Transoesophageal echocardiography during scoliosis repair: comparison with CVP monitoring

Abstract

Transoesophageal echocardiography during scoliosis repair: comparison with CVP monitoringPurpose: Accurate haemodynamic assessment during surgical repair of scoliosis is crucial to the care of the patient. The purpose of this study was to compare transoesophageal echocardiography (TEE) with central venous pressure monitoring in patients with spinal deformities requiring surgery in the prone position. Methods: Twelve paediatric patients undergoing corrective spinal surgery for scoliosis/kyphosis in the prone position were studied. Monitoring included TEE, intra-arterial and central venous pressure monitoring (CVP). Haemodynamic assessment was performed prior to and immediately after positioning the patient prone on the Relton-Hall table. Data consisted of mean arterial blood pressure (mBP), heart rate (HR), CVR left ventricular end-systolic and end-diastolic diameters (LVESD and LVEDD respectively) and fractional shortening (FS). Right ventricular (RV) function and tricuspid regurgitation (TR) were assessed qualitatively. Analysis was performed using descriptive statistics, Student's t test, sign rank, and correlation analysis. Results: There was an increase in CVP (8.7 mmHg to 17.7 mmHg; P <.01), and decreases in LVEDD (37. I mm to 33.2 mm; P <.05), and mean blood pressure (75.0 mmHg to 65.7 mmHg; P <.05) when patients were placed in the prone position. Fractional shortening, LVESD, and HR did not change from the supine to the prone position. Right ventricular systolic function and tricuspid regurgitation were unchanged. Conclusion: These data indicate that the CVP is a misleading monitor of cardiac volume in patients with kyphosis/scoliosi5 in the prone position. This is consistent with previous studies. In this clinical situation, TEE may be a more useful monitoring tool to assess on-line ventricular size and function.

TEE Monitoring

“…In the study of Soliman et al it is unfortunate that no measurements of right ventricular function and preload were obtained. 4 …”

“…2 Other applications include its use in embolism detection and in the evaluation of atherosclerotic disease of the aorta, s The study by Soliman et al demonstrates the expanding role of TEE as a monitor in patients with elevated central venous pressure undergoing kyphoscoliosis repair. 4 This study has limitations, as pointed out by the authors, especially pertaining to the systematic and thorough evaluation of the following cardiovascular parameters with TEE.…”

Perioperative Management of an Adolescent With Friedreich’s Ataxia and Hypertrophic Cardiomyopathy

“…In the surgical setting with a patient placed in the prone position, CVP monitoring may be inaccurate [10,11]. Intraoperative transesophageal echocardiography (TEE) may be warranted in this setting to ensure proper volume management and hemodynamic stability.…”

A transesophageal echocardiography examination clarifies the cause of cardiovascular collapse during scoliosis surgery in a child

“…[3][4][5] The most common abnormalities found were decreases in the cardiac index and stroke volume with preserved ejection fraction. These abnormalities are consistent with a decrease in venous return, possibly due to compression of the inferior vena cava.…”

“…3,4 Previous reports have described severe hemodynamic instability associated with using transverse chest supports in the prone position. 5,6 Soliman et al 5 reported two cases with an increase in the CVP and a decrease in the left ventricular diameters in the TEE after the patients were positioned in the Relton-Hall frame. They hypothesized that mechanical compression of the mediastinal structures may cause impaired ventricular filling and an increase in the CVP.…”