Assessment of Left Ventricular Dimensions by Transoesophageal Echocardiography in Patients During Coronary Artery Bypass Surgery.

Objective: Normative values of left ventricular (LV) end-diastolic area and diameter (EDA and EDD) for intraoperative transoesophageal echocardiography (TEE) have not been established. We aimed to define the ranges of LV EDA and EDD for intraoperative TEE examinations in patients undergoing coronary artery bypass graft (CABG) surgery.

Methods: A MEDLINE search for studies reporting LV EDA and EDD in CABG patients was performed.

Intra-operative assessment of pulmonary artery pressure by transoesophageal echocardiography.

The clinical value of the estimation of systolic pulmonary artery pressure, based on Doppler assessment of peak tricuspid regurgitant velocity using transoesophageal echocardiography, is unclear. We studied 109 patients to evaluate the feasibility of obtaining adequate Doppler recordings, and compared Doppler estimates with values measured using a pulmonary artery catheter in a subset of 33 patients. Tricuspid regurgitation was evaluated at the mid-oesophageal level at 0-120° using Doppler echocardiography.

Volatile anaesthetics and positive pressure ventilation reduce left atrial performance: a transthoracic echocardiographic study in young healthy adults.

Background: Animal and in vitro studies suggest that volatile anaesthetics affect left atrial (LA) performance. We hypothesized that human LA pump function and dimensions are altered by volatile anaesthetics in vivo.

Methods: We performed transthoracic echocardiographic (TTE) measurements in 59 healthy subjects (aged 18-48 yr) undergoing minor surgery under general anaesthesia.

Additional cross-sectional transesophageal echocardiography views improve perioperative right heart assessment.

Background: Right heart failure is an important cause of perioperative morbidity and mortality, and transesophageal echocardiography (TEE) is crucial for its diagnosis. However, only four of the 20 cross-sectional views recommended in current guidelines for intraoperative TEE focus on the right heart. This study analyzed whether incorporating additional views into the standard TEE examination improves assessment of the right heart.

Remifentanil does not impair left ventricular systolic and diastolic function in young healthy patients.

Background: Experimental studies and investigations in patients with cardiac diseases suggest that opioids at clinical concentrations have no important direct effect on myocardial relaxation and contractility. In vivo data on the effect of remifentanil on myocardial function in humans are scarce. This study aimed to investigate the effects of remifentanil on left ventricular (LV) function in young healthy humans by transthoracic echocardiography (TTE).

A Swiss anaesthesiology closed claims analysis: report of events in the years 1987-2008.

Background And Objective: In 1999, the Swiss Society of Anaesthesiology and Reanimation (SSAR) initiated an analysis of closed malpractice claims filed against anaesthetists in a project intended to improve patient safety. This article discusses the results of a review of closed claims between 1987 and 2008 and filed up to the end of 2009.

Methods: Records of closed claims were provided by Swiss professional medical liability insurance companies and the Office for Extrajudicial Expert Review of the Swiss Medical Association.

A randomized comparison of right ventricular function after on-pump versus off-pump coronary artery bypass graft surgery.

Objectives: Right ventricular dysfunction occurs very soon after conventional coronary bypass surgery with cardiopulmonary bypass and might not recover within 1 year after the operation. It has been postulated that performing coronary surgery without cardiopulmonary bypass might preserve right ventricular function. We hypothesized that right ventricular global and overall systolic functions are better preserved 3 months after off-pump surgery than after conventional coronary bypass surgery.

Different effects of sevoflurane, desflurane, and isoflurane on early and late left ventricular diastolic function in young healthy adults.

Background: Knowledge on the effects of volatile anaesthetics on left ventricular (LV) diastolic function in humans in vivo is limited. We tested the hypothesis that sevoflurane, desflurane, and isoflurane do not impair LV diastolic function in young healthy humans.

Methods: Sixty otherwise healthy subjects (aged 18-48 yr) undergoing minor procedures under general anaesthesia were studied.

Feasibility of measuring myocardial performance index of the right ventricle in anesthetized patients.

Objective: Myocardial performance index, the sum of the 2 isovolumic times divided by the ejection time, contains information on global systolic and diastolic function. This study was performed to determine the feasibility of right ventricular myocardial performance index measurements if measured by transesophageal echocardiography in patients under general anesthesia and positive-pressure ventilation.

Design: A prospective cohort study.

Intra-operative myocardial ischaemia cannot be detected by analysis of transmitral inflow patterns in patients undergoing off-pump coronary surgery.

Background And 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.

[Perioperative betablockade].

Adverse cardiac outcomes continue to be an important cause of perioperative morbidity and mortality in the non-cardiac surgery. This is related to the high prevalence of coronary artery disease in the aging surgical population. Beta-blockers were proved useful and efficacious in the treatment of perioperative myocardial ischaemia and arrhythmia.

Effects of simulated hypovolaemia on haemodynamics, left ventricular function, mesenteric blood flow and gastric Pco2.

Background: Compensated clinically silent hypovolaemia may lead to low cardiac output, hypoperfusion and ischaemia. We investigated the cardiovascular effects of simulated hypovolaemia to determine whether it caused mesenteric ischaemia detectable by gastric tonometry.

Methods: Thirteen healthy volunteers, aged 21-36 years, were investigated.

Transesophageal Doppler echocardiographic detection of intramyocardial collateral flow to the right coronary artery and changes in the flow to the inferior left ventricular wall immediately after coronary artery bypass grafting.

This study examined the feasibility of Doppler transesophageal echocardiography (TEE) to detect collateral flow to the myocardium supplied by the right coronary artery (RCA) in the inferior left ventricular wall. Forty-four patients who underwent elective coronary artery bypass grafting (CABG) were prospectively studied. Presence of collateral flow to the RCA was diagnosed on preoperative angiography using the Rentrop score and by intraoperative Doppler TEE.

Effects of sevoflurane and propofol on left ventricular diastolic function in patients with pre-existing diastolic dysfunction.

Background: The effects of anaesthetics on left ventricular (LV) diastolic function in patients with pre-existing diastolic dysfunction are not well known. We hypothesized that propofol but not sevoflurane will worsen the pre-existing LV diastolic dysfunction.

Methods: Of 24 randomized patients, 23 fulfilled the predefined echocardiographic criterion for diastolic dysfunction.

The role of transoesophageal echocardiography for anaesthetists.

Transoesophageal echocardiography has proved to be a valuable monitor of global and regional ventricular function in the perioperative period. In addition, it is increasingly used by anaesthetists as a diagnostic tool in patients with heart disease. During the past year, important steps towards quality assurance and the standardization of perioperative echocardiography were undertaken, and our understanding of the perioperative cardiovascular structure and function improved.

Perioperative hypertension: new strategies for management.

Perioperative hypertension is a very frequent occurrence and requires the anaesthetist to make clinical decisions regarding antihypertensive therapy, evaluation of risk, cancellation of surgery and treatment of high and low blood pressure. Perioperative management of hypertensive patients must take into account the possible consequences of left ventricular diastolic dysfunction and reduced coronary reserve.

Effects of on-pump versus off-pump coronary artery bypass graft surgery on right ventricular function.

Objectives: Right ventricular dysfunction is a possible cause of cardiac failure after coronary surgery. The use of cardiopulmonary bypass is regarded as a major cause for its occurrence, and it has been postulated that performing coronary surgery without cardiopulmonary bypass might reduce ventricular dysfunction. Therefore, this prospective, randomized, controlled study tested the hypothesis that off-pump coronary surgery would better preserve right ventricular systolic and diastolic function than conventional bypass surgery.

Accuracy of tissue Doppler estimation of the right atrial pressure in anesthetized, paralyzed, and mechanically ventilated patients.

The ratio of tricuspid peak early inflow velocity to peak early diastolic velocity of the lateral tricuspid annulus (the E/Ea ratio) measured by transthoracic echocardiography has been reported to correlate with right atrial (RA) pressure. In this study, the correlation between the E/Ea ratio and RA pressure was tested in 44 anesthetized, paralyzed, and mechanically ventilated patients by transesophageal echocardiography. Mean RA pressure and the following echocardiographic data were recorded simultaneously: tricuspid peak early inflow velocities by Doppler echocardiography, peak early diastolic velocity of the lateral tricuspid annulus by tissue Doppler imaging, and right ventricular and left ventricular end-diastolic areas.

Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation.

Background: There is limited knowledge of the effects of anaesthetics on left ventricular (LV) diastolic function in humans. Our aim was to evaluate these effects in humans free from cardiovascular disease.

Methods: Sixty patients (aged 18-47 yr) who had no history or signs of cardiovascular disease were randomized to receive general anaesthesia with halothane, sevoflurane or propofol.

Transesophageal echocardiography for monitoring segmental wall motion during off-pump coronary artery bypass surgery.

In this prospective, observational study, we evaluated whether transesophageal echocardiography allows for monitoring left ventricular segmental wall motion during cardiac displacement for off-pump coronary artery bypass (OPCAB) surgery. On the basis of a pilot study that showed frequent loss of transgastric views during OPCAB surgery, we analyzed only midesophageal views. The midesophageal 4-chamber view, 2-chamber view, and long-axis view were recorded in 60 patients after opening the chest and placing an epicardial stabilizer on the displaced heart.

Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease.

Objectives: The aim of this study was to determine whether perioperative measurements of heart rate variability (HRV) and cardiac troponin I (cTnI) add additional prognostic information to established risk scores for first-year mortality in patients at risk of coronary artery disease (CAD) undergoing major noncardiac surgery.

Background: In cardiac-risk patients undergoing major noncardiac surgery, the short- and long-term prognoses are mainly influenced by perioperative cardiac complications. Heart rate variability and cTnI are important prognostic markers in patients with congestive heart failure and myocardial infarction.

Use of myocardial tissue Doppler imaging for intraoperative monitoring of left ventricular function.

Background: Detection of myocardial ischaemia during surgery is usually by assessment of regional wall motion using two-dimensional transoesophageal echocardiography (TOE). Tissue Doppler imaging (TDI) may assist this assessment and improve its accuracy.

Methods: We measured peak myocardial velocities in the anterior mid-wall of the left ventricle by TOE and pulsed-wave TDI in addition to transmitral flow velocity, two-dimensional echocardiography and cardiovascular variables.

Doppler indices of diastolic transmitral flow velocity are invalid indicators of myocardial ischaemia during high-dose dobutamine infusion in anaesthetized patients.

Background And Objective: Doppler echocardiography of diastolic transmitral flow velocity is more sensitive for the detection of myocardial ischaemia in awake patients than echocardiographic analysis of systolic wall motion. However, its diagnostic value in anaesthetized patients is unknown.

Methods: Doppler indices of diastolic transmitral flow velocity previously found to be highly sensitive for detecting ischaemia in awake patients were studied in 72 anaesthetized patients with documented coronary artery disease undergoing dobutamine stress echocardiography.