Quantitative analysis of left ventricular regional wall motion with color kinesis during abdominal aortic cross-clamping.
OBJECTIVE
The authors aimed to establish a technique for quantitative analysis of regional wall motion abnormality (RWMA) using color kinesis (CK) of transesophageal echocardiography (TEE) in surgical patients. This technique was used to determine whether RWMAs develop de novo after infrarenal aortic cross-clamping in patients undergoing vascular surgery with a preoperative dipyridamole thallium stress test (DTST).


METHODS
An observational study.


METHODS
University hospital.


METHODS
Thirty-eight patients undergoing infrarenal abdominal aortic aneurysm resection or aortofemoral bypass.


RESULTS
CK images of the left ventricle (LV) were obtained from the midventricular transgastric short-axis view before and after infrarenal aortic cross-clamping using TEE and analyzed off-line using custom software. The predictive value of the category "reversible perfusion defect" (RD) was also estimated from DTST for predicting new RWMAs with CK. CK analysis is suitable for clinical use based on the comparison with conventional two-dimensional echocardiogram measurements and interobserver variability. CK analysis showed all 7 patients with persistent perfusion defects on DTST had RWMAs. New RWMAs occurred in 2 of 9 patients with RD and in 2 of 15 patients with normal DTST, indicating that there was no significant difference between RD and normal DTST in the incidence of new RWMAs.


CONCLUSIONS
A new method is available for clinical use, which is capable of visualizing RWMAs. These results suggest that new RWMAs introduced by aortic cross-clamping occur irrespective of the risk as assessed by preoperative DTST. CK with the new analysis method might be a useful tool to quantitatively evaluate RWMAs during surgery.
Yamaura
Ken
K
Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. keny@kuaccm.med.kyushu-u.ac.jp
Hoka
Sumio
S
Okamoto
Hirotsugu
H
Takahashi
Shosuke
S
D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*