Kenneth R. LaMantia

Yale University

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Paul G. Barash

Yale University

Albert C. Perrino

Yale University

Charles J. Kopriva

Yale University

Michael D. Ezekowitz

Lankenau Institute for Medical Research

John Fleming

University Hospital Southampton NHS Foundation Trust

Terence D. Rafferty

Yale University

Henry K. Godek

Yale University

David D. Jaeger

Yale University

Elizabeth A. Davis

Princess Margaret Hospital for Children

Edward K. Prokop

Yale University

Cooperative Institutions

Yale University

Yale New Haven Hospital

University of Pennsylvania

Duke University

University of New Haven

Massachusetts General Hospital

Hospital of the University of Pennsylvania

Duke Medical Center

Harvard University

Icahn School of Medicine at Mount Sinai

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Transesophageal Doppler Ultrasonography

Anesthesia & Analgesia (1990)

Albert C. Perrino Julia Fleming Kenneth R. LaMantia

Cardiac output monitoring by transesophageal Doppler ultrasound has not gained wide clinical acceptance. A recently developed transesophageal Doppler device, Accucom 2, features technological advances aimed to reduce the error of this approach to the monitoring of cardiac output. To determine if Accucom 2 enables more accurate cardiac output monitoring, a prospective investigation was undertaken. Analyses of 923 simultaneous measurements of transesophageal Doppler and thermodilution cardiac output in 47 anesthetized patients were compared. Results using Accucom 2 were highly correlated with the results obtained with thermodilution (R = 0.91) and provided significantly greater accuracy in comparison with a previously developed Doppler cardiac output monitor, Accucom 1. Technological advances in transesophageal Doppler ultrasound hold promise for clinically useful noninvasive monitoring of cardiac output.

Doppler ultrasound

Cardiac Ultrasound

10.1213/00000539-199012000-00013

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Citations (42)

Quality Assurance for Intraoperative Transesophageal Echocardiography Monitoring

Survey of Anesthesiology (1993)

Terence D. Rafferty Kenneth R. LaMantia Ellie Davis Daniel B. Phillips Susan R Harris

RAFFERTY, T.; LaMANTIA, K. R.; DAVIS, E.; PHILLIPS, D.; HARRIS, S.; CARTER, J.; EZEKOWITZ, M.; McCLOSKEY, G.; GODEK, H.; KRAKER, P.; JAEGER, D.; KOPRIVA, C.; BARASH, P. Author Information

10.1097/00132586-199310000-00011

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Evaluation of transoesophaeal doppler 140nitoring in patients with severe aorto-iliac disease

Journal of Cardiothoracic and Vascular Anesthesia (1992)

Albert C. Perrino John Fleming Kenneth R. LaMantia

10.1016/1053-0770(92)90452-d

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Transesophageal color flow Doppler imaging for aortic insufficiency in patients having cardiac operations

Journal of Thoracic and Cardiovascular Surgery (1992)

Terence D. Rafferty Michael Durkin Dean F. Sittig Michael Ezekowitz Kenneth R. LaMantia

Transesophageal color flow Doppler findings were studied in 30 patients with aortic insufficiency who had cardiac operations. Measurements were expressed as ratios of corresponding left ventricular outflow tract dimensions. Regurgitant jet proximal width ratio was significantly related to jet area ratio (r = 0.92) and correlated poorly with the degree of jet penetration into the left ventricular cavity (r = 0.32). The vectors of the regurgitant jets were variable. Nine patients had undergone aortography. Regurgitant jet proximal width and area ratios were significantly related to angiographic grade (r = 0.88 and 0.87, respectively) in these patients. We concluded that the esophagus offers a satisfactory transducer orientation for color flow Doppler assessment of aortic insufficiency.

Ventricular outflow tract

Aortography

Color doppler

10.1016/s0022-5223(19)34815-9

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Transesophageal Doppler Cardiac Output Monitoring

Anesthesia & Analgesia (1991)

Albert C. Perrino Julia Fleming Kenneth R. LaMantia

Transesophageal Doppler (TED) monitoring provides continuous, noninvasive monitoring of cardiac output by measurement of aortic flow velocities. Because of the effects on aortic flow dynamics resulting from atherosclerosis, aortic cross-clamping, and wide variations in arterial blood pressure, the validity of TED monitoring during aortic surgery is unresolved. The authors prospectively evaluated a second-generation TED cardiac output monitor in 42 patients undergoing aortic reconstructive surgery. Four hundred eighty-nine simultaneous measurements of TED and thermodilution cardiac output were obtained. Transesophageal Doppler measurements were highly correlated to thermodilution measurements (R = 0.94); however, Bland-Altman analysis revealed a moderate error in the TED measurements (2 SD of the bias = 1.4 L/min). Trending analysis showed that TED monitoring accurately tracked changes in thermodilution cardiac output. Placement of an aortic cross-clamp resulted in significant reductions in the accuracy of Doppler measurements. Arterial blood pressure variations did not systematically affect the accuracy of the transesophageal technique. Limitations of TED monitoring, including a difficult calibration procedure, poor performance during aortic cross-clamping, and the need for probe repositioning, suggest further development is warranted.

10.1213/00000539-199112000-00006

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Citations (43)

PROTAMINE REQUIREMENT FOLLOWING CARDIOPULMONARY BYPASS IN CHILDREN

Anesthesia & Analgesia (1987)

Tae Hee Oh Kenneth R. LaMantia Jeffrey Ngeow Gary S. Kopf

*Department of Anesthesiology, Yale University School of Medicine, New Haven, CT +Department of Surgery, Yale University School of Medicine, New Haven, CT

10.1213/00000539-198702001-00130

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Measurement of Cardiac Output By Transesophageal Pulsed Wave Doppler

Anesthesia & Analgesia (1990)

Kenneth R. LaMantia J. Carter Elizabeth A. Davis Michael D. Ezekowitz

LaMantia, K. R. M.D.; Carter, J. M.D.; Davis, E. LPN; Ezekowitz, M. M.D. Author Information

10.1213/00000539-199002001-00224

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Quality Assurance for Intraoperative Transesophageal Echocardiography Monitoring

Anesthesia & Analgesia (1993)

Terence D. Rafferty Kenneth R. LaMantia Elizabeth A. Davis Daniel Phillips Stephen N. Harris

We evaluated our experience with 846 consecutive transesophageal echocardiography (TEE) intraoperative monitoring procedures performed between November 1989 and July 1991. TEE frequency was 36 +/- 11 per month (range 16-55) and represented 69.8% of cardiac valve surgery cases, 40.2% of coronary artery bypass graft cases, and 2.2% of total operative caseload. Major patient complications consisted of transient vocal cord paresis and ingestion of glutaraldehyde-disinfectant solution. Minor complications consisted of a chipped tooth (one case) and pharyngeal abrasions (three cases). The Quality Assurance (Q/A) Program evaluated both record keeping and quality of imaging, as judged by cardiologist echocardiographer reviewers. The percentage of completion for each Q/A indicator was as follows: medical record documentation, 88%; database form annotation, 94%; and provision of videotape recording, 91%. TEE database forms were analyzed further in terms of the percentage of fields completed. Completion scores were 73%. The following scoring system was utilized for videotape evaluation by the cardiologists: 1 = excellent; 2 = good; 3 = poor. The median grade for both two-dimensional echocardiography and color flow Doppler (CFD) examinations was 2. Poor quality images (grade 3) were present in 15.2% of two-dimensional echocardiography and 20.3% of color flow Doppler examinations, and disproportionately associated with 4/26 attendings. Supplemental audit of the cardiology reviewers performance demonstrated 569/846 videotapes showed no objective evidence of review. The cardiology reviewer forms of the remaining 277 videotapes were evaluated in terms of the percentage of fields completed. The completion score was 56%. These data suggest the need for formal Q/A for intraoperative TEE, both for anesthesiologists and reviewing cardiologists.

Medical record

10.1213/00000539-199302000-00005

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Citations (33)

HEMODYNAMIC EFFECTS OF PANCURONIUM VS. VECURONTIIM DURING SUFENTANTL INDUCTION FOR CABG

Anesthesiology (1985)

Ben J. Shulman John Manos Barry I. Feinberg Cristina Mora Kenneth R. LaMantia

Pancuronium bromide

10.1097/00000542-198509001-00099

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DIASTOLIC FUNCTION DURING CABG

Anesthesiology (1989)

J. E. Carter Kenneth R. LaMantia L. A. Davis Ezekowitz

10.1097/00000542-198909001-00046

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Citations (1)