Feasibility of Measuring Descending Aortic Blood Flow Using Transesophageal Ultra-sound Doppler Technique under Cardiopulmonary Bypass_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 XIEAn ¹ , WEIWei ²

1. Graduate Faculty, West China school of Medicine, Sichuan University, Chengdu 610041, P. R. China;
2. Department of anethesia, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

XIEAn, Email: 15802821332@163.com

Keywords：

Transesophageal echocardiography; Descending aortic blood flow; Cadiopulmonary bypass

DOI：

10.7507/1007-4848.20160187

Video：

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Object To evaluate the feasibility of measuring the descending aortic blood flow using transesophageal ultrasound Doppler under cardiopulmonary bypass (CPB). Method We retrospectively analyzed the clinical data of 10 adult patients accepted elective cardiac surgery under CPB in March 2014 year. There were 4 males and 6 females with a mean age of 44.5±12.3 years ranging from 24.5-64.0 years. The descending aorta diameter and velocity time integral (VTI) of blood flow of middle esophageal and lower esophageal of these patients were detected by transesophageal echocardiography (TEE) under CPB. We took the formula of classic ultrasound texting the blood flow to calculate the descending aorta blood flow (DABF). At the same time, we recorded the data of CPB and index of hemodynamics. Compared with the flow of CPB pump, we analyzed the correlation between pump flow and the raliability of DABF texting value under CPB. Results Two patients quit the trail for blurred imaging. The quality of blood flow spectrum images aquirded from the middle esophageal were inferior to those from the lower esophageal (P < 0.01) in the 10 patients. Among the patients 90% of DABF from the middle esophageal and 50% of DABF from the lower esophageal were more than pump flow. however, the texting value had an excellence correlation to PF (r=0.795, r=0.825). Conclusion The classical TEE technique can not obtain accurate blood flow during CPB.

Citation： XIEAn, WEIWei. Feasibility of Measuring Descending Aortic Blood Flow Using Transesophageal Ultra-sound Doppler Technique under Cardiopulmonary Bypass. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(8): 778-783. doi: 10.7507/1007-4848.20160187 Copy

1.	Weyland A, Stephan H, Kazmaier S, et al. Flow velocity measure-ments as an index of cerebral blood flow:Validity of transcranial Doppler sonographic monitoring during cardiac surgery. Anesthe-siology, 1994, 81(6):1401-1410.
2.	Jonassen AE, Quaegebeur JM, Young WL. Cerebral blood flow velocity in pediatric patients is reduced after cardiopulmonary bypass with profound hypothermia. J Thorac Cardiovasc Surg, 1995, 110(4):934-943.
3.	Greeley W, Ungerleider R, Kern F, et al. Effects of cardiopulmonary bypass on cerebral blood flow in neonates, infants, and children. Circulation, 1989, 80(3 Pt 1):1209-1215.
4.	Zimmerman AA, Burrows FA, Jonas RA, et al. The limits of detec-table cerebral perfusion by transcranial Doppler sonography in neonates undergoing deep hypothermic low-flow cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1997, 114(4):594-600.
5.	Zhu D, Yu H, Zhou Y, et al. Feasibility of measuring renal blood flow using transesophageal echocardiography in pediatric patients undergoing cardiac surgery. J Cardiothorac Vasc Anesthes, 2012, 26(1):39-45.
6.	Yang PL, Wong DT, Dai SB, et al. The feasibility of measuring renal blood flow using transesophageal echocardiography in patients und-ergoing cardiac surgery. Anesthes Analges, 2009, 108(5):1418-1424.
7.	李茜, 朱达, 曾俊, 等.食道超声评价儿童及婴幼儿体外循环下肾脏血流量与体外循环灌注流量关系的临床研究.四川大学学报(医学版), 2013, (1):89-93.
8.	刘永辉.圆管过渡区流速特性的研究.济南:山东大学, 2011.
9.	Schober P, Loer SA, Schwarte LA. Perioperative hemodynamic monitoring with transesophageal Doppler technology. Anesthes Analges, 2009, 109(2):340-353.
10.	Kotake Y, Yamada T, Nagata H, et al. Descending aortic blood flow during aortic cross-clamp indicates postoperative splanchnic perfusion and gastrointestinal function in patients undergoing aortic reconstruction. Brit J Anaesthes, 2012, 108(6):936-942.
11.	金元, 秦炳启, 谢峰.超声脉冲多普勒技术的临床应用.中国超声医学杂志, 1985, (1):61-66.
12.	Stevenson J, Kawabori I, Guntheroth W. Differentiation of ventri-cular septal defects from mitral regurgitation by pulsed Doppler echocardiography. Circulation, 1977, 56(1):14-18.
13.	Stevenson JG, Kawabori I, Guntheroth WG. Noninvasive detection of pulmonary hypertension in patent ductus arteriosus by pulsed Doppler echocardiography. Circulation, 1979, 60(2):355-359.
14.	Grossi EA, Kanchuger MS, Schwartz DS, et al. Effect of cannula length on aortic arch flow:protection of the atheromatous aortic arch. Ann Thorac Surg, 1995, 59(3):710-712.
15.	罗守南.基于超声多普勒方法的管道流量测量研究.北京:清华大学, 2004.
16.	Dormandy J. Clinical significance of blood viscosity. Ann Roy Coll Surg Engl, 1970, 47 (4):211.
17.	汪源源, 王威琪.利用超声多普勒技术检测血流的湍流和涡流.中国医疗器械信息, 2002, (2):8-9.
18.	Censor D, Newhouse V, Vontz T, et al. Theory of ultrasound Doppler-spectra velocimetry for arbitrary beam and flow configurations. IEEE Transact Biomed Engin, 1988, 35(9):740-751.
19.	Newhouse V, Faure P, Cathignol D, et al. The transverse Doppler spectrum for focused transducers with rectangular apertures. J Acoust Soc Amer, 1994, 95(4):2091-2098.
20.	李俊博, 万明习.横向超声多普勒互相关湍流测量方法研究.仪器仪表学报, 1998, 19(6):49-54.
21.	万明习, 李俊博, 钱明, 等.横向超声多普勒技术的应用.中国生物医学工程学报, 2000, 19(1):84-92.
22.	Sun JP, Pu M, Fouad FM, et al. Automated cardiac output measure-ment by spatiotemporal integration of color Doppler data In vitro and clinical validation. Circulation, 1997, 95(4):932-939.
23.	Akamatsu S, Oda A, Terazawa E, et al. Automated cardiac output measurement by transesophageal color Doppler echocardiography. Anesthes Analges, 2004, 98(5):1232-1238.

1. Weyland A, Stephan H, Kazmaier S, et al. Flow velocity measure-ments as an index of cerebral blood flow:Validity of transcranial Doppler sonographic monitoring during cardiac surgery. Anesthe-siology, 1994, 81(6):1401-1410.
2. Jonassen AE, Quaegebeur JM, Young WL. Cerebral blood flow velocity in pediatric patients is reduced after cardiopulmonary bypass with profound hypothermia. J Thorac Cardiovasc Surg, 1995, 110(4):934-943.
3. Greeley W, Ungerleider R, Kern F, et al. Effects of cardiopulmonary bypass on cerebral blood flow in neonates, infants, and children. Circulation, 1989, 80(3 Pt 1):1209-1215.
4. Zimmerman AA, Burrows FA, Jonas RA, et al. The limits of detec-table cerebral perfusion by transcranial Doppler sonography in neonates undergoing deep hypothermic low-flow cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1997, 114(4):594-600.
5. Zhu D, Yu H, Zhou Y, et al. Feasibility of measuring renal blood flow using transesophageal echocardiography in pediatric patients undergoing cardiac surgery. J Cardiothorac Vasc Anesthes, 2012, 26(1):39-45.
6. Yang PL, Wong DT, Dai SB, et al. The feasibility of measuring renal blood flow using transesophageal echocardiography in patients und-ergoing cardiac surgery. Anesthes Analges, 2009, 108(5):1418-1424.
7. 李茜, 朱达, 曾俊, 等.食道超声评价儿童及婴幼儿体外循环下肾脏血流量与体外循环灌注流量关系的临床研究.四川大学学报(医学版), 2013, (1):89-93.
8. 刘永辉.圆管过渡区流速特性的研究.济南:山东大学, 2011.
9. Schober P, Loer SA, Schwarte LA. Perioperative hemodynamic monitoring with transesophageal Doppler technology. Anesthes Analges, 2009, 109(2):340-353.
10. Kotake Y, Yamada T, Nagata H, et al. Descending aortic blood flow during aortic cross-clamp indicates postoperative splanchnic perfusion and gastrointestinal function in patients undergoing aortic reconstruction. Brit J Anaesthes, 2012, 108(6):936-942.
11. 金元, 秦炳启, 谢峰.超声脉冲多普勒技术的临床应用.中国超声医学杂志, 1985, (1):61-66.
12. Stevenson J, Kawabori I, Guntheroth W. Differentiation of ventri-cular septal defects from mitral regurgitation by pulsed Doppler echocardiography. Circulation, 1977, 56(1):14-18.
13. Stevenson JG, Kawabori I, Guntheroth WG. Noninvasive detection of pulmonary hypertension in patent ductus arteriosus by pulsed Doppler echocardiography. Circulation, 1979, 60(2):355-359.
14. Grossi EA, Kanchuger MS, Schwartz DS, et al. Effect of cannula length on aortic arch flow:protection of the atheromatous aortic arch. Ann Thorac Surg, 1995, 59(3):710-712.
15. 罗守南.基于超声多普勒方法的管道流量测量研究.北京:清华大学, 2004.
16. Dormandy J. Clinical significance of blood viscosity. Ann Roy Coll Surg Engl, 1970, 47 (4):211.
17. 汪源源, 王威琪.利用超声多普勒技术检测血流的湍流和涡流.中国医疗器械信息, 2002, (2):8-9.
18. Censor D, Newhouse V, Vontz T, et al. Theory of ultrasound Doppler-spectra velocimetry for arbitrary beam and flow configurations. IEEE Transact Biomed Engin, 1988, 35(9):740-751.
19. Newhouse V, Faure P, Cathignol D, et al. The transverse Doppler spectrum for focused transducers with rectangular apertures. J Acoust Soc Amer, 1994, 95(4):2091-2098.
20. 李俊博, 万明习.横向超声多普勒互相关湍流测量方法研究.仪器仪表学报, 1998, 19(6):49-54.
21. 万明习, 李俊博, 钱明, 等.横向超声多普勒技术的应用.中国生物医学工程学报, 2000, 19(1):84-92.
22. Sun JP, Pu M, Fouad FM, et al. Automated cardiac output measure-ment by spatiotemporal integration of color Doppler data In vitro and clinical validation. Circulation, 1997, 95(4):932-939.
23. Akamatsu S, Oda A, Terazawa E, et al. Automated cardiac output measurement by transesophageal color Doppler echocardiography. Anesthes Analges, 2004, 98(5):1232-1238.

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Feasibility of Measuring Descending Aortic Blood Flow Using Transesophageal Ultra-sound Doppler Technique under Cardiopulmonary Bypass

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