Improved monitoring of myocardial ischaemia during major vascular surgery using transoesophageal echocardiography.

Abstract:

:As regional wall motion abnormality (RWA) is the first sign of ischaemia, transoesophageal echocardiography was evaluated as a monitoring device in 51 patients undergoing abdominal aortic surgery. Wall motion of the entire left ventricular wall (nine segments) was semiquantitatively evaluated 15 min before and after aortic cross-clamping and 3 h after declamping. In addition, limb lead II of the electrocardiogram was simultaneously recorded. At baseline, RWA was present in 16 patients (31%). New or worsened RWA 15 min after aortic cross-clamping was seen in 17 patients, of whom 11 had persistent RWA, i.e. it was still present 3 h after declamping. This was associated in seven patients with enzymatically documented myocardial infarction. Only one infarct patient demonstrated ST segment changes of more than 1 mm. Thus, a single electrocardiographic surface lead is insensitive for perioperative myocardial ischaemia detection. Furthermore, new and/or worsened RWA after aortic cross-clamping, which persists until 3 h after declamping, is, to a considerable degree, associated with perioperative infarction.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Koolen JJ,Visser CA,Reichert SL,Jaarsma WJ,Kromhout JG,van Wezel HB,Dunning AJ

doi

10.1093/oxfordjournals.eurheartj.a060309

subject

Has Abstract

pub_date

1992-08-01 00:00:00

pages

1028-33

issue

8

eissn

0195-668X

issn

1522-9645

journal_volume

13

pub_type

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