Department of Anesthesiology, Rhode Island Hospital, Providence, RI.
Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA.
J Cardiothorac Vasc Anesth. 2021 Mar;35(3):786-795. doi: 10.1053/j.jvca.2020.10.026. Epub 2020 Oct 19.
To compare two-dimensional (2D) and 3D imaging of the left ventricular outflow tract (LVOT) and to evaluate geometric changes pre- to post-cardiopulmonary bypass (CPB).
Retrospective review of intraoperative transesophageal echocardiographic examinations.
Single academic medical center.
The study comprised 69 cardiac surgical patients-27 with aortic valve stenosis (AS) and 42 without AS.
Two-dimensional and 3D analysis of the LVOT pre- and post-CPB.
Pre- and post-CPB 2D assessment of LVOT diameter (2D LVOTd) was compared with 3D analysis of the minor (3D LVOTd-min) and major diameters. LVOT areas (LVOTa) were calculated using LVOTd to yield 2D LVOTa and 3D LVOTa-min. These were compared with LVOTa measured by planimetry (3D LVOTa-plan). An ellipticity ratio (ER) (ER = 3D minor/major axes) was calculated. The 2D LVOTd was larger than the 3D LVOTd-min before (2.12 v 2.02 cm respectively (resp); p < 0.001) and after (1.96 v 1.85 cm resp; p = 0.04) CPB. Compared with pre-CPB, there were significant decreases in the 2D LVOTd (p = 0.003) and the 3D LVOTd-min (p < 0.001) post-CPB. Ellipticity increased after CPB (ER 0.80 v 0.75; p = 0.004), and the 2D LVOTa was larger than the 3D LVOTa-min before CPB (3.60 cmv 3.28 cm; p < 0.001) and less so after CPB (3.11 cmv 2.79 cm; p = 0.053). Compared with pre-CPB, all LVOTa measurements decreased significantly after CPB (p < 0.001). The 3D LVOTa-plan decreased after CPB by approximately 10% (4.05 cmv 3.61 cm; p < 0.001). The 2D LVOTa and 3D LVOTa-min underestimated the 3D LVOTa-plan before and after CPB (p < 0.001) by 11% to 14% and 19% to 23%, respectively. When compared with non-AS patients, patients with AS had a smaller LVOTa pre- and post-CPB (p < 0.05).
The LVOT is smaller and more elliptical after CPB. Patients with AS have a smaller LVOT compared with non-AS patients. LVOTa calculated using LVOTd underestimates the 3D LVOTa-plan by as much as 23% depending on patient type and timing of measurement. Accurate assessment of the LVOT requires 3D imaging.
比较左心室流出道（LVOT）的二维（2D）和 3D 成像，并评估体外循环（CPB）前后的几何变化。
回顾性分析术中经食管超声心动图检查。
单家学术医疗中心。
该研究纳入 69 例心脏外科患者-27 例主动脉瓣狭窄（AS）患者和 42 例非 AS 患者。
CPB 前后的 2D 和 3D LVOT 分析。
比较 CPB 前后 2D LVOT 直径（2D LVOTd）与 3D 分析的小直径（3D LVOTd-min）和大直径。使用 LVOTd 计算 LVOT 面积（LVOTa），得出 2D LVOTa 和 3D LVOTa-min。将这些与通过平面测量法（3D LVOTa-plan）测量的 LVOTa 进行比较。计算椭圆率（ER）（ER=3D 小/大轴）。CPB 前 2D LVOTd 大于 3D LVOTd-min（分别为 2.12 厘米和 2.02 厘米（resp）；p < 0.001），CPB 后分别为 1.96 厘米和 1.85 厘米（resp）；p = 0.04）。与 CPB 前相比，CPB 后 2D LVOTd（p = 0.003）和 3D LVOTd-min（p < 0.001）均显著下降。CPB 后，椭圆率增加（ER 0.80 比 0.75；p = 0.004），CPB 前 2D LVOTa 大于 3D LVOTa-min（3.60 厘米比 3.28 厘米；p < 0.001），CPB 后则较小（3.11 厘米比 2.79 厘米；p = 0.053）。与 CPB 前相比，CPB 后所有 LVOTa 测量值均显著降低（p < 0.001）。CPB 后 3D LVOTa-plan 减少约 10%（4.05 厘米比 3.61 厘米；p < 0.001）。CPB 前和 CPB 后，2D LVOTa 和 3D LVOTa-min 分别低估了 3D LVOTa-plan 11%至 14%和 19%至 23%。与非 AS 患者相比，AS 患者 CPB 前后的 LVOTa 较小（p < 0.05）。
CPB 后 LVOT 更小且更呈椭圆形。AS 患者的 LVOT 比非 AS 患者小。LVOTa 使用 LVOTd 计算，根据患者类型和测量时间，低估 3D LVOTa-plan 多达 23%。准确评估 LVOT 需要 3D 成像。
