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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 637-641, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Transesophageal echocardiographic evaluation of aortic valve integrity with antegrade crystalloid cardioplegic solution used as an imaging agent

T Rafferty, M Durkin, J Elefteriades and TZ O'Connor
Department of Anesthesiology, Yale University School of Medicine, New Haven, Conn. 06510.

Forceful intravascular injection of crystalloid causes microbubble (cavitation) formation. The resulting ultrasound-opaque medium is widely used in echocardiography as a source of contrast. The following study was performed to determine the feasibility of using antegrade crystalloid cardioplegic solution as a transesophageal two-dimensional echocardiographic imaging agent to evaluate aortic valve integrity. In patients with preexisting aortic regurgitation (n = 12), cardioplegic solution administration (driving pressure 150 to 200 mm Hg) was associated with the appearance of intracardiac cavitations in 12 of 12 patients. Among patients without preexisting valve dysfunction (n = 22), intracardiac cavitations were manifested in 20 of 22, with extension of the cavitations to the left atrium in 17. Associated cardiac dimensions (left ventricular outflow tract area and left ventricular diameter) did not exceed preceding cardiopulmonary bypass values in these patients (2.0 +/- 1.6 cm2 versus 2.6 +/- 1.2 cm2 and 1.4 +/- 0.7 cm versus 1.5 +/- 0.8 cm, respectively). It was concluded that antegrade crystalloid cardioplegic solution can be used as an echocardiographic contrast agent in this context. The inability to establish a relationship between the extent of cardioplegic intracardiac penetration and left ventricular dimensional changes limits the technique, as presently employed, to qualitative analysis of valve dysfunction.

This article has been cited by other articles:

				T. D. Rafferty Transesophageal Echocardiography Training, Credentialing, and Certification: How Do Anesthesiologists Do It? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 1997; 1(1): 81 - 95. [PDF]