The risk of cardiac injury during laparoscopic fundoplication: cardiac troponin I and ECG study.
BACKGROUND
Myocardial trauma has been described during gastroesophageal reflux laparoscopic surgery, in association with the proximity of cardiac structures. In addition, specific haemodynamic changes induced by CO2 pneumoperitoneum could exacerbate perioperative cardiac complication even in patients without cardiac risk factors. The aim of this study was to evaluate the influence of gastroesophageal reflux laparoscopic surgery on the perioperative ECG, cardiac troponin I and myocardial enzyme changes.


METHODS
Forty-two ASA I-II patients without ischaemic heart disease or combined double-risk factors were studied. Automated ST segment analysis was used intraoperatively. ECG, plasma myocardial enzyme and cardiac troponin I concentrations were reported on arrival in the recovery room (HO), 4 h (H4) and 24 h (H24) postoperatively.


RESULTS
Intraoperative ST segment changes occurred in two patients: the first during a hypotensive episode (MAP<55 mmHg; 3/42 patients) and the second during a hypertensive episode (MAP >110 mmHg; 3/42 patients). One case of intraoperative subcutaneous emphysema occurred without ST disturbance. One case of pneumothorax was observed at H0-H4 in another patient without clinical symptoms. Cardiac troponin I and CK-MB were not increased postoperatively. Transaminase concentrations increased (2-fold normal values) in 26/42 patients. In these 26 patients, 7 experienced 5-fold isolated transaminase increase, associated with left hepatic artery section.


CONCLUSIONS
According to perioperative ECG changes and/or specific cardiac troponin I measurements, we did not identify specific myocardial damage following gastroesophageal reflux laparoscopic surgery. Unexpectedly, the incidence of hepatic cytolysis was frequent (62%) and has not previously been reported in the literature.
Boccara
G
G
Department of Anaesthesiology and Intensive Care B, Medical University of Montpellier, Hospital of Saint-Eloi, France. g-boccara@chu-montpellier.fr
Pouzeratte
Y
Y
Troncin
R
R
Bonardet
A
A
Boularan
A M
AM
Colson
P
P
Mann
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications; D007527:Isoenzymes; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009206:Myocardium / Q000201:enzymology / Q000378:metabolism; D009211:Myoglobin / Q000097:blood; D011183:Postoperative Complications; D019210:Troponin I / Q000097:blood*
D007527:Isoenzymes; D009211:Myoglobin; D019210:Troponin I; D003402:Creatine Kinase