Validating TEE Measurements of Right Ventricular Function

Traditionally, all echocardiographic measurements have been studied utilizing TTE. Therefore the normal values and ranges for pathology findings have been defined by transthoracic means alone. TEE offers different images planes when compared to TTE, which may make the measurements obtained differ from those obtained by TTE. In the operating room environment the vast majority of echocardiography is completed by transesophageal means for many reasons; largely access to the patient and the continuous use of TEE as a hemodynamic monitor. However, given the fact that most echocardiographic measurements have only been validated by TTE, there remains a question as to the validity or precision of TEE-derived measurements.

• Transesophageal Echocardiography (Diagnostic test), also known as TEE: TEE measures of right ventricular function
• Transthoracic Echocardiography (Diagnostic test), also known as TTE: TTE measures of right ventricular function

Primary outcomes

• Right ventricular index of myocardial performance (RIMP) [Immediately following the induction of anesthesia and TEE probe placement]: Right ventricular index of myocardial performance (RIMP) will be measured using both TTE and TEE.
• Tricuspid annular plane systolic excursion (TAPSE) [Immediately following the induction of anesthesia and TEE probe placement]: Tricuspid annular plane systolic excursion (TAPSE) will be measured using both TTE and TEE.
• Right ventricular fractional area change (FAC) [Immediately following the induction of anesthesia and TEE probe placement]: Right ventricular fractional area change (FAC) will be measured using both TTE and TEE.
• RV annular systolic velocity (S') [Immediately following the induction of anesthesia and TEE probe placement]: RV annular systolic velocity (S') will be measured using both TTE and TEE.
• RV free wall longitudinal strain [Immediately following the induction of anesthesia and TEE probe placement]: RV free wall longitudinal strain will be measured using both TTE and TEE.

Secondary outcomes

• Ease of obtaining appropriate TEE measures of right ventricular function [Within 15 minutes following anesthesia induction]: Ease of acquisition will be assessed by the echocardiographers
• Define values for normal right ventricular free wall strain [Through study completion, an estimate of 1 year]: The data collected will be used to define normal values for right ventricular free wall strain

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Adult patients undergoing elective cardiac surgery requiring TEE

Exclusion Criteria:

* Patient who do not wish to consent
* Patients with contraindications to TEE
* Urgent or emergent cardiac surgery
* Patients with preexisting open chest
* Patients with intrathoracic hardware (VAD, thoracostomy tube, etc)
* Non-English speaking subjects
* Cognitively impaired adults
* Pregnancy

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• Shayne M Roberts, DO, Principal investigator, Milton S. Hershey Medical Center