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, 朱達, 曾俊, 等.食道超聲評價兒童及嬰幼兒體外循環下腎臟血流量與體外循環灌注流量關系的臨床研究.四川大學學報(醫學版), 2013, (1):89-93.
8.	劉永輝.圓管過渡區流速特性的研究.濟南:山東大學, 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, 秦炳啟, 謝峰.超聲脈沖多普勒技術的臨床應用.中國超聲醫學雜志, 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.	羅守南.基于超聲多普勒方法的管道流量測量研究.北京:清華大學, 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.利用超聲多普勒技術檢測血流的湍流和渦流.中國醫療器械信息, 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, 萬明習.橫向超聲多普勒互相關湍流測量方法研究.儀器儀表學報, 1998, 19(6):49-54.
21.	萬明習, 李俊博, 錢明, 等.橫向超聲多普勒技術的應用.中國生物醫學工程學報, 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, 朱達, 曾俊, 等.食道超聲評價兒童及嬰幼兒體外循環下腎臟血流量與體外循環灌注流量關系的臨床研究.四川大學學報(醫學版), 2013, (1):89-93.
8. 劉永輝.圓管過渡區流速特性的研究.濟南:山東大學, 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, 秦炳啟, 謝峰.超聲脈沖多普勒技術的臨床應用.中國超聲醫學雜志, 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. 羅守南.基于超聲多普勒方法的管道流量測量研究.北京:清華大學, 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.利用超聲多普勒技術檢測血流的湍流和渦流.中國醫療器械信息, 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, 萬明習.橫向超聲多普勒互相關湍流測量方法研究.儀器儀表學報, 1998, 19(6):49-54.
21. 萬明習, 李俊博, 錢明, 等.橫向超聲多普勒技術的應用.中國生物醫學工程學報, 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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