Feasibility of Intraoperative Three-Dimensional Transesophageal Echocardiography in the Evaluation of Right Ventricular Volumes and Function in Patients Undergoing Cardiac Surgery

Background The aim of this study was to test the feasibility of the assessment of right ventricular (RV) volumes and function using real-time three-dimensional (3D) transesophageal echocardiographic (TEE) imaging in patients undergoing cardiac surgery. Methods One hundred-fifty surgical patients were enrolled: 65 undergoing mitral valve repair, 10 undergoing mitral valve and tricuspid valve repair, four with congenital heart disease, two undergoing Jarvik implantation, 13 undergoing aortic valve surgical replacement, and 56 undergoing transcatheter aortic valve implantation. Real-time 3D TEE acquisition for RV evaluation was performed before and after the surgical procedure and compared with standard two-dimensional multiplane TEE measurements. In a subgroup of 81 patients, 3D transthoracic echocardiographic imaging was also performed. RV volumetric quantification was performed for all data using dedicated software. Results Three-dimensional RV analysis was feasible in 98.7% in the preoperative TEE data set and in 92.7% in the postoperative TEE data set. Agreement between 3D transthoracic and transesophageal echocardiography for end-diastolic volume ( r = 0.98; 95% confidence interval [CI], −0.2 ± 13.6 mL), end-systolic volume ( r = 0.97; 95% CI, −2.1 ± 10.2 mL), ejection fraction ( r = 0.77; 95% CI, 1.8 ± 8.2%), and stroke volume ( r = 0.91; 95% CI, 2.0 ± 12.9 mL) was significant. RV parameters were highly reproducible in patients with both normal and dilated RV volumes. Conclusions Intraoperative 3D TEE assessment of RV volumes and function is feasible in patients with normal and dilated right ventricles, with good correlation between 3D transthoracic echocardiographic and TEE RV parameters. These measurements could improve the quantitative evaluation of RV function during cardiac surgery.