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CARDIOVASCULAR ANESTHESIA

Hemodynamic-Induced Changes in Aortic Valve Area: Implications for Doppler Cardiac Output Determinations

Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut; and VA Connecticut Healthcare System, West Haven, Connecticut

Address correspondence and reprint requests to Pamela E. Gray, MD, Department of Anesthesiology/186, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516. Address e-mail to gray.pamela_e{at}west-haven.VA.gov

Monitoring cardiac output (CO) by transesophageal echocardiography involves measurements of ascending aortic flow and an initial measurement of aortic valve area (AVA). Hemodynamic-induced changes in AVA are a potential source of error for this simplified method. Our goal was to quantify these changes in AVA and their effects on CO calculations. In 17 anesthetized patients, a dobutamine infusion was titrated to achieve a 50% increase in ascending aortic flow velocity (V_max). Hemodynamic and echocardiographic variables, including V_max and planimetry of AVA, were determined at baseline and at maximal dobutamine dose. Dobutamine produced a 3.0 ± 1.4 L/min increase in CO, a 54.5% ± 19.6% increase in V_max, and a 50.6% ± 34.2% increase in systolic blood pressure. AVA increased by 4.3% ± 2.6% during dobutamine infusion (P < 0.001). The simplified CO method, which does not account for increases in AVA, produced a 0.32 ± 0.24 L/min underestimation of CO. This investigation demonstrates hemodynamic-induced changes in AVA. The use of a single AVA measurement for all subsequent CO calculations introduces a clinically acceptable degree of error, supporting a simplified CO protocol requiring less probe manipulation and reduced procedural time.

Implications: An intraoperative dobutamine infusion was used to increase aortic blood flow and demonstrate hemodynamic-induced changes in aortic valve area. These valve-area changes affect the accuracy of Doppler cardiac output determinations.

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