Acute diastolic dysfunction in thoracoabdominal aortic aneurysm surgery.
OBJECTIVE
To report transesophageal echocardiographic (TEE) findings consistent with intraoperative acute diastolic dysfunction in a series of patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair.


METHODS
A series of nine consecutive patients underwent TAAA repair with intraoperative TEE monitoring. Surgical repair was performed with the adjunct of a left atrio-femoral bypass. Invasive arterial and venous pressures were monitored. Intraoperative TEE was utilized to assess the diastolic function before, and during aortic cross clamping. Diastolic dysfunction was defined as a mitral inflow pulsed wave Doppler (E: A ratio) < 1.


RESULTS
All patients demonstrated an E: A ratio > 1 (1.3 +/- 0.08) before aortic cross clamping. During cross clamp, the E: A ratio decreased to < 1 (0.75 +/- 0.05) in six of nine patients consistent with diastolic dysfunction. The three patients who did not develop E: A changes were receiving ss-blockers pre-operatively. Patients with diastolic dysfunction were treated with nitroglycerin infusions, which resulted in restoration of their E: A ratios > 1 (1.2 +/- 0.09). Three of the patients with intraoperative diastolic dysfunction developed postoperative myocardial infarction.


CONCLUSIONS
Chronic diastolic dysfunction is a well-known entity. This report describes acute diastolic dysfunction, which was observed frequently in patients undergoing TAAA during aortic cross clamp. Further research is required to confirm this phenomenon and determine its possible association with increased postoperative cardiac morbidity.
Fayad
Ashraf
A
Department of Anesthesia, University of Ottawa, B309, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. afayad@ottawahospital.on.ca
Yang
Homer
H
Nathan
Howard
H
Bryson
Gregory L
GL
Cina
Claudio S
CS
D000208:Acute Disease; D000368:Aged; D001011:Aorta / Q000502:physiology; D001014:Aortic Aneurysm / Q000601:surgery*; D003250:Constriction; D003971:Diastole; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology*