Intraoperative vector flow imaging of the heart

The cardiac flow is complex and multidirectional, and difficult to measure with conventional Doppler ultrasound (US) methods due to the one-dimensional and angle-dependent velocity estimation. The vector velocity method Transverse Oscillation (TO) has been proposed as a solution to this. TO is implemented on a conventional US scanner (Pro Focus 2202 UltraView, BK Medical) using a linear transducer (8670, BK Medical) and can provide real-time, angle-independent vector velocity estimates of the cardiac blood flow. During cardiac surgery, epicardiac US examinations using TO were performed on three patients. Antegrade central jet and retrograde flow near the vessel wall in the ascending aorta and the pulmonary artery were seen during systole, while stable vortices were seen in the aortic sinuses and complex flow patterns were seen around the valves during diastole. In the right atrium, a stable vortex was seen during the entire heart cycle. For comparison, simultaneous measurements were obtained with conventional spectral Doppler (SD) and intravenous catheter thermodilution technique (TD). Peak systolic velocities were underestimated by 18% compared to SD and cardiac output was underestimated by 16% compared to TD. This is the first time TO measurements have been obtained of cardiac flow. TO can potentially reveal new information of cardiovascular physiology and blood flow dynamics, and become a valuable tool in cardiology.