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CLINICAL RESEARCH: ECHOCARDIOGRAPHY

The use of live three-dimensional Doppler echocardiography in the measurement of cardiac output

An in vivo animal study

James Pemberton, MD^*, Xiaokui Li, MD^*, Tara Karamlou, MD, Chloe A. Sandquist, MD, Karl Thiele, PhD, Irving Shen, MD, Ross M. Ungerleider, MD, Antoinette Kenny, MD and David J. Sahn, MD, MACC^*,*

^{* *}Clinical Care Center for Congenital Heart Disease
Department of Pediatric Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
Philips Medical Systems, Andover, Massachusetts
Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom

Manuscript received August 18, 2004; revised manuscript received October 5, 2004, accepted October 12, 2004.

^* Reprint requests and correspondence: Dr. David J. Sahn, The Clinical Center for Congenital Heart Disease, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L608, Portland, Oregon, 97239-3098 (Email: sahnd{at}ohsu.edu).

OBJECTIVES: The purpose of this study was to investigate whether cardiac output (CO) could be accurately computed from live three-dimensional (3-D) Doppler echocardiographic data in an acute open-chested animal preparation.

BACKGROUND: The accurate measurement of CO is important in both patient management and research. Current methods use invasive pulmonary artery catheters or two-dimensional (2-D) echocardiography or esophageal aortic Doppler measures, with the inherent risks and inaccuracies of these techniques.

METHODS: Seventeen juvenile, open-chested pigs were studied before undergoing a separate cardiopulmonary bypass procedure. Live 3-D Doppler echocardiography images of the left ventricular outflow tract and aortic valve were obtained by epicardial scanning, using a Philips Medical Systems (Andover, Massachusetts) Sonos 7500 Live 3-D Echo system with a 2.5-MHz probe. Simultaneous CO measurements were obtained from an ultrasonic flow probe placed around the aortic root. Subsequent offline processing using custom software computed the CO from the digital 3-D Doppler DICOM data, and this was compared to the gold standard of the aortic flow probe measurements.

RESULTS: One hundred forty-three individual CO measurements were taken from 16 pigs, one being excluded because of severe aortic regurgitation. There was good correlation between the 3-D Doppler and flow probe methods of CO measurement (y = 1.1x – 9.82, R² = 0.93).

CONCLUSIONS: In this acute animal preparation, live 3-D Doppler echocardiographic data allowed for accurate assessment of CO as compared to the ultrasonic flow probe measurement.

Abbreviations and Acronyms   AV = aortic valve   CO = cardiac output   CPB = cardiopulmonary bypass   LVOT = left ventricular outflow tract   PW = pulse wave   2-D = two-dimensional   2-DE = two-dimensional echocardiography   3-D = three-dimensional   3-DE = three-dimensional echocardiography

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