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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: mfilipovic@uhbs.ch; Tel: +41 61 265 25 25; Fax: +41 61 265 73 20
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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

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