title: Transesophageal echocardiography for monitoring segmental wall motion during off-pump coronary artery bypass surgery.
abstract: In this prospective, observational study, we evaluated whether transesophageal echocardiography allows for monitoring left ventricular segmental wall motion during cardiac displacement for off-pump coronary artery bypass (OPCAB) surgery. On the basis of a pilot study that showed frequent loss of transgastric views during OPCAB surgery, we analyzed only midesophageal views. The midesophageal 4-chamber view, 2-chamber view, and long-axis view were recorded in 60 patients after opening the chest and placing an epicardial stabilizer on the displaced heart. Using the 16-segment model, 2 echocardiographers independently performed offline analysis of segmental wall motion. The percentage of patients in whom >or=14 left ventricular segments were readable was calculated at baseline and after cardiac displacement and placement of an epicardial stabilizer. At baseline, >or=14 segments were readable in 59 (98%) of 60 patients. After cardiac displacement, >or=14 segments were readable during 58 (76%) of 76 revascularizations of the left anterior descending coronary artery (P < 0.01 versus baseline), during 33 (83%) of 40 revascularizations of the left circumflex coronary artery (P < 0.01 versus baseline), and during 29 (94%) of 31 revascularizations of the right coronary artery (not significant). We conclude that the number of readable segments decreased after cardiac displacement but that availability of >or=14 readable segments allowed for reliable monitoring of segmental wall motion in 4 of 5 patients during OPCAB surgery.
authors.affiliation: Departments of *Anesthesia, †Internal Medicine (Division of Cardiology), and ‡Surgery (Division of Cardiothoracic Surgery), University of Basel, Basel, Switzerland.
authors.forename: Jianwen
authors.initials: J
authors.lastname: Wang
authors.forename: Miodrag
authors.initials: M
authors.lastname: Filipovic
authors.forename: Ainars
authors.initials: A
authors.lastname: Rudzitis
authors.forename: Isabelle
authors.initials: I
authors.lastname: Michaux
authors.forename: Karl
authors.initials: K
authors.lastname: Skarvan
authors.forename: Peter
authors.initials: P
authors.lastname: Buser
authors.forename: Atanas
authors.initials: A
authors.lastname: Todorov
authors.forename: Franziska
authors.initials: F
authors.lastname: Bernet
authors.forename: Manfred D
authors.initials: MD
authors.lastname: Seeberger
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D011446:Prospective Studies