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1 Cardiothoracic Unit, Great Ormond Street Hospital For Children, London WC1N 3JH; 2 Department of Cardiology, Royal Brompton Hospital, London SW3 6NP, United Kingdom; and 3 Institute of Experimental Clinical Research, Skejby University Hospital, DK-8200 Aarhus N, Denmark
The parallel conductance
volume, created by the conductivity of structures surrounding the
ventricular blood pool, can be estimated by using a saline dilution
technique. This paper examines the use of a novel volume reduction
method, during a standard vena caval preload reduction maneuver, as an
alternative to the routinely used saline dilution method to calibrate
conductance catheter measurements in the left (LV) and right ventricle
(RV) of animals and humans. The serial reproducibility of both methods was examined by measurement of percent difference, and by assessing the
coefficient of repeatability 1) between two measurements
within the same subject, 2) between the two techniques, and
3) interobserver variability. The effect of ventricular size
and contractile state on the volume reduction technique was also
observed. It was essential to ensure the technique was not affected by
inotropic state. The volume reduction technique and saline dilution
method were repeated at three different loading states (baseline, 5, and 10 µg · kg
1 · min1 of
dobutamine). The coefficient of repeatability between serial measurements was similar for both the volume reduction and saline dilution methods, and good interobserver variability was demonstrated. The volume reduction technique was compared with the saline dilution technique over a large range of ventricular sizes. No significant difference was observed in the RV or LV of adult humans or in the LV of
neonatal pigs and children. There was no significant effect on
either the saline dilution or the volume reduction technique as the
inotropic state increased. In conclusion, the volume reduction technique is neither affected by ventricular size nor contractile state, is repeatable between different observers, and can be used to
substitute the saline dilution method when preload reduction of the
ventricle is being employed.
saline dilution; right ventricle; left ventricle; ventricular volume; conductance catheter
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