We hypothesize that also in patients with diminished left ventricular ejection fraction or left ventricular hypertrophy, echocardiographic Doppler measurement of mitral inflow and venous pulmonary flow more reliably reflects actual left atrial…
ID
Source
Brief title
Condition
- Heart failures
- Cardiac therapeutic procedures
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Comparison of left atrium pressure measurement with pulmonary artery occlusion
pressure and echo-Doppler derived variables (pulsed wave Doppler of mitral
inflow, tissue Doppler imaging of the mitral annulus, pulsed wave Doppler of
pulmonary vein flow en colour M-mode of mitral inflow).
Secondary outcome
not applicable
Background summary
The clinical gold standard for estimation of mean left atrial pressure (LAP)
is the pulmonary artery occlusion pressure (PAOP) which is used as an indirect
indicator of left ventricular filling pressures. This method requires
cannulation of the pulmonary artery and may be associated with the occurrence
of adverse events. Several recent studies have demonstrated that LAP can
reliably be estimated in a less invasive way using pulsed-wave Doppler
echocardiograpy.
Until now research on this subject was performed in groups of patients with
good left ventricular function undergoing cardiac surgery. Correct estimation
of left ventricular filling pressures is especially important in patients with
an impaired left ventricular function. However, to date, there is no evidence
that the use of the Doppler-derived variables for estimation of left
ventricular filling pressure is also reliable in the presence of impaired
myocardial function or in the presence of myocardial hypertrophy.
Study objective
We hypothesize that also in patients with diminished left ventricular ejection
fraction or left ventricular hypertrophy, echocardiographic Doppler measurement
of mitral inflow and venous pulmonary flow more reliably reflects actual left
atrial pressures than the PAOP measurement.
Study design
The study is designed as a prospective observational study.
Study burden and risks
Induction of anesthesia, monitoring and surgery will be performed according to
the institutional protocol.
Measurements will be obtained after pericardiotomy and after insertion of a
fluid filled catheter in the left atrium. This canulation site will hereafter
be used for canulation of the left ventricular vent according to standard
surgical protocol and will be accompanied by a minimal risk of bleeding which
imediatelly will be intercepted by the cardiac surgeon.
Meibergdreef 9
1105 AZ
Nederland
Meibergdreef 9
1105 AZ
Nederland
Listed location countries
Age
Inclusion criteria
1) Patients scheduled to undergo elective aortic valve replacement due to significant aortic valve stenosis, defined by an aortic valve area of <1 cm², and concordingly left ventricular hypertrophy, defined by an interventricular septum thickness > 11 mm on echocardiography.
2) Patients undergoing coronary artery bypass surgery suffering from compromised left ventricular function, defined by a left ventricular ejection fraction of < 45% on preoperative echocardiography
3) written informed consent
Exclusion criteria
Preoperative exclusion criteria include: intracardiac shunts, more than trivial regurge of the mitral valve or tricuspid valve and patients with any degree of mitral valve stenosis.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL25344.018.08 |