Prediction of Intraoperative Hypovolemia in Patients with Left Ventricular Hypertrophy: Comparison of Transesophageal Echocardiography and Swan‐Ganz Monitoring

We have compared the pulmonary artery catheterization and transesophageal echocardiography (TEE) as an index of left ventricular (LV) volume in 32 patients with LV hypertrophy. Twenty-four of the 32 patients had episodes of low LV volume using TEE. Of these 24 patients, five had low pulmonary capillary wedge pressures ranging from 6-11 mmHg (mean +/- SD, 8.8 +/- 1.9 mmHg). Nineteen patients had elevated pulmonary capillary wedge pressures (PCWPs) (mean 18.3 +/- 2.2 mmHg) and TEE showed signs of hypovolemia. Volume repletion resulted in increased blood pressure in these patients. The poor correlation between PCWP and LV end-diastolic volume in the present study may result from impaired compliance of the ventricle. Diagnosis of hypovolemia should not be solely based on hemodynamic parameters alone and TEE provides accurate estimates of ventricular volume.