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CARDIOVASCULAR ANESTHESIA

Guiding Surgical Cannulation of the Inferior Vena Cava with Transesophageal Echocardiography

Idar Kirkeby-Garstad, MD^*, Arve Tromsdal, MD, Olav F. M. Sellevold, MD PhD^*, Mads Bjørngaard, MD^*, Lise K. Bjella, MD^*, Einar M. Berg, MD^*, Asbjørn Karevold, MD, Rune Haaverstad, MD PhD, Alexander Wahba, MD PhD, Ole Tjomsland, MD PhD, Rafael Astudillo, MD PhD, Arne Krogstad, CCP, and Roar Stenseth, MD PhD^*

Departments of *Anaesthesia, Cardiology, and Surgery, St. Elisabeth Heart Centre, University Hospital of Trondheim, Norway

Address correspondence and reprint requests to Idar Kirkeby-Garstad, MD, Department of Anesthesia and Intensive Care, St. Elisabeth Heart Centre, University Hospital of Trondheim, Hans Nissensgt 3, N 7018 Trondheim, Norway. Address e-mail to Idar.Kirkeby-Garstad{at}medisin.ntnu.no

We studied 150 adult cardiac surgery patients to assess visualization of the venous cannula and the venous system by intraoperative transesophageal echocardiography and to register the incidence of cannulation of hepatic veins. The quality of images, the dimensions of the venous system, the position of the venous cannula, and the adequacy of venous return were registered. Acceptable image quality of the inferior vena cava and the right hepatic vein (RHV) was obtained in 95% and 87% of cases, respectively. Considerable individual variations were found in the dimensions of the venous system. The cannula position could be determined in 99% of the cases. Ten percent of venous cannulae were primarily placed in the RHV. A short distance between the eustachian valve and the RHV possibly predisposes to cannulation of the RHV. No other patient-related factors were associated with cannula position. Placement of the cannula deep in the inferior vena cava was associated with reduced venous return and may be a more important cause of reduced return than a cannula positioned in a hepatic vein.

IMPLICATIONS: Correct positioning of the venous cannula draining blood to the cardiopulmonary bypass circuit is important. Intraoperative transesophageal echocardiography allows satisfactory determination of the cannula position in nearly all patients. Ten percent of venous cannulae are primarily positioned in the right hepatic vein and not in the inferior vena cava as intended.

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