Transesophageal echocardiography in hypotensive patients after cardiac operations. Comparison with hemodynamic parameters.

Because it is sometimes difficult to determine the cause of hypotension in patients after cardiac operations, we assessed the value of transesophageal echocardiography in this respect, and we studied 60 consecutive patients who had hypotension despite positive inotropic medication and, in some patients, mechanical support. Echocardiographic diagnoses were compared with diagnoses based on hemodynamic parameters. Follow-up examinations were completed in all patients to confirm the final diagnoses.

Systolic and diastolic pressure-volume relationships during cardiac surgery.

Seven patients undergoing elective coronary artery bypass surgery were studied to assess left ventricular (LV) performance by pressure-volume loops. LV pressure was measured by micromanometry and instantaneous LV volume by a conductance catheter. Continuous pressure-volume relationships were determined during preload reduction before and after cardiopulmonary bypass (CPB).

Frequency of myocardial indium-111 antimyosin uptake after uncomplicated coronary artery bypass grafting.

The reported incidence of myocardial damage after coronary artery bypass grafting (CABG) is highly related to the methods used. Since indium-111 monoclonal antimyosin antibody scintigraphy has been shown to be highly specific and sensitive for myocardial necrosis, even in small lesions, uptake of this radiotracer was evaluated after CABG. In 23 consecutive patients without previous myocardial infarction who underwent CABG for stable angina, 80 MBq indium-111 antimyosin was injected on the third postoperative day.

Transesophageal examination of the left coronary artery with a 7.5 MHz annular array two-dimensional color flow Doppler transducer.

To determine the value of a recently developed 7.5 MHz annular array two-dimensional and color flow Doppler transducer for examination of the proximal parts of the left coronary artery, 25 patients were studied immediately after coronary artery bypass surgery, and the findings were compared with preoperative coronary angiograms. With two-dimensional imaging, the left main coronary artery was visualized in 22 patients (88%), left anterior descending in 13 patients (52%), and circumflex in 22 patients (88%).

The efficacy of nicardipine and nitroprusside in preventing poststernotomy hypertension.

The efficacy of nicardipine and nitroprusside in preventing poststernotomy hypertension was compared in two groups of 45 patients undergoing coronary artery surgery. Patients were anesthetized with fentanyl, 100 micrograms/kg, and oxygen. Group N received nicardipine at an initial rate of 3 micrograms/kg/min.

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.

Transesophageal two-dimensional echocardiographic evaluation of biventricular dimension and function during positive end-expiratory pressure ventilation after coronary artery bypass grafting.

Transesophageal 2-dimensional echocardiography was performed in 21 patients soon after uncomplicated coronary artery bypass grafting to determine the mechanism of positive end-expiratory pressure (PEEP) ventilation-induced decreased cardiac output. End-diastolic and end-systolic short-axis area and percent area reduction of right and left ventricles were determined during 5-cm H2O stepwise increments of PEEP ventilation. Simultaneously, cardiac output and right- and left-sided hemodynamic values were determined.