ultrasound (CDU). MethodsFifty-four recipients of LDLT underwent intraoperative measurement of portal flow after completion of vascular anastomosis of the implanted partial liver graft. Both TTU and CDU were used concurrently. Agreement of TTU and CDU was assessed by intraclass correlation coefficient using a model of 2-way random effects, absolute agreement, and single measurement. A Bland-Altman plot was applied to assess the variability between the 2 devices. ResultsThe mean, median, and range of portal venous flow was 1456, 1418, and 117 to 2776 mL/min according to TTU; and 1564, 1566, and 119 to 3216 mL/min according to CDU. The intraclass correlation coefficient of portal venous flow between TTU and CDU was 0.68 (95% confidence interval, 0.51–0.80). The Bland-Altman plots revealed an average variation of 4.8% between TTU and CDU but with a rather wide 95% confidence interval of variation ranging from −57.7% to 67.4%. ConclusionsIntraoperative TTU and CDU showed moderate agreement in portal flow measurement. However, a relatively wide range of variation exists between TTU and CDU, indicating that data obtained from the 2 devices may not be interchangeable.

Measurement of Cardiac Output Before and After Cardiopulmonary Bypass: Comparison Among Aortic Transit-Time Ultrasound, Thermodilution, and Noninvasive Partial CO2 Rebreathing

Measurement of Cardiac Output Before and After Cardiopulmonary Bypass: Comparison Among Aortic Transit-Time Ultrasound, Thermodilution, and Noninvasive Partial CO2 Rebreathing

Hemodynamic effects of acute and chronic administration of vapreotide in rats with cirrhosis.

The aim of this study was to assess the hemodynamic effects of acute and chronic administration of vapreotide, a somatostatin analog, in rats with intrahepatic portal hypertension induced by dimethylnitrosamine (DMNA) administration. Acute effects were evaluated at baseline and 30 min after placebo (N = 13) or vapreotide (8 /microg/kg/hr, N = 13) infusions in DMNA rats. Chronic hemodynamic effects were evaluated using subcutaneous implants for five weeks in anesthetized DMNA rats (placebo: N = 13, vapreotide: N = 13) and in sham rats (placebo: N = 10, vapreotide: N = 10). Hemodynamic measurements included splenorenal shunt blood flow (SRS BF) by the transit time ultrasound (TTU) method and cardiac output by the combined dilution-TTU method. Acute administration of vapreotide significantly decreased SRS BF (-17.3 +/- 19 vs - 1.1 +/- 14%, P < 0.05) and portal pressure (-8 +/- 9 vs 0 +/- 8%, p < 0.05) compared to placebo without systemic effects. Chronic administration of vapreotide significantly reduced the increase in SRS BF (2.4 +/- 1.5 vs 1.2 +/- 1.0 ml/min, P < 0.05) and cardiac index (50 +/- 15 vs 33 +/- 10 ml/min/100 g, P < 0.0001) while portal pressure and blood flow, and mean arterial pressure were not significantly changed compared to placebo. In conclusion, the acute administration of vapreotide decreased collateral circulation blood flow while chronic administration attenuated its development. Vapreotide seems to have a vasoconstrictive effect on collateral circulation.

New method of cardiac output measurement using ultrasound velocity dilution in rats.

The aim of this study was to validate a new technique for the measurement of cardiac output (CO) based on ultrasound and dilution (COUD) in anesthetized rats. A transit time ultrasound (TTU) probe was placed around the rat carotid artery, and ultrasound velocity dilution curves were generated on intravenous injections of saline. CO by COUD were calculated from the dilution curves for normal and portal hypertensive rats in which CO was known to be increased. COUD was compared with the radiolabeled microsphere method and with direct aortic TTU flowmetry for baseline CO and drug-induced CO variations. CO in direct aortic TTU flowmetry was the ascending aorta blood flow measured directly by TTU probe (normal use of TTU flowmetry). The reproducibility of COUD within the same animal was also determined under baseline conditions. COUD detected the known CO increase in portal hypertensive rats compared with normal rats. CO values by COUD were correlated with those provided by microsphere technique or direct aortic TTU flowmetry (adjusted r = 0.76, P < 10(-4) and r = 0.79, P < 0.05, respectively). Baseline CO values and terlipressin-induced CO variations were detected by COUD and the other techniques. Intra- and interobserver agreements for COUD were excellent (intraclass r = 0.99 and 0.98, respectively). COUD was reproducible at least 10 times in 20 min. COUD is an accurate and reproducible method providing low-cost, repetitive CO measurements without open-chest surgery. It can be used in rats as an alternative to the microsphere method and to direct aortic flowmetry.

Spleno-renal shunt blood flow is an accurate index of collateral circulation in different models of portal hypertension and after pharmacological changes in rats

Background/Aims: Recently, we developed a new method to measure collateral blood flow in rats: splenorenal shunt (SRS) blood flow (BF). The aims were to evaluate the reproducibility of SRSBF measurement in different models of portal hypertension, and to investigate the ability of SRSBF to disclose pharmacological changes.Methods: Hemodynamics were determined in anesthetized rats with secondary biliary, CCl4 or DMNA cirrhosis and portal vein ligation (PVL) under baseline and pharmacological (octreotide, vapreotide) conditions. The main measurements performed were: SRSBF by the transit time ultrasound (TTU) method and % portosystemic shunts (PSS) by the microsphere method.Results: SRSBF was 6 to 10 times higher in portal hypertensive rats and was similar in the different models of cirrhosis but was higher in portal vein ligated rats than in cirrhotic rats (1.1±0.7 vs 0.6±0.7 ml·min−1·100 g−1, p=0.01). SRSBF was correlated with mesenteric %PSS (r=0.61, p<0.01), splenic %PSS (r=0.54, p<0.05), portal pressure (r=0.32, p<0.05) and the area of liver fibrosis (r=0.33, p<0.05). Octreotide significantly decreased SRSBF (−23±20%, p<0.01 vs placebo: −6±8%, NS). Vapreotide significantly decreased SRSBF but not mesenteric or splenic %PSS compared to placebo. The variations in SRSBF (−26±32%) and in splenic %PSS (0±15%) with vapreotide were significantly different (p<0.05) and not correlated (r=−0.1, NS).Conclusions: Determination of SRSBF by TTU is an accurate way to measure collateral blood flow in different models of intra- and extra-hepatic portal hypertension in rats. Its sensitivity provides accurate measurement of pharmacological changes, unlike the traditional estimation of %PSS by the microsphere method.

Endoscopic Ultrasound Duplex Scanning for Measurement of Portal Venous Flow: Validation against Transit Time Ultrasound Flowmetry in Pigs

Background: Endoscopic ultrasound (EUS) is a new technique that makes it possible to measure portal venous flow when transabdominal ultrasound fails. As the technique has not been evaluated previously, we compared simultaneous measurements of portal venous flow using EUS Doppler with that of transit time ultrasound (TTU) in healthy pigs. The ability of EUS to detect changes in the portal venous flow after pharmacologic intervention was also investigated. Methods: Six anaesthetized pigs were studied. Portal venous flow was measured simultaneously by EUS duplex scanning, using a Pentax FG-32UA echoendoscope connected to a Hitachi EUB 515-A ultrasound scanner, and by TTU with a Cardiomed CM 4000 flowmeter probe placed on the portal vein. Terlipressin, 1 mg, and placebo were administered in a blind, randomized, crossover design. Measurements were taken at base line and 30 min after each drug administration. Results: Portal venous flow measured by EUS flowmetry and TTU flowmetry correlated significantly (R = 0.92, P < 0.001, n = 18). The limits of agreement in a Bland-Altman plot were from -0.262 l/min to +0.164 l/min. The change in portal venous flow after terlipressin measured by EUS and TTU correlated significantly (R = 0.88, P < 0.05, n = 6). All values used for analyses were the means of five repeated measurements. Conclusions: EUS measures portal venous flow with an acceptable correlation and agreement with TTU in anaesthetized pigs. The method is capable of monitoring the effects of pharmacologic intervention on the portal system.

Noninvasive analysis of renal artery blood flow dynamics with MR cine phase-contrast flow measurements.

It was the aim of this study to quantify the measurement of pulsatile flow in the renal artery with the noninvasive magnetic resonance cine phase-contrast (MRCPC) method and combine it with the simultaneous assessment of pulsatile flow with a transit-time ultrasound (TTUS) flowmeter. In seven foxhounds with a chronically implanted precalibrated TTUS flow probe, MRCPC flow measurements were made in the renal artery with a temporal resolution of 32 ms. Mean and pulsatile flow signal were compared by the simultaneous ipsi- or contralateral measurement of the renal blood flow signal by both methods (TTUS and MRCPC). In addition, comparative MRCPC and TTUS flow measurements were made with artificial renal artery stenosis and after the administration of angiotensin II. The mean flow data assessed by the noninvasive MRCPC flow measurements showed an excellent correlation with corresponding TTUS recording (r = 0.99). The MRCPC flow signal displayed a waveform of the renal artery flow profile that was very similar to the TTUS flow pulse. The hemodynamic changes induced by angiotensin II or due to renal artery stenosis were also reliably detected by MRCPC. MRCPC provides a reliable noninvasive method for the quantification of mean blood flow and the assessment of the pulsatile flow signal in the renal artery and proves to be sensitive to hemodynamic changes of pathophysiological importance. Alternatively, the method may be used for studies in physiology that demand a noninvasive approach.

Transit time ultrasound measurement of portal blood flow in cattle

Portal blood flow (PF) is central to the quantitative characterisation of dietary nutrient uptake. Dilution of PAH (p-aminohippurate) is unsuited to rapidly changing flow and visceral studies often use frequent-feeding to encourage “steady-state” digestion and absorption and minimise postprandial PF variation. Such data is of limited value to understanding nutrient flux and visceral responses to conventional feeding (once/twice daily) eg. insulin levels did not differ on similar ME intakes of frequently-fed (12x2h) forage or concentrates (Reynolds and Tyrrell, 1991) whereas in steers fed once daily, insulin was higher (P&lt;0.10) postprandially on a concentrate diet (Thorp et al., 1996). Transit-time ultrasound (TTU) gives real-time, continuous flow but the steer portal vein was regarded as anatomically unsuitable for TTU (Huntington et al., 1990) with PF of less than half those by PAH (20 vs 42ml/min/kg LW). The current study was initiated to monitor temporal PF changes by TTU in steers fed once-daily.

Transit time ultrasound measurement of portal blood flow in cattle

Portal blood flow (PF) is central to the quantitative characterisation of dietary nutrient uptake. Dilution of PAH (p-aminohippurate) is unsuited to rapidly changing flow and visceral studies often use frequent-feeding to encourage “steady-state” digestion and absorption and minimise postprandial PF variation. Such data is of limited value to understanding nutrient flux and visceral responses to conventional feeding (once/twice daily) eg. insulin levels did not differ on similar ME intakes of frequently-fed (12x2h) forage or concentrates (Reynolds and Tyrrell, 1991) whereas in steers fed once daily, insulin was higher (P&lt;0.10) postprandially on a concentrate diet (Thorp et al., 1996). Transit-time ultrasound (TTU) gives real-time, continuous flow but the steer portal vein was regarded as anatomically unsuitable for TTU (Huntington et al., 1990) with PF of less than half those by PAH (20 vs 42ml/min/kg LW). The current study was initiated to monitor temporal PF changes by TTU in steers fed once-daily.

Measurement of volumetric coronary blood flow by simultaneous intravascular two-dimensional and Doppler ultrasound: Validation in an animal model

We examined the accuracy and feasibility of using simultaneous intracoronary Doppler and two-dimensional (2D) ultrasound imaging in the measurement of volumetric coronary blood flow (CBF). A femoral artery-to-circumflex coronary artery shunt was created in four dogs with tubing that incorporated an in-line transit-time ultrasound (TTU) flow probe. A 2D ultrasound catheter was introduced over a 0.014-inch Doppler guide wire into the circumflex artery with the guide wire tip positioned 2 cm beyond the imaging catheter tip. Cross-sectional area (CSA) and average peak velocity (APV) were recorded. CBF was determined from the previously validated relation CBF = CSA × 0.5 APV and the adjusted measurement formula CBF = CSA × 0.47 APV. Within the 119 measurements made, TTU CBF varied from 31 to 385 ml/min. An excellent correlation was found between 2D/Doppler-derived and TTU CBF with both constants; measurement agreement was improved and bias minimal with the 0.47 constant (slope = 0.9997; r = 0.99; p < 0.0001; SEE = −6.7 ± 8.6). We conclude that simultaneous 2D and Doppler ultrasound yields accurate estimates of volumetric CBF.

Comparison of Changes in Transit Time Ultrasound, Esophageal Doppler, and Thermodilution Cardiac Output After Changes in Preload, Afterload, and Contractility in Pigs

The purpose of this study was to compare how well changes in cardiac output (CO) measured by esophageal Doppler (Doppler) and thermodilution (TD) followed changes in CO measured by transit time ultrasound (TTU). Simultaneous Doppler, TD, and TTU measurements of CO were made before and after changes in preload, afterload, or contractility in seven piglets. Mean changes in each CO method for each type of change in CO were compared by analysis of variance. Changes in TTU CO, TD CO, and Doppler CO were compared by correlation, linear regression, and bias and precision statistics. Of 86 TTU changes in CO greater than 10%, Doppler changed the same direction as TTU 59 times, changed in an opposite direction 6 times, and changes less than 10% 21 times. Thermodilution changed in the same direction as TTU 72 times, in the opposite direction 4 times, and changed less than 10% 10 times. Changes (% delta) in TTU and TD measurements of CO were not significantly different in any group. Changes in Doppler CO and TTU CO were different for two afterload and contractility groups. Percent changes in Doppler CO had a correlation coefficient (r) = 0.74, m = 0.72, and bias (mean % delta Doppler CO - mean % delta TTU CO) = 6.3 +/- 29.7 with % delta TTU CO. Percent changes in TD CO had an r = 0.90, m = 0.92, and bias = 5.7 +/- 19.1 with % delta TTU CO. Cardiac output measured by Doppler underestimated changes in CO due to changes in preload and contractility and exaggerated changes in CO due to changes in afterload.