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ASSESSMENT OF RIGHT VENTRICULAR DIASTOLIC FUNCTION USING PULSED WAVE DOPPLER OF THE CORONARY SINUS

Department of Anesthesiology, Box 3094 Duke University Medical Center, Durham, NC, USA, 27710

INTRODUCTION

Transesophageal echocardiography (TEE) is routinely used to monitor left ventricular (LV) function during cardiac surgery. In addition to assessments of systolic function, TEE can utilize pulsed wave Doppler of both pulmonary vein and mitral valve flow velocities to assess LV diastolic function ¹. We sought to determine the feasibility of using pulsed wave Doppler measurements of coronary sinus (CS) flow to measure right ventricular (RV) diastolic function.

METHODS

11 consecutive patients undergoing coronary artery bypass grafting (CABG) had both pre and post-CPB TEE examinations of the CS. The CS was imaged by retroflexing and advancing the TEE probe from the mid-esophageal four chamber view. The CS was then interrogated with pulsed wave Doppler allowing measurement of the velocity time integral (VTI). The ratio of the systolic to diastolic VTI (VTIs/VTId ) represents a measurement of diastolic function. In addition, heart rate (HR), blood pressure (MAP), central venous pressure (CVP), and hematocrit (Hct) were also recorded. Comparisons were made between the pre and post-CPB measurements using a paired sign test. A p< 0.05 was considered significant.

RESULTS

Compared to the pre-CPB measurement, the post-CPB CS VTIs/VTId was significantly reduced suggesting the development of RV diastolic dysfunction.

While a high proportion of patients following cardiac surgery have LV diastolic dysfunction², the proportion with right-sided dysfunction is unknown. Our results demonstrate that, in a similar fashion to using pulmonary venous Doppler examination to assess LV diastolic function, CS Doppler examinations are both feasible and may demonstrate the occurrence of post-CPB RV diastolic dysfunction.

REFERENCES

1 J Am Soc Echocardiogr 9:736-60, 1996[Medline]

2 Sem Thorac Cardiovasc Surg 11:125-33, 1999[Medline]

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