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Regional Ventricular Function

  • Tariq NaseemEmail author
  • Timothy M. Maus
Chapter
  • 1.8k Downloads

Abstract

One of the most useful applications of intra-operative 2D transesophageal echocardiography (TEE) in noncardiac surgery is qualitative assessment of myocardial function in acutely unstable patients. When hemodynamic instability occurs intraoperatively, TEE can serve as an adjunct to other modalities in diagnosing or ruling out an ischemic event. In fact, compared to other monitoring methods, regional wall motion abnormality (RWMA) observed on echocardiography is the most sensitive method for early detection of ischemic changes in the heart. In noncardiac surgery, this can be especially useful in patients with no existing invasive or detailed monitoring that shows a sudden change in clinical status. Knowledge of normal coronary anatomy and its myocardial distribution is key in determining the location of an ischemic event. Recognizing the attributes of a wall motion abnormality such as decreased wall excursion or decreased wall thickening is key in diagnosing ischemic events, while recognizing that not all wall motion abnormalities are ischemic events (e.g., pacing effect).

Keywords

Ischemia Infarction Regional wall motion abnormalities Ischemic detection Coronary artery Coronary blood flow 

Supplementary material

Video 5.1

Transgastric midpapillary short axis view in a patient with inferior wall hypokinesis (AVI 6,489 KB)

Video 5.2

Transgastric midpapillary short axis view in a patient with anterior wall akinesis (AVI 7,373 KB)

Video 5.3

Midesophageal four-chamber view in a patient with septal akinesis (AVI 2,808 KB)

Video 5.4

Transgastric midpapillary short axis view in a patient with anterior dyskinesis (AVI 2,340 KB)

Video 5.5

Midesophageal long axis view in a patient with prior anterior wall MI and a resulting anteroseptal left ventricular aneurysm (AVI 11,147 KB)

Video 5.6

Midesophageal long axis view in a patient with ischemic mitral regurgitation. Note the akinetic anteroseptal wall (AVI 1,621 KB)

Video 5.7

Transgastric midpapillary short axis view in a patient with an inferior wall myocardial infarction and inferior wall rupture. Color flow Doppler demonstrates flow through the large wall rupture (AVI 4,679 KB)

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of California San DiegoLa Jolla, San DiegoUSA

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