Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Intraoperative transesophageal echocardiography patients with various forms of ischemic heart disease

Authors: L.A. Вockeria, M.M. Alshibaya, V.Yu. Merzlyakov, N.O. Sokol'skaya, N.S. Kopylova, E.V. Skripnik

Company:
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russia, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

UDC: 616.12-089.16-073.432.19:616.12-005.4

Link: Clinical Physiology of Blood Circulaiton. 2016; 13 (3): 139-147

Quote as: Вockeria L.A., Alshibaya M.M., Merzlyakov V.Yu., Sokol'skaya N.O., Kopylova N.S., Skripnik E.V. Intraoperative transesophageal echocardiography patients with various forms of ischemic heart disease. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2016; 13 (3): 139-47 (in Russ.)

Received / Accepted:  14.09.2016 /14.09.2016

Full text:  

Abstract

Objective - to assess the capabilities of intraoperative transesophageal echocardiography in patients with different forms of coronary heart disease (CHD), identify the echocardiographic predictors of early postoperative complications.

Material and methods . The study included 92 patients with CHD. Depending on the form of the disease the patients were divided into 2 groups: the first group included 23 patients with uncomplicated coronary heart disease, the second group of 69 patients with coronary artery disease complicated by postinfarction left ventricular aneurysm.

Results . Analysis of the obtained echocardiographic parameters were allowed to establish regularities and to identify the predictors that characterize the smooth and complicated course of early postoperative period. Patients on the background of a smooth flow, there is a trend towards normalization of the volume characteristics of the left ventricle (LV), improving the pumping function of the myocardium (increase of LVEF 7%), normal levels stroke and cardiac indexes, the absence of haemodynamically significant dysfunction of the atrioventricular valves. The General pattern of adverse flow included a decrease in the pumping function of the LV myocardium, cardiac and stroke indices of LV, increase of the degree of mitral and/or tricuspid insufficiency. On the basis of data obtained by intraoperative transesophageal echocardiography, in 10% of cases was changed tactics of surgical intervention. 8% of patients after the main phase of the operation was diagnosed dysfunction of the myocardium, determined by etiology of heart failure and in accordance with the adjusted tactic anesthesia and the hemodynamic management.

Conclusion . Thus, intraoperative transesophageal echocardiography in patients with various forms of CHD is a universal diagnostic tool which can modify the operations plan quickly diagnose myocardial dysfunction, and to analyze, allowing time to influence the way in surgical tactics and management of hemodynamics.

References

  1. Бокерия Л.А., Алшибая М.М., Сокольская Н.О., Копылова Н.С., Сливнева И.В. Эхокардиография в периоперационном периоде у больных ишемической болезнью сердца с постинфарктным разрывом межжелудочковой перегородки. Клиническая физиология кровообращения. 2015; 4: 34—40.
  2. Бокерия Л.А., Сокольская Н.О., Копылова Н.С., Алшибая М.М. Эхокардиографические предикторы тяжести течения раннего послеоперационного периода у больных после хирургической реваскуляризации миокарда. Анестезиология и реаниматология. 2015; 5: 8—11.
  3. Бокерия Л.А., Голухова Е.З. Основы семиотики и функциональной диагностики в кардиологии. М.: НЦССХ им. А.Н. Бакулева; 2015.
  4. Бокерия Л.А., Бузиашвили Ю.И. Чреспищеводная эхокардиография в коронарной хирургии. М.: НЦССХ им. А.Н. Бакулева РАМН; 1999.
  5. Сокольская Н.О., Копылова Н.С. Эхокардиографическая оценка функционального состояния миокарда и корня аорты у больных с аневризмой восходящей аорты до и в ранние сроки после операции: Методические рекомендации. М.: НЦССХ им. А.Н. Бакулева РАМН; 2014.
  6. Thys D.M., Abel M.D., Brooker F.R. Practice guidelines for perioperative transesophageal echocardiography. Anesthesiology. 2010; 112: 1084—96.
  7. Chikage Kihara, Kazuya Murata, Yasuaki Wada, Yasuyuki Hadano, Rikimaru Ohyama, Shinichi Okuda et al. Impact of intraoperative transesophageal echocardiography in cardiac and thoracicaortic surgery: Experience in 1011 cases. J. Cardiol. 2009; 54 (2): 282-8.
  8. Eltzschig H.K., Rosenberger P, Loffler M., Fox J.A., Aranki S.F., Shernan S.K. Impact of intraoperative transesophageal echocardiography on surgical decisions in 12,566 patients undergoing cardiac surgery. Ann. Thorac. Surg. 2008; 85: 845-52.
  9. Couture P, Denault A., McKenty S., Boudreault D., Plante F., Perron R. et al. Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery. Canad. J. Anesth. 2000; 47, Is. 1: 20-6.
  10. Minhaj M., Patel K., Muzic D., Tung A., Jeevanan- dam V., Raman J. et al. The effect of routine intraoperative transesophageal echocardiography on surgical management. J. Cardiothorac. Vasc. Anesth. 2007; 21: 800-4.
  11. Galhardo C.Jr, Souza Leal Botelho E., Dos Santos Diego L.A. Intraoperative monitoring with transesophageal echocardiography in cardiac surgery. Rev. Bras. Anestesiol. 2011; 61 (4).
  12. Reichert C.L., Visser C.A., Koolen J.J. et al. Transesophageal echocardiography in hypotensive patients after cardiac operations. Comparison with hemodynamic parameters. J. Thorac. Cardiovasc. Surg. 1992; 104: 321-6.
  13. Bergquist B.D., Bellows W.H., Leung J.M. Transesophageal echocardiography in myocardial revascularization: II. Influence on intraoperative decision-making. Anesth. Analg. 1996; 82: 1139-45.
  14. Shanewise J.S. How to reliably detect ischemia in the intensive care unit and operating room. Semin. Cardiothorac. Vasc. Anesth. 2006; 10: 101-9.
  15. Sheikh K.H., de Bruijn N.P., Rankin J.S. The utility of transesophageal echocardiography and Doppler color flow imaging in patients undergoing cardiac valve surgery. J. Am. Coll. Cardiol. 1990; 15: 363-72.
  16. Brown M.L., Abel M.D., Click R.L. et al. Systolic anterior motion after mitral valve repair: is surgical intervention necessary? J. Thorac. Cardiovasc. Surg. 2007; 133: 136-43.
  17. Flachskampf F., Wouters P, Edvardsen T, Evangelista A., Habib G., Hoffman P et al. Recommendations for transesophageal echocardiography: EACVI update 2014. Eur. Heart J. 2014; 15: 353-65.

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