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CARDIOVASCULAR ANESTHESIA

Neither the Accuracy nor the Precision of Thermal Dilution Cardiac Output Measurements Is Altered by Acute Tricuspid Regurgitation in Pigs

Charles W. Buffington, MD^*, and Elisabet U. M. Nystrom, MD, PhD Section Editor

*Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, and the Department of Anesthesiology, Creighton University, Omaha, Nebraska

Address correspondence and reprint requests to Charles W. Buffington, MD, MUH N-463, 200 Lothrop Street, Pittsburgh, PA 15213. Address email to buffingtoncw{at}anes.upmc.edu

Whether measurement of cardiac output using the thermal dilution technique (TDCO) is valid in the presence of tricuspid regurgitation (TR) is controversial. We assessed the accuracy and precision of the technique in pigs by comparison with data from an electromagnetic flowmeter on the aorta (EMCO). TR was created with sutures that immobilized the free-wall leaflets of the tricuspid valve, and cardiac output was adjusted with dobutamine to give values comparable to control measurements. TR reduced forward stroke volume from 17.2 to 12.6 mL/beat and caused the right atrium to dilate and pulse in synchrony with the right ventricle. Acute TR did not affect the linear regression relation between TDCO and EMCO and did not alter the correlation coefficient (r = 0.94 during both control and TR). These data demonstrate that acute TR does not affect the accuracy or precision of TDCO in pigs.

IMPLICATIONS: Cardiac output is a valuable measurement that guides the medical care of patients with heart and lung disease. This study demonstrates that the thermal dilution technique of determining cardiac output is valid when acute tricuspid valve regurgitation is present in pigs.

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