title: Intra-operative myocardial ischaemia cannot be detected by analysis of transmitral inflow patterns in patients undergoing off-pump coronary surgery.
abstract: OBJECTIVE
  Transmitral inflow patterns have been used for detection of myocardial ischaemia. However, its diagnostic value has not been tested in anaesthetized and mechanically ventilated patients undergoing coronary artery bypass graft surgery.
  
  
  METHODS
  Transmitral inflow patterns were studied by transoesophageal Doppler echocardiography in 43 patients undergoing coronary artery bypass graft surgery without cardiopulmonary bypass after opening of the sternum (baseline) and during grafting of the left anterior descending artery. Peak early (E) and peak late (A) transmitral velocities and their ratio (E/A) were recorded. Myocardial ischaemia was defined by standard criteria using two-dimensional echocardiography and seven-lead electrocardiogram.
  
  
  RESULTS
  Thirty-one patients (64 +/- 8 yr, 9 women) fulfilled the predefined inclusion criteria for analysis. During distal revascularization, 16 patients showed myocardial ischaemia and 15 did not. The use of vasoactive drugs, haemodynamic findings and transmitral inflow patterns were similar in both groups at baseline and during grafting. In the ischaemic group, E was 67.1 +/- 13.9 cm s-1 at baseline and 69.5 +/- 23.2 cm s-1 during grafting, and the E/A ratios were 1.3 +/- 0.3 and 1.4 +/- 0.9, respectively. In the non-ischaemic group, E was 64.0 +/- 17.1 cm s-1 at baseline and 60.9 +/- 14.8 cm s-1 during grafting, and the E/A ratios were 1.4 +/- 0.7 and 1.2 +/- 0.3, respectively.
  
  
  CONCLUSIONS
  Analysis of Doppler findings of transmitral inflow patterns did not allow for detection of myocardial ischaemia during surgical revascularization of the myocardium.
authors.affiliation: University Hospital Basel, Department of Anaesthesia, Basel, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: M D
authors.initials: MD
authors.lastname: Seeberger
authors.forename: K
authors.initials: K
authors.lastname: Skarvan
authors.forename: I
authors.initials: I
authors.lastname: Michaux
authors.forename: F
authors.initials: F
authors.lastname: Bernet
authors.forename: R
authors.initials: R
authors.lastname: Arsenic
authors.forename: P
authors.initials: P
authors.lastname: Buser
authors.forename: M
authors.initials: M
authors.lastname: Filipovic
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology*; D016343:Monitoring, Intraoperative / Q000379:methods; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009204:Myocardial Revascularization / Q000009:adverse effects; D014463:Ultrasonography