Influence of coronary artery bypass surgery on regional left ventricular wall motion: an intraoperative two-dimensional transesophageal echocardiographic study.
Two-dimensional transesophageal echocardiography was used to evaluate the effect of coronary revascularization on regional myocardial function in 30 patients. Cross-sections at the level of the papillary muscles were obtained 15 minutes after intubation, 15 minutes after sternal closure, and 6 and 12 hours later, in the intensive care unit. Regional myocardial function of eight segmental areas was obtained using a floating axis system. The segments were allocated to one of four conditions, depending on baseline regional area ejection fraction (RAEF): condition I) RAEF < 0%; condition II) RAEF = 0% to 25%; condition III) RAEF = 26% to 50%; or condition IV) RAEF > 50% (normal). Compared to baseline values (postinduction), RAEF changed after sternal closure in condition I from -10.4% +/- 5.4% to 17.6% +/- 10.3% (P < .01), in condition II from 14.3% +/- 6.1% to 30.7% +/- 7.8% (P < .01), and in condition III from 35.0% +/- 6.1% to 50.4% +/- 6.3% (P < .01). In condition IV there was no significant change in RAEF. Further improvement of RAEF in conditions I, II, and III was not seen in the intensive care unit. Thus, preoperative normal regional myocardial function was not affected by coronary revascularization, and dysfunctioning myocardium frequently improved immediately after revascularization.
Koolen
J J
JJ
Departments of Cardiology, Cardiac Surgery, and Anesthesiology, Academic Medical Centre, Amsterdam, The Netherlands.
Visser
C A
CA
van Wezel
H B
HB
Meyne
N G
NG
Dunning
A J
AJ
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D011182:Postoperative Care; D016277:Ventricular Function, Left / Q000502:physiology*