title: Improved monitoring of myocardial ischaemia during major vascular surgery using transoesophageal echocardiography.
abstract: As regional wall motion abnormality (RWA) is the first sign of ischaemia, transoesophageal echocardiography was evaluated as a monitoring device in 51 patients undergoing abdominal aortic surgery. Wall motion of the entire left ventricular wall (nine segments) was semiquantitatively evaluated 15 min before and after aortic cross-clamping and 3 h after declamping. In addition, limb lead II of the electrocardiogram was simultaneously recorded. At baseline, RWA was present in 16 patients (31%). New or worsened RWA 15 min after aortic cross-clamping was seen in 17 patients, of whom 11 had persistent RWA, i.e. it was still present 3 h after declamping. This was associated in seven patients with enzymatically documented myocardial infarction. Only one infarct patient demonstrated ST segment changes of more than 1 mm. Thus, a single electrocardiographic surface lead is insensitive for perioperative myocardial ischaemia detection. Furthermore, new and/or worsened RWA after aortic cross-clamping, which persists until 3 h after declamping, is, to a considerable degree, associated with perioperative infarction.
authors.affiliation: Department of Cardiology, Surgery and Anaesthesiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Koolen
authors.forename: C A
authors.initials: CA
authors.lastname: Visser
authors.forename: S L
authors.initials: SL
authors.lastname: Reichert
authors.forename: W J
authors.initials: WJ
authors.lastname: Jaarsma
authors.forename: J G
authors.initials: JG
authors.lastname: Kromhout
authors.forename: H B
authors.initials: HB
authors.lastname: van Wezel
authors.forename: A J
authors.initials: AJ
authors.lastname: Dunning
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000503:physiopathology / Q000601:surgery; D001018:Aortic Diseases / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation / Q000502:physiology; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology