Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-26T23:01:56.477Z Has data issue: false hasContentIssue false
  • English
  • Français

Intra-operative myocardial ischaemia cannot be detected by analysis of transmitral inflow patterns in patients undergoing off-pump coronary surgery

Published online by Cambridge University Press:  01 January 2008

J. Wang ,
M. D. Seeberger ,
K. Skarvan ,
I. Michaux ,
F. Bernet ,
R. Arsenic ,
P. Buser  and
M. Filipovic
J. Wang
Affiliation:
University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
M. D. Seeberger
Affiliation:
University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
K. Skarvan
Affiliation:
University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
I. Michaux
Affiliation:
University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
F. Bernet
Affiliation:
University Hospital Basel, Department of Surgery, Division of Cardiac Surgery, Basel, Switzerland
R. Arsenic
Affiliation:
University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
P. Buser
Affiliation:
University Hospital Basel, Department of Internal Medicine, Division of Cardiology, Basel, Switzerland
M. Filipovic*
Affiliation:
University Hospital Basel, Department of Anaesthesia, Basel, Switzerland
*
Corresponemce to: Miodrag Filipovic, Department of Anaesthesia, University Hospital Basel, CH 4031 Basel, Switzerland. E-mail: [email protected]; Tel: +41 61 265 25 25; Fax: +41 61 265 73 20
Get access

Summary

Background and objective

Transmitral inflow patterns have been used for detection of myocardial ischaemia. However, its diagnostic value has not been tested in anaesthetized and mechanically ventilated patients undergoing coronary artery bypass graft surgery.

Methods

Transmitral inflow patterns were studied by transoesophageal Doppler echocardiography in 43 patients undergoing coronary artery bypass graft surgery without cardiopulmonary bypass after opening of the sternum (baseline) and during grafting of the left anterior descending artery. Peak early (E) and peak late (A) transmitral velocities and their ratio (E/A) were recorded. Myocardial ischaemia was defined by standard criteria using two-dimensional echocardiography and seven-lead electrocardiogram.

Results

Thirty-one patients (64 ± 8 yr, 9 women) fulfilled the predefined inclusion criteria for analysis. During distal revascularization, 16 patients showed myocardial ischaemia and 15 did not. The use of vasoactive drugs, haemodynamic findings and transmitral inflow patterns were similar in both groups at baseline and during grafting. In the ischaemic group, E was 67.1 ± 13.9 cm s−1 at baseline and 69.5 ± 23.2 cm s−1 during grafting, and the E/A ratios were 1.3 ± 0.3 and 1.4 ± 0.9, respectively. In the non-ischaemic group, E was 64.0 ± 17.1 cm s−1 at baseline and 60.9 ± 14.8 cm s−1 during grafting, and the E/A ratios were 1.4 ± 0.7 and 1.2 ± 0.3, respectively.

Conclusions

Analysis of Doppler findings of transmitral inflow patterns did not allow for detection of myocardial ischaemia during surgical revascularization of the myocardium.

Keywords

CARDIOPULMONARY BYPASSCARDIAC SURGICAL PROCEDURESMYOCARDIAL ISCHAEMIAECHOCARDIOGRAPHY DOPPLER
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 1 , January 2008 , pp. 1 - 7
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Rodgers, GP, Ayanian, JZ, Balady, G et al. . American College of Cardiology/American Heart Association Clinical Competence statement on stress testing: a report of the American College of Cardiology/American Heart Association/American College of Physicians – American Society of Internal Medicine Task Force on Clinical Competence. J Am Coll Cardiol 2000; 36: 1441–1453.CrossRefGoogle Scholar
2Rouine-Rapp, K, Ionescu, P, Balea, M, Foster, E, Cahalan, MK. Detection of intraoperative segmental wall-motion abnormalities by transesophageal echocardiography: the incremental value of additional cross sections in the transverse and longitudinal planes. Anesth Analg 1996; 83: 1141–1148.CrossRefGoogle ScholarPubMed
3.Labovitz, AJ, Lewen, MK, Kern, M et al. . Evaluation of left ventricular systolic and diastolic dysfunction during transient myocardial ischemia produced by angioplasty. J Am Coll Cardiol 1987; 10: 748–755.CrossRefGoogle ScholarPubMed
4.el-Said, ES, Roelandt, JR, Fioretti, PM et al. . Abnormal left ventricular early diastolic filling during dobutamine stress Doppler echocardiography is a sensitive indicator of significant coronary artery disease. J Am Coll Cardiol 1994; 24: 1618–1624.CrossRefGoogle ScholarPubMed
5.Filipovic, M, Seeberger, MD, Rohlfs, R et al. . Doppler indices of diastolic transmitral flow velocities are invalid indicators of myocardial ischaemia during high dose dobutamine infusion in anesthetized patients. Eur J Anaesthesiol 2002; 19: 789–795.CrossRefGoogle Scholar
6.Seeberger, MD, Filipovic, M, Rohlfs, R et al. . The diagnostic value of Doppler echocardiographic indexes of diastolic filling for detecting demand ischemia in anesthetized patients. Int J Card Imaging 2000; 16: 437–446.CrossRefGoogle ScholarPubMed
7.Sergeant, P, de Worm, E, Meyns, B, Wouters, P. The challenge of departmental quality control in the reengineering towards off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg 2001; 20: 538–543.CrossRefGoogle ScholarPubMed
8.Wang, J, Filipovic, M, Rudzitis, A et al. . Transesophageal echocardiography for monitoring segmental wall motion during off-pump coronary artery bypass surgery. Anesth Analg 2004; 99: 965–973.CrossRefGoogle ScholarPubMed
9.Shanewise, JS, Cheung, AT, Aronson, S et al. . ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Anesth Analg 1999; 89: 870–884.Google Scholar
10.Schiller, NB, Shah, PM, Crawford, M et al. . Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2: 358–367.CrossRefGoogle ScholarPubMed
11.Rakowski, H, Appleton, C, Chan, KL et al. . Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography: from the Investigators of Consensus on Diastolic Dysfunction by Echocardiography. J Am Soc Echocardiogr 1996; 9: 736–760.CrossRefGoogle ScholarPubMed
12.European Study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. Eur Heart J 1998; 19: 990–1003.CrossRefGoogle Scholar
13.Marsch, SC, Wanigasekera, VA, Ryder, WA, Wong, LS, Foex, P. Graded myocardial ischemia is associated with a decrease in diastolic distensibility of the remote nonischemic myocardium in the anesthetized dog. J Am Coll Cardiol 1993; 22: 899–906.CrossRefGoogle ScholarPubMed
14.Wijns, W, Serruys, PW, Slager, CJ et al. . Effect of coronary occlusion during percutaneous transluminal angioplasty in humans on left ventricular chamber stiffness and regional diastolic pressure-radius relations. J Am Coll Cardiol 1986; 7: 455–463.CrossRefGoogle ScholarPubMed
15.Lange, HW, Schluter, M, Hamm, C et al. . Left ventricular diastolic function in PTCA: a Doppler echocardiographic study. Z Kardiol 1987; 76: 525–529.Google ScholarPubMed
16.Vatner, SF, Braunwald, E. Cardiovascular control mechanisms in the conscious state. N Engl J Med 1975; 293: 970–976.CrossRefGoogle ScholarPubMed
17.Filipovic, M, Wang, J, Michaux, I et al. . Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation. Br J Anaesth 2005; 94: 186–192.CrossRefGoogle ScholarPubMed
18.Belhomme, D, Peynet, J, Louzy, M et al. . Evidence for preconditioning by isoflurane in coronary artery bypass graft surgery. Circulation 1999; 100: II340–II344.CrossRefGoogle ScholarPubMed
19.Pagel, PS, Hettrick, DA, Lowe, D, Tessmer, JP, Warltier, DC. Desflurane and isoflurane exert modest beneficial actions on left ventricular diastolic function during myocardial ischemia in dogs. Anesthesiology 1995; 83: 1021–1035.CrossRefGoogle ScholarPubMed
20.Schulman, DS, Biondi, JW, Zohgbi, S et al. . Left ventricular diastolic function during positive end-expiratory pressure. Impact of right ventricular ischemia and ventricular interaction. Am Rev Respir Dis 1992; 145: 515–521.CrossRefGoogle ScholarPubMed
21.Stoddard, MF, Pearson, AC, Kern, MJ et al. . Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans. Circulation 1989; 79: 1226–1236.CrossRefGoogle ScholarPubMed
22.Applegate, RJ. Load dependence of left ventricular diastolic pressure-volume relations during short-term coronary artery occlusion. Circulation 1991; 83: 661–673.CrossRefGoogle ScholarPubMed
23.Biswas, S, Clements, F, Diodato, L, Hughes, GC, Landolfo, K. Changes in systolic and diastolic function during multivessel off-pump coronary bypass grafting. Eur J Cardiothorac Surg 2001; 20: 913–917.CrossRefGoogle ScholarPubMed
24.Smith, JS, Cahalan, MK, Benefiel, DJ et al. . Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography. Circulation 1985; 72: 1015–1021.CrossRefGoogle ScholarPubMed
25.Moises, VA, Mesquita, CB, Campos, O et al. . Importance of intraoperative transesophageal echocardiography during coronary artery surgery without cardiopulmonary bypass. J Am Soc Echocardiogr 1998; 11: 1139–1144.CrossRefGoogle ScholarPubMed
26.Garcia, MJ, Thomas, JD, Klein, AL. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 1998; 32: 865–875.CrossRefGoogle Scholar
27.Wang, CH, Cherng, WJ, Hung, MJ. Effect of dobutamine-induced myocardial ischemia on Doppler echocardiography after myocardial infarction. Am Heart J 1997; 134: 1058–1065.CrossRefGoogle ScholarPubMed
28.Dabrowska-Kugacka, A, Claeys, MJ, Rademakers, FE. Diastolic indexes during dobutamine stress echocardiography in patients early after myocardial infarction. J Am Soc Echocardiogr 1998; 11: 26–35.CrossRefGoogle ScholarPubMed