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Anesth Analg 2001;92:1364-1369
© 2001 International Anesthesia Research Society

CARDIOVASCULAR ANESTHESIA

Pulmonary Arterial Pressure Can Be Estimated by Transesophageal Pulsed Doppler Echocardiography

Shinji Kawahito, MD, PhD, Hiroshi Kitahata, MD, PhD, Katsuya Tanaka, MD, PhD, Junpei Nozaki, MD, and Shuzo Oshita, MD, PhD

Department of Anesthesiology, Tokushima University School of Medicine, Kuramoto, Tokushima, Japan

Address correspondence and reprint requests to Dr. Shinji Kawahito, Department of Anesthesiology, Tokushima University School of Medicine, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan Address e-mail to kawahito{at}pb4.so-net.ne.jp

We examined whether pulmonary arterial pressure can be estimated on the basis of pulmonary arterial flow velocity determined via intraoperative pulsed Doppler transesophageal echocardiography (TEE) in 20 patients undergoing cardiac surgery. Standard pulmonary artery measurements were taken as well. Measurements were taken before sternotomy, after pericardiotomy, after cardiopulmonary bypass, and after sternum closure. The variables obtained by TEE included preejection period (PEP), acceleration time (AT), right ventricular ejection time (RVET), and R-R interval (RR). Five ratios were calculated as indices of pulmonary arterial pressure—PEP/AT, PEP/RVET, AT/RVET, PEP/{surd}RR, and AT/{surd}RR—and were compared with pulmonary artery catheterization findings, i.e., systolic pulmonary arterial pressure (sPAP), log sPAP, mean PAP (mPAP), and log mPAP. Before sternotomy, PEP/AT, PEP/{surd}RR, and AT/{surd}RR showed significant correlation with all pulmonary artery catheterization values. AT/RVET showed correlation with all pulmonary artery values except log mPAP. PEP/AT showed the closest correlation with sPAP (r = 0.771) and log sPAP (r = 0.789). PEP/AT also showed close correlation with mPAP (r = 0.764) and log mPAP (r = 0.777). Significant agreement between sPAP and mPAP values calculated from a regression equation and values measured via pulmonary artery catheter was observed by plotting the differences against the mean values of the two measurements. We therefore conclude that noninvasive estimation of pulmonary arterial pressure is feasible via intraoperative TEE when sternotomy is not involved.

Implications: Accurate measurement of pulmonary arterial pressure has generally required cardiac catheterization; noninvasive intraoperative estimation of pulmonary arterial pressure has been an important clinical challenge for anesthesiologists. We demonstrated that pulsed Doppler transesophageal echocardiography can be used to estimate intraoperative pulmonary arterial pressure.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2001 by the International Anesthesia Research Society.