title: Evaluation of acute ischemic mitral regurgitation following cardiopulmonary bypass assessed by biplane transesophageal echocardiography.
abstract: The aim of this study was to evaluate pathogenesis and outcome of acute ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) using biplane transesophageal echocardiography (TEE). Biplane TEE was continuously monitored in a total of 96 patients who were scheduled for elective CABG surgery. Of 96 patients, 10 with no MR at stages 1 (after anesthetic induction but before skin incision) and 2 (after cardiopulmonary bypass [CPB] and decannulation) were excluded. In the remaining 86 patients with MR between stages 1 and 2, 45 (group A) had an increase in MR, and 41 (group B) had a decrease in MR. An increase in MR at stage 2 in group A was associated with a significant increase in annular diameter (p < 0.05), and pulmonary capillary wedge pressure (p < 0.01) compared with stage 1. A significant decrease in the left ventricular end-diastolic area (p < 0.01), end-systolic area (p < 0.05) and the mean wall motion abnormality score (WMA score) (p < 0.001) was observed at stage 2 compared with stage 1 in group B. In 16 of 17 patients (94%) with an increased WMA score in group A, a regional wall motion abnormality (RWMA) was detected in the right coronary artery (RCA) and/or left circumflex coronary artery (LCX) areas. In 7 patients in group A, MR increased continuously until stage 3 (after sternal closure) despite treatment. In 2 of these 7 patients, pulmonary venous systolic flow (PVSF) decreased during stage 2 and persisted to stage 3. The post operative course of these 2 patients was complicated with atrial fibrillation (AF). The increase in annular diameter and worsening in RWMA in RCA and/or LCX areas are associated with acute ischemic MR following CPB. The majority of acute ischemic MR cases were resolved by pharmacological intervention. Post operative AF was noted in 2 patients with acute ischemic MR associated with persistently decreased PVSF following CPB despite treatment.
authors.affiliation: Department of Anesthesiology and Cardiothoracic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10461, USA.
authors.forename: T
authors.initials: T
authors.lastname: Nakao
authors.forename: K
authors.initials: K
authors.lastname: Fujimoto
authors.forename: R F
authors.initials: RF
authors.lastname: Brodman
authors.forename: Y
authors.initials: Y
authors.lastname: Oka
mesh_terms: D000208:Acute Disease; D001281:Atrial Fibrillation / Q000209:etiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D006439:Hemodynamics; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology