Abstract
Purpose
To report transesophageal echocardiographic (TEE) findings consistent with intraoperative acute diastolic dysfunction in a series of patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair.
Methods
A series of nine consecutive patients underwent TAAA repair with intraoperative TEE monitoring. Surgical repair was performed with the adjunct of a left atrio-femoral bypass. Invasive arterial and venous pressures were monitored. Intraoperative TEE was utilized to assess the diastolic function before, and during aortic cross clamping. Diastolic dysfunction was defined as a mitral inflow pulsed wave Doppler (E: A ratio) < 1.
Results
All patients demonstrated an E: A ratio > 1 (1.3 ± 0.08) before aortic cross clamping. During cross clamp, the E: A ratio decreased to < 1 (0.75 ± 0.05) in six of nine patients consistent with diastolic dysfunction. The three patients who did not develop E: A changes were receiving ß-blockers preoperatively. Patients with diastolic dysfunction were treated with nitroglycerin infusions, which resulted in restoration of their E: A ratios < 1 (1.2 ± 0.09). Three of the patients with intraoperative diastolic dysfunction developed postoperative myocardial infarction.
Conclusions
Chronic diastolic dysfunction is a well-known entity. This report describes acute diastolic dysfunction, which was observed frequently in patients undergoing TAAA during aortic cross clamp. Further research is required to confirm this phenomenon and determine its possible association with increased postoperative cardiac morbidity.
Résumé
Objectif
Présenter les résultats de ľéchocardiographie transœsophagienne (ETO) compatibles avec une dysfonction peropératoire diastolique aiguë chez une série de patients opérés pour un anévrysme aortique thoraco-abdominal (AATA).
Méthode
Neuf patients consécutifs ont subi la réparation ďun AATA sous monitorage peropératoire avec ETO. Une dérivation auriculo-fémorale gauche et un monitorage endovasculaire des pressions artérielle et veineuse ont été utilisés. ĽETO peropératoire a servi à évaluer la fonction diastolique avant et pendant le clampage de la crosse aortique. La dysfonction diastolique était une onde Doppler pulsée ďentrée mitrale (ratio E: A) < 1.
Résultats
Tous les patients ont démontré un ratio E: A > 1 (1,3 ± 0,08) avant le clampage de la crosse aortique. Pendant le clampage, le ratio E: A a baissé à < 1 (0,75 ± 0,05) chez six des neuf patients, indiquant une dysfonction diastolique. Les trois autres patients avaient reçu des ß bloquants préopératoires. La dysfonction diastolique a été traitée avec une perfusion de nitroglycérine, ce qui a restauré le ratio E: A < 1 (1,2 ± 0,09). Trois des patients qui ont présenté une dysfonction diastolique peropératoire ont subi un infarctus du myocarde postopératoire.
Conclusion
La dysfonction diastolique chronique est bien connue. Nous avons décrit une dysfonction diastolique aiguë observée souvent pendant le clampage de la crosse aortique chez des patients opérés pour un AATA. Il faut encore confirmer ce phénomène et déterminer son lien possible avec la hausse de la morbidité cardiaque postopératoire.
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Fayad, A., Yang, H., Nathan, H. et al. Acute diastolic dysfunction in thoracoabdominal aortic aneurysm surgery. Can J Anesth 53, 168–173 (2006). https://doi.org/10.1007/BF03021823
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DOI: https://doi.org/10.1007/BF03021823