Aortic regurgitation in coronary artery bypass grafting: implications for cardioplegia administration.
BACKGROUND
Echocardiography can detect aortic regurgitation (AR) that may interfere with the adequate delivery of cardioplegia solution to the myocardium during cardiac operation. When aware of this lesion, the surgeon can modify the operative technique accordingly. We sought to evaluate the ability of intraoperative transesophageal echocardiography to detect AR and to correlate the severity of the lesion with the need for retrograde cardioplegia administration.


METHODS
Eighty-four consecutive patients undergoing coronary artery bypass grafting were evaluated. When AR was noted by intraoperative transesophageal echocardiography, a cannula was placed in the coronary sinus for possible retrograde cardioplegia administration. The surgeon was unaware of the severity of AR. After operation, the severity of AR was quantitated using the ratio of the regurgitation jet width to the left ventricular outflow tract diameter.


RESULTS
The AR patients who required retrograde cardioplegia had a significantly higher ratio of regurgitation jet width to left ventricular outflow tract diameter than those AR patients who did not (0.36 +/- 0.06 versus 0.19 +/- 0.06, p < 0.005).


CONCLUSIONS
Transesophageal echocardiography can provide accurate information regarding the presence and severity of AR. The calculated severity of AR on transesophageal echocardiography is associated with the need for retrograde cardioplegia administration.
Moisa
R B
RB
Department of Medicine, Winthrop-University Hospital, Mineola, New York 11501, USA.
Zeldis
S M
SM
Alper
S A
SA
Scott
W C
WC
D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D002404:Catheterization; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology; D003331:Coronary Vessels; D003971:Diastole; D017548:Echocardiography, Transesophageal; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007430:Intraoperative Care; D008875:Middle Aged; D016277:Ventricular Function, Left
D002314:Cardioplegic Solutions