Quantification of Right Ventricular Function Using Simultaneous Transthoracic and Transoesophageal Echocardiography

National University Health System (NUHS)

Status: Withdrawn

Conditions: Cardiac Surgery

Treatments: Diagnostic Test: TTE and TOE

Study type: Interventional

Funder types: Other

Identifiers

NCT03954002

2018/00987

Details and patient eligibility

About

The aims of this study are to evaluate the usefulness of various methods of quantifying right ventricular (RV) function using perioperative transoesophageal echocardiographic (TOE), compared with simultaneous transthoracic echocardiographic (TTE) findings.

Full description

The hypothesis of this study that perioperative TOE is useful in quantifying RV function, and that the quantification methods used will correlate well to commonly used, well-studied TTE parameters obtained simultaneously, under the same loading conditions.

Assessment of RV function is of particular importance in the perioperative period. RV dysfunction can be due to a myriad of causes - myocardial ischemia, pulmonary embolism, pulmonary hypertension, congenital heart disease, or cardiomyopathy. The presence of RV failure can lead to difficulty in separation from cardiopulmonary bypass in cardiac surgical patients, and has been shown to be an independent predictor of mortality in high-risk cardiac surgery patients. Additionally, correct identification of RV dysfunction is crucial in order for the correct treatment to be administered. RV failure can lead to underfilling of the left ventricle, and mimic hypovolaemia with hypotension and an exaggerated stroke volume variation. In such a case, failure to diagnose RV dysfunction can wrongly lead to fluid loading and further worsening of right ventricular failure.

While evaluation of right heart function is well described in TTE studies, there is insufficient data at present to recommend a reliable method to quantify RV function using TTE.

In addition to traditional measurements of RV function, we hope to study the usefulness of speckle tracking and strain imaging in assessment of RV function, modalities of echocardiographic image analysis which have garnered increasing interest in recent years.

Sex: All

Ages: 21+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age > 21 years
• Undergoing elective cardiac surgery
• Planned for intraoperative TOE

Exclusion criteria

• Patient refusal
• Emergency surgery
• Haemodynamic instability
• Previous tricuspid valve surgery
• Severe tricuspid regurgitation
• Rhythm other than sinus
• Previous oesophageal / gastric surgery
• Oesophageal stricture / tumour
• Oesophageal diverticulum / fistula
• Active upper GI haemorrhage
• Oesophageal varices

Trial design

Primary purpose: Diagnostic

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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0 participants in 1 patient group

TTE and TOE

Experimental group

Description:

A small flexible tube (TOE probe) will be inserted into your oesophagus, or food pipe, to take images of your heart as per routine anaesthetic care for cardiac surgery. Just before and after general anaesthesia is administered, a short transthoracic echocardiography (TTE scan will be performed to acquire images of your heart. This is an ultrasound scan of your heart using a probe on the outside of the chest. During this period, relevant haemodynamic data such as blood pressure and heart rate will be recorded.

Treatment:

Diagnostic Test: TTE and TOE