Author + information
- Received August 9, 1989
- Revision received November 11, 1989
- Accepted November 13, 1989
- Published online April 1, 1990.
- Roberto Bolli, MD, FACC∗,1,
- Craig J. Hartley, PhD,
- Jacques E. Chelly, MD, PhD,
- Bharat S. Patel, MD,
- Raphael S. Rabinovitz, PhD,
- Mohamed O. Jeroudi, MD,
- Robert Roberts, MD, FACC and
- George Noon, MD, FACC
- ↵∗Address for reprints: Roberto Bolli, MD, Section of Cardiology, Baylor College of Medicine, 6535 Fannin, MS F-905, Houston, Texas 77030.
Measurement of systolic wall thickening by sonomicrometry provides an accurate index of regional left ventricular function, but the trauma of crystal insertion limits its widespread clinical use. The first clinical application of a 10 MHz ultrasonic Doppler probe that can be either sutured or applied by suction to the epicardium and can measure wall thickening at any depth of the left ventricular wall is described. In 18 dogs, measurements obtained with the suction probe correlated well (r = 0.97) with those of a previously validated sutured probe.
To assess clinical feasibility, the probe was applied to the epicardium of patients undergoing coronary bypass surgery. Good quality wall thickening signals were obtained with no complications. Transmural left ventricular thickening fraction before bypass surgery was 34 ± 3% (mean value ± SE) at the mid-ventricular lateral wall, 33 ± 4% at the anterior basal wall and 26 ± 4% at the mid-ventricular posterior wall. Right ventricular thickening fraction averaged 25 ± 3%. Endocardial thickening fraction tended to exceed epicardial thickening fraction, although the difference attained statistical significance (p < 0.05) only at the anterior basal wall.
On average, thickening fraction during the immediate postoperative period remained unchanged compared with the preoperutive values, but a marked individual variability was observed, with 7 of 15 patients exhibiting a decrease and 8 an increase. Exteriorization of the wires attached to the sutured probe allowed continuous in situ monitoring of wall thickening in the postoperative period and subsequent removal of the probe, in six patients the crystal was left in place for 48 to 72 h after surgery and then removed without complications; good wall thickening signals were obtained for the entire period during which the probe was implanted.
Thus, the Doppler probe is an accurate, atraumatic method for measuring right and left ventricular regional function. Transmural, endocardial and epicardial function can be mapped at various sites during surgery, and postoperatively one can monitor serial changes of regional function and assess the effects of cardioplegia and other therapeutic interventions. This technique should be useful for both investigative and clinical purposes.
↵1 Dr. Bolli was a recipient of the Physician-Scientist Award of the American College of Chest Physicians, Park Ridge, Illinois.
☆ This study was supported in part by Grant-in-Aid 88R-171 from the American Heart Association, Texas Affiliate, Austin, Texas; by SCOR Grant HL-42267 from the National Institutes of Health, Bethesda, Maryland; and by Grants HL-43151, HL-22512, HL-26377 and HL-23161 from the National Heart, Lung, and Blood Institute, Bethesda.
- Received August 9, 1989.
- Revision received November 11, 1989.
- Accepted November 13, 1989.