Regional Ventricular Function

  • Tariq NaseemEmail author
  • Timothy M. Maus


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).


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)


  1. 1.
    Beaupre PN, Kremer PF, Cahalan MK, et al. Intraoperative detection of changes in left ventricular segmental wall motion by transesophageal two-dimensional echocardiography. Am Heart J. 1984;107:1021.CrossRefPubMedGoogle Scholar
  2. 2.
    van Daele ME, Sutherland GR, Mitchell MM, et al. Do changes in pulmonary capillary wedge pressure adequately reflect myocardial ischemia during anesthesia? A correlative preoperative hemodynamic, electrocardiographic, and transesophageal echocardiographic study. Circulation. 1990;81:865.CrossRefPubMedGoogle Scholar
  3. 3.
    Akchurin RS, Tkachuk LM, Lepilin MG, et al. Intraoperative transesophageal echocardiography for detection of myocardial ischemia. Herz. 1993;18:372.PubMedGoogle Scholar
  4. 4.
    Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in Adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015, 28:1–39.Google Scholar
  5. 5.
    Rouine-Rapp, et al. Detection of intraoperative segmental wall-motion abnormalities by transesophageal echocardiography: The incremental value of additional cross sections in the transverse and longitudinal planes. Anesthesia & Analgesia 1996, 83:6, 1141–1148.Google Scholar
  6. 6.
    Braunwald RA. Kloner: The stunned myocardium: Prolonged, postischemic ventricular dysfunction. Circulation. 1982;66:1146–1149 (tmn).Google Scholar
  7. 7.
    Otsuji Y, Handschumacher MD, Kisanuki A, et al. Functional mitral regurgitation. Cardiologia. 1998;43:1011–6.PubMedGoogle Scholar
  8. 8.
    Russo A, Suri RM, Grigioni F, Roger VL, Oh JK, Mahoney DW, et al. Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture. Circulation. 2008;118:1528–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Reeder GS. Identification and treatment of complications of myocardial infarction. Mayo Clin Proc. 1995;70:880.CrossRefPubMedGoogle Scholar
  10. 10.
    López-Sendón J, González A, López de Sá E, et al. Diagnosis of subacute ventricular wall rupture after acute myocardial infarction: sensitivity and specificity of clinical, hemodynamic and echocardiographic criteria. J Am Coll Cardiol. 1992;19:1145.CrossRefPubMedGoogle Scholar
  11. 11.
    Figueras J, Alcalde O, Barrabés JA, et al. Changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation. 2008;118:2783.CrossRefPubMedGoogle Scholar
  12. 12.
    Giannuzzi P, Temporelli PL, Bosimini E, et al. Heterogeneity of left ventricular remodeling after acute myocardial infarction: results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico-3 Echo Substudy. Am Heart J. 2001;141:131.CrossRefPubMedGoogle Scholar
  13. 13.
    Glower DG, Lowe EL. Left ventricular aneurysm. In: Cardiac surgery in the adult. Edmunds LH (ed) McGraw-Hill, New York 1997. p. 677.Google Scholar
  14. 14.
    Douglas PS, et al. ACCF/ACR/AHA/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR 2008 health policy statement on structured reporting in cardiovascular imaging. J Am Coll Cardiol. 2009;53(1):76–90.Google Scholar

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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