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Identification of intraoperative myocardial ischemia by transesophageal echocardiography

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Ultrasound in Coronary Artery Disease

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 113))

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Abstract

The perioperative management of patients who are at risk for cardiac complications has improved dramatically with both the introduction of invasive hemodynamic monitoring and the aggressive use of inotropic and vasoactive drugs [1]. Nevertheless myocardial ischemia and infarction remain the primary cause of perioperative morbidity and mortality in the increasing number of older patients undergoing major surgery [2–6]. This perioperative cardiac mortality could be further reduced if myocardial ischemia could reliably be detected early enough to allow therapeutical intervention before ischemia has progressed to infarction as perioperative infarction carries a mortality of 50–70%. In this respect previous studies have found both hemodynamic monitoring and the electrocardiogram to be insensitive detectors [5, 7, 8].

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References

  1. Rao TLK, Jacobs KH, El-etr AA (1983) Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 59: 499–505.

    Article  PubMed  CAS  Google Scholar 

  2. Steen PA, Tinker JH, Tarhan S (1978) Myocardial reinfarction after anesthesia and surgery. JAMA 239: 2566.

    Article  PubMed  CAS  Google Scholar 

  3. Kennedy JW, Kaiser GC, Fisher LD (1981) Clinical and angiographica predictors of operative mortality from the collaborative study in coronary artery surgery (CASS). Circulation 63: 793–802.

    Article  PubMed  CAS  Google Scholar 

  4. Lunn JN, Mushin WW (1982) Mortality Associated with Anesthesia. London: Muffield Provincial Hospitals Trust.

    Google Scholar 

  5. Roizen MF, Beaupre PN, Alpert RA (1984) Monitoring with two-dimensional transesophageal echocardiography. J Vase Surg: 300–305.

    Google Scholar 

  6. Jamieson WRF, Janusz MT, Miyagihima RT, Gerein AN (1982) Influence of ischemic heart disease on early and late mortality after surgery for peripheral occlusive vascular disease. Circulation 66: 92–7.

    Google Scholar 

  7. Roy WL, Edelist G, Gilbert B (1979) Ischemia during non-cardiac surgical procedures in patients with coronary artery disease. Anesthesiology 51: 393–397.

    Article  PubMed  CAS  Google Scholar 

  8. Beaupre PN, Kremer PF, Cahalan MK (1984) Intraoperative detection of changes of left ventricular segmental wall motion by transesophageal two-dimensional echocardiography. Am Heart J 107: 1021–1023.

    Article  PubMed  CAS  Google Scholar 

  9. Barnard RJ, Buckberg GD, Duncan HW (1980) Limitations of the standard transthoracic electrocardiogram in detecting subendocardial ischemia. Am Heart J 99: 476.

    Article  PubMed  CAS  Google Scholar 

  10. Sughishita Y, Koseki S, Matsuda M (1983) Dissociation between regional myocardial dysfunction and ECG changes during myocardial ischemia induced by exercise in patients with angina pectoris. Am Heart J 106: 1–8.

    Article  Google Scholar 

  11. Battler A, Froelicher VF, Gallagher KP, Kemper WS, Ross J, Jr (1980) Dissociation between regional myocardial dysfunction and ECG changes during ischemia in the conscious dog. Circulation 62: 735.

    PubMed  CAS  Google Scholar 

  12. Chaitman BR, Bourassa MG, Wagmans P (1978) Improved efficacy of treadmill exercise testing multiple lead ECG system and basic hemodynamic response. Circulation 57: 71.

    PubMed  CAS  Google Scholar 

  13. Slogoff S, Keats AS (1985) Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 200 62 (2): 107 - 114.

    Article  PubMed  CAS  Google Scholar 

  14. Leung J, O’Kelly MB, Browner W (1988) Are regional wall motion abnormalities detected by transesophageal echocardiography triggered by acute changes in supply and demand? Anesthesiology V69 (3A): A801.

    Article  Google Scholar 

  15. Häggmark S, Hohner P, Ostman M (1989) Comparison of hemodynamic, electrocardiographic, mechanical and metabolic indicators of intraoperative myocardial ischemia in patients with coronary artery disease. Anesthesiology 70: 19–25.

    Article  PubMed  Google Scholar 

  16. Tennant R, Wiggers CJ (1935) The effect of coronary occlusion on myocardial contraction. Am J Physiol 112: 351–361.

    Google Scholar 

  17. Kerber RE, Marcus ML, Ehrhardt J (1975) Correlation between echocardiographically demonstrated segmental dyskinesis and regional myocardial perfusion. Circulation 52: 1097–1104.

    PubMed  CAS  Google Scholar 

  18. Vatner SF (1980) Correlation between acute reductions in myocardial blood flow and function in conscious dogs. Circ Res 47: 201–207.

    PubMed  CAS  Google Scholar 

  19. Wyatt HL, Forrester JS, Tyberg JV (1975) Effect of graded reductions in regional coronary perfusion on regional and total cardiac function. Am J Cardiol 36: 185–192.

    Article  PubMed  CAS  Google Scholar 

  20. Smith JS, Cahalan MK, Benefiel DJ (1985) Intraoperative detection of myocardial ischemia in high risk patients: Electrocardiography versus two-dimensional transesophageal echocardiography. Circulation 72: 1015–1021.

    Article  PubMed  CAS  Google Scholar 

  21. Gewertz BL, Kremer PC, Zarins CK (1987) Transesophageal echocardiographic monitoring of myocardial ischemia during vascular surgery. J Vase Surg 5 (4): 607–613.

    CAS  Google Scholar 

  22. Forrester JS, Wyatt HL, Protasio L (1976) Functional significance of regional ischemic contraction abnormalities, circulation 54: 64.

    PubMed  CAS  Google Scholar 

  23. Gallagher KP, Kumada T, Koziol JA (1980) Significance of regional wall thickening relative to transmural myocardial perfusion in anesthetized dogs. Circulation 62: 1266.

    PubMed  CAS  Google Scholar 

  24. Kerber RE, Marcus ML, Erhardt J, Wilson R, Abboud FM (1975) Correlation between echocardiographically demonstrated segmental dyskinesia and regional myocardial perfusion. Circulation 52: 1097.

    PubMed  CAS  Google Scholar 

  25. Waters DP, Luz PD, Wyatt HL, Swan HJC, Forrester JS (1977) Early changes in regional and global left ventricular function induced by graded reductions in regional coronary perfusion. am J Cardiol 39: 537.

    Article  PubMed  CAS  Google Scholar 

  26. Massie BM, Botvinick EM, Brundage BR (1978) Relationship of regional myocardial perfusion to segmental wall motion: A physiological basis for understanding the presence of reversibility of asynergy. Circulation 58: 1154–63.

    PubMed  CAS  Google Scholar 

  27. Visser CA, David GK, Kan G (1986) Two-dimensional echocardiography during percutaneous transluminal coronary angioplasty. Am Heart J 111: 1035–1041.

    Article  PubMed  CAS  Google Scholar 

  28. Clements FM, de Bruyn P (1987) Perioperative evaluation of regional wall motion by transesophageal two-dimensional echocardiography. Anesth analg 66: 249–261.

    Article  PubMed  CAS  Google Scholar 

  29. Hisanaga K, Hisanaga A, Nagata K, Yoshida S (1977) A new transesophageal real-time two dimensional echocardiographic system using a flexible tube and its clinical application. Proc Jpn Soc Ultrason Med 32: 43–44.

    Google Scholar 

  30. Hisanaga K, Hisanaga A, Nagata K, Ichie Y (1980) Transesophageal cross-sectional echocardiography. Am Heart J 100: 605–609.

    Article  PubMed  CAS  Google Scholar 

  31. Schluter M, Langenstein BA, Polster J (1982) Transesophageal cross-sectional echocardiography with phased array transducer system: Technique and initial clinical results. Br Heart J 48: 67–72.

    Article  PubMed  CAS  Google Scholar 

  32. Schluter M, Hinrichs A, Wolfgang T (1990) Transesophageal Two-dimensional Echocardiography: Comparison of ultrasonic and anatomic sections. Am J Cardiol 53: 1173–1178.

    Article  Google Scholar 

  33. Rankin JS, McHale PA, Arentzen CE (1976) Three dimensional dynamic geometry of the left ventricle in the conscious dog. Circ Res 39: 304–313.

    PubMed  CAS  Google Scholar 

  34. Cucchiara RF, Nugent M, Sewart JB (1984) Air embolism in upright neurosurgical patients: detection and localization by two-dimensional transesophageal echocardiography. Anesthesiology 60: 353–355.

    Article  PubMed  CAS  Google Scholar 

  35. Kremer P, Gahalan MK, Beaupre PN (1983) Intraoperative myocardial ischemia detected by Transesophageal Two-Dimentional Echocardiography. Circulation 68: 332.

    Google Scholar 

  36. van Daele MERM, Sutherland GR, Mitchell MM (1990) Do changes in pulmonary capillary wedge pressure adequately detect myocardial ischemia? A correlative hemodynamic, electrocardiographic and transesophageal echocardiographic study, submitted.

    Google Scholar 

  37. Clements FM, Hill R, Kisslo J, Orchard R (1986) How easily can we learn to recognize regional wall motion abnormalities with 2D transesophageal echocardiography? Proc Soc Cardiovasc Anesthesiol, 7th annual meeting, Montreal, 1986.

    Google Scholar 

  38. Shively BK, Schiller MB (1986) Transesophageal echocardiography in the intraoperative detection of myocardial ischemia and infarction. Echocardiography 3: 433–443.

    Article  Google Scholar 

  39. Cahalan MK, Prakash O, Rulf EN (1987) Addition of nitrous oxide to fentanyl anesthesia does not induce myocardial ischemia in patients with ischemic heart disease. Anesthesiology 67-6: 925–929.

    Article  Google Scholar 

  40. Schnittger I, Fitzgerald PJ, Jordan EP (1984) Computerized quantitative analysis of left ventricular wall motion by two-dimensional echocardiography. Circulation 70: 242–250.

    Article  PubMed  CAS  Google Scholar 

  41. Haendchen RV, Wyatt HL, Maurer G (1983) Quantitation of regional cardiac function by two-dimensional echocardiography. 1. Patterns of contraction in the normal left ventricle. Circulation 67 (6): 1234–44.

    Article  PubMed  CAS  Google Scholar 

  42. Weyman AE, Franklin TD, Hogan RD (1984) Importance of temporal hetrogeneity in assessing the contraction abnormalities associated with acute myocardial ischemia. Circulation 70: 102.

    Article  PubMed  CAS  Google Scholar 

  43. Zieher AM, Wollschlaeger HW, Bonzel T, Kasper W, Just H (1987) Hierarchy of levels of ischemia-induced impairment in regional left ventricular systolic function in man. Circulation 76 (4): 768–776.

    Article  Google Scholar 

  44. Wyatt HL, Meerbaum S (1981) Experimental evaluation of the extent of myocardial dyssynergy and infarct size by two-dimensional echocardiography. Circulation 63: 607–614.

    Article  PubMed  CAS  Google Scholar 

  45. Braunwald E, Kloner RA (1982) The stunned myocardium: prolonged post-ischemic ventricular dysfunction. Circulation 66: 1146 - 1149.

    Article  PubMed  CAS  Google Scholar 

  46. Burggraf GW, Craige E (1975) Echocardiographic studies of left ventricular wall motion and dimensions after valvular heart surgery. Am J Cardiol 35: 473–80.

    Article  PubMed  CAS  Google Scholar 

  47. Ezekiel A, Areeda JS, Garcia EV, Corday SR (1987) Intelligent left ventricular contour detection results from two-dimensional echocardiograms. Comp Cardiol pp 603–606. Long Beach, California: IEEE Computer Society.

    Google Scholar 

  48. Chu CH, Delp EJ, Buda AJ (1990) Detecting left ventricular endocardial and epicardial boundaries by digital two-dimensional echocardiography. Comp Cardiol, pp 393–396. Long Beach, California: IEEE Computer Society.

    Google Scholar 

  49. Chu CH, Delp EJ, Buda AJ (1990) Detecting left ventricular endocardial and epicardial boundaries by digital two-dimensional echocardiography. Comp Cardiol, pp 393–396. Long Beach, California: IEEE Computer Society.

    Google Scholar 

  50. Miller JG, Perez JE, Sobel BE (1985) Ultrasonic characterization of myocardium. Progress in Cardiovascular Diseases, Vol 28 (2): 85–110.

    Article  PubMed  CAS  Google Scholar 

  51. Chandraratna PAN, Jones JP, Leeman S (1988) Ultrasonic tissue characterization of the heart. Echocardiography 5 (3): 183–198.

    Article  Google Scholar 

  52. Perez JE, Miller JG, Barzilai B (1988) Progress in quantitative ultrasonic characterization of myocardium: From the laboratory to the bedside. Journal of the American Society of Echocardiography 1 (4): 294–304.

    PubMed  CAS  Google Scholar 

  53. Vered Z, Mohr G, Barzilai B (1989) Ultrasound integrated backscatter tissue characterization of remote myocardial infarction in human subjects. JACC 13 (1): 84–91.

    PubMed  CAS  Google Scholar 

  54. Berwing K, Schlepper M (1988) Echocardiographic imaging of the left ventricle by peripheral intravenous injection of echo contrast agent. Am Heart J 115: 399–408.

    Article  PubMed  CAS  Google Scholar 

  55. Feinstein FB, Heidenreich PA, Dick CD (1988) A new intravascular ultrasound contrast agent: Preliminary safety and efficacy results. Circulation 78 (suppl 4): II–565.

    Google Scholar 

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Authors
  1. Marc E. R. M. Van Daele
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  2. George R. Sutherland
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  3. Jos R. T. C. Roelandt
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Editor information

Editors and Affiliations

  1. Department of Cardiology, University of Bari, I-70124, Bari, Italy

    Sabino Iliceto  & Paolo Rizzon  & 

  2. Thorax Center, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    Jos R. T. C. Roelandt

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© 1991 Kluwer Academic Publishers

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Van Daele, M.E.R.M., Sutherland, G.R., Roelandt, J.R.T.C. (1991). Identification of intraoperative myocardial ischemia by transesophageal echocardiography. In: Iliceto, S., Rizzon, P., Roelandt, J.R.T.C. (eds) Ultrasound in Coronary Artery Disease. Developments in Cardiovascular Medicine, vol 113. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0611-2_8

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  • DOI: https://doi.org/10.1007/978-94-009-0611-2_8

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6762-1

  • Online ISBN: 978-94-009-0611-2

  • eBook Packages: Springer Book Archive

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