Validating TEE Measurements of Right Ventricular Function

Study Overview
=================
Brief Summary
-----------------
Transesophageal echocardiography (TEE) is becoming a more prevalent method of monitoring and diagnosis in the perioperative setting for critically ill patients and patients undergoing cardiac surgery. Many TEE measurements are extrapolated from transthoracic echocardiography (TTE) data and have not validated by transesophageal means. The aim of this study is to validate TEE assessment of right ventricular function by comparing them to simultaneously measured TTE measurements. Likewise, there are currently no agreed upon values for RV free wall strain. Therefore, the investigators will attempt to define a range of normal values of RV free wall strain as compared to the other measures of RV function.

Detailed Description
-----------------
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.

Official Title
-----------------
Validating Transesophageal Echocardiographic Measurements of Right Ventricular Function

Conditions
-----------------
Ventricular Function, Right, Echocardiography, Transesophageal

Intervention / Treatment
-----------------
* Diagnostic Test: Transesophageal Echocardiography
* Diagnostic Test: Transthoracic Echocardiography


Participation Criteria
=================
Eligibility Criteria
-----------------
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

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Transesophageal Echocardiography|TEE measures of right ventricular function|
|Diagnostic Test: Transthoracic Echocardiography|TTE measures of right ventricular function|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Right ventricular index of myocardial performance (RIMP) | Right ventricular index of myocardial performance (RIMP) will be measured using both TTE and TEE. | Immediately following the induction of anesthesia and TEE probe placement | 
| Tricuspid annular plane systolic excursion (TAPSE) | Tricuspid annular plane systolic excursion (TAPSE) will be measured using both TTE and TEE. | Immediately following the induction of anesthesia and TEE probe placement | 
| Right ventricular fractional area change (FAC) | Right ventricular fractional area change (FAC) will be measured using both TTE and TEE. | Immediately following the induction of anesthesia and TEE probe placement | 
| RV annular systolic velocity (S') | RV annular systolic velocity (S') will be measured using both TTE and TEE. | Immediately following the induction of anesthesia and TEE probe placement | 
| RV free wall longitudinal strain | RV free wall longitudinal strain will be measured using both TTE and TEE. | Immediately following the induction of anesthesia and TEE probe placement | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ease of obtaining appropriate TEE measures of right ventricular function | Ease of acquisition will be assessed by the echocardiographers | Within 15 minutes following anesthesia induction | 
| Define values for normal right ventricular free wall strain | The data collected will be used to define normal values for right ventricular free wall strain | Through study completion, an estimate of 1 year |