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Perioperative feasibility of imaging the heart and pleura in patients with aortic stenosis undergoing aortic valve replacement

Published online by Cambridge University Press:  01 July 2007

C.-J. Jakobsen ,
P. Torp  and
E. Sloth
C.-J. Jakobsen*
Affiliation:
Aarhus University Hospital, Department of Anaesthesia and Intensive Care, Skejby, Aarhus, Denmark
P. Torp
Affiliation:
Aarhus University Hospital, Department of Anaesthesia and Intensive Care, Skejby, Aarhus, Denmark
E. Sloth
Affiliation:
Aarhus University Hospital, Department of Anaesthesia and Intensive Care, Skejby, Aarhus, Denmark
*
Correspondence to: Carl-Johan Jakobsen, Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark. E-mail: cjj@dadlnet.dk; Tel: +45 89498751; Fax: +45 89498809
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Summary

Background

The postoperative monitoring and treatment of the patient undergoing aortic valve replacement is a complex challenge. Echocardiography is the only method which provides dynamic and real-time bedside imaging of the heart. Focused assessed transthoracic echocardiography has been shown to provide a usable window for cardiac imaging in a mixed ICU population. The aim of this study was to evaluate the feasibility of perioperative imaging of the heart and pleura according to the focused assessed transthoracic echocardiography protocol in patients scheduled for aortic valve replacement.

Method

Thirty-five adult patients scheduled for aortic valve replacement were followed perioperatively with focused assessed transthoracic echocardiography examinations. A Vivid-7 echo-machine and a 2.5 MHz matrix transducer with second-harmonic imaging were used for data acquisition. The image quality for the cardiac window was graded 1–5 (1 = no image, 2 = poor and unusable image quality, 3 = usable image quality, 4 = good image quality and 5 = perfect image quality). A score ⩾3 equalled an image quality judged to be of sufficient quality to be interpreted and thereby to contribute to clinical decision-making.

Results

All patients had at least one usable window preoperatively. At least one usable window was obtained in 88% of patients on the first postoperative day, and in 97% at discharge. The image quality changed over time, with the poorest quality being observed on the first postoperative day. The apical view with the patient in the left lateral position provided the best cardiac window on all occasions. The presence of drains did not significantly affect the achievability of a satisfactory examination. The number of patients with pleural effusion was relatively high. On the first postoperative day, 10 subjects had unilateral and one subject had bilateral pleural effusions. At discharge, 14 patients had unilateral and four patients had bilateral effusions.

Conclusions

We conclude that the image quality of the heart and pleura, according to the focused assessed transthoracic echocardiography concept, is sufficient to undergo interpretation and thereby contribute to the perioperative clinical decision-making in patients with aortic stenosis.

Keywords

ECHOCARDIOGRAPHY, transthoracic, transoesophagealMONITORING INTRAOPERATIVEHEART DISEASES, aortic valveCARDIAC SURGERY
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 7 , July 2007 , pp. 589 - 595
Copyright
Copyright © European Society of Anaesthesiology 2007

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