Transesophageal Doppler Ultrasonography
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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.Keywords:
Doppler ultrasound
Cardiac Ultrasound
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Abstract Objective The sonographic technique of automated cardiac output measurement (ACM) is a promising new method to measure cardiac output and could be of use in a high‐risk obstetric unit in the treatment of pre‐eclamptic patients. The aim was to determine the accuracy of the ACM method. Design Comparative study of the sonographic technique of ACM versus cardiac output measured by thermodilution (TD). Methods The study included 39 intensive care patients, 21 men, 13 non‐pregnant women and five severely pre‐eclamptic pregnant patients, with a wide range of cardiac outputs, in whom TD catheters had been inserted for clinical reasons. Two separate experienced observers, blinded to the results obtained with the other method, performed four successive measurements in each patient with either the ACM or TD technique. The averaged cardiac output value per patient and method was used for comparison. Results Cardiac output was successfully measured with ACM and TD in 85 and 100% of patients, respectively. Mean cardiac output measured by ACM (6.77 ± 1.90 L/min) was significantly lower than that measured by TD (9.12 ± 3.06 L/min). Although cardiac output values obtained with ACM were significantly correlated with those measured by TD, the ACM values were consistently lower than TD values in the higher cardiac output range; the relationship was represented by ACM = 0.35 TD + 3.55 L/min ( r = 0.57, P < 0.001). The (ACM − TD) difference increased significantly with cardiac output, through a difference in stroke volume, not in heart rate. Conclusion The ACM is not an accurate tool to measure cardiac output in patients with a high cardiac output, including treated pre‐eclamptic women. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
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Objectives: To determine the velocity of heart valves’ flow in fit Sudanese males. Materials and Methods: The study was conducted on 160 men and the mean age was 44.2 years (mean age 44.2 ±9.7 years). Free from any heart problems. Different ultrasound modes were used in this survey. Results: The healthy participant males, show standard normal limits of heart valves’ mean velocity. In comparison to previous studies, there was no difference in the detected values. onclusion: The outcomes of the current survey indicate that the velocities of cardiac valves in Sudanese population correspond to those reported values in Western literature. So normal values of these Doppler parameters should be borne in mind for non-invasive cardiovascular function assessment. Keywords: Echocardiography; Velocity values; Valves; Healthy Males; Heart.
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Ultrasonography is proposed as a useful diagnostic aid for primary care physicians. This prospective study describes the demand for ultrasound examinations, excluding heart, vessels and pregnancy monitoring, in primary care in Switzerland. Eleven independent physicians requested an average of 2.7 ultrasound examinations per month and 18 residents 1.9 per month, which was similar to the figure of 2.2 obtained in a population-based study of 82 primary care physicians serving a region of 80, 000 inhabitants. Current demand for ultrasound scanning is low and does not indicate systematic training of primary care physicians until the efficacy of ultrasonography in this setting has been shown.
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To compare cardiac output measured by the transoesophageal Doppler and thermodilution techniques.Prospective direct comparison of paired measurements by both techniques in each patient.Intensive care unit in a cardiovascular centre.65 patients after open heart surgery (mean (SD) age 53 (12) years).Cardiac output was measured simultaneously by the transoesophageal Doppler and thermodilution techniques. Cardiac output was measured again after a mechanical intervention or volume loading.The limits of agreement were -2.53 to +0.83 1.min-1 for cardiac output measured by the Doppler and thermodilution techniques. This suggests that the Doppler method alone would not be suitable for clinical use. The second measurement of cardiac output by thermodilution was compared with cardiac output estimated from the first and second Doppler measurements and the first thermodilution measurement. The limits of agreement (-0.55 to +0.51 1.min-1) were good enough for clinical use.After cardiac output had been measured simultaneously by both the Doppler and thermodilution techniques, subsequent transoesophageal Doppler alone gave a clinically useful measurement of cardiac output.
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Ultrasound is of proven clinical utility for imaging cardiac structures. Doppler ultrasonic techniques can be used with or without echocardiography for noninvasive hemodynamic studies. The usefulness of Doppler ultrasonic techniques in the noninvasive laboratory has been shown recently at the Massachusetts General Hospital, Boston. In 61 of 100 consecutive patients in a prospective study, Doppler ultrasound provided clinical information that could not be obtained with echocardiographic studies alone. The advantages of this technique for noninvasive cardiac studies are now being recognized in the general medical community. The results of ongoing clinical investigations will help define the role of Doppler echocardiography as a clinically useful diagnostic tool for cardiac evaluation.
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The authors used the pulse and continuous-wave Doppler technique to perform 51 measurements of stroke volume and cardiac output in 37 persons. Results were compared with those obtained using Fick's principle of thermodilution (immediately subsequent or simultaneous). Regression analysis showed a close correlation between Doppler and haemodynamic values - r = 0.86 for stroke volume and 0.94 for cardiac output (p less than 0.001). Using the paired t-test, the methods did not differ significantly. Standard deviation of Doppler stroke volume values from reference haemodynamic values was 10%, and only two measurements differed by more than 25%. Doppler determination of cardiac output can be therefore recommended as an alternative method in patients with high-quality echo Doppler recordings.
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Abstract During the past decade Doppler echocardiography has evolved to an extent that it has become a major noninvasive tool for cardiac evaluation in both acquired and congenital heart disease. This article describes current applications of Doppler techniques in the evaluation of cardiac anatomy and hemodynamics. The principles and methods employed in the use of Doppler echocardiography are described and illustrated for assessment and quantitation of flow velocities, pressure gradients, valve areas, valve regurgitation, stroke volume, cardiac output, cardiac shunts, and diastolic filling indices. The increasing accuracy of these applications has led to a substantial reduction in the need for invasive diagnostic methods, such as cardiac catheterization, especially in patients where frequent follow‐up evaluations are indicated.
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