Korean J Anesthesiol.  1995 Sep;29(3):351-357. 10.4097/kjae.1995.29.3.351.

Intraoperative Management of Myocardial Ischemia with Transesophageal Echocardiography during Coronary Bypass Surgery

• Hong YW
• Kwak YL
• Bang SO
• Yoon DM
• Yoo ES
• Lim HK

• KMID: 2237842
• DOI: http://doi.org/10.4097/kjae.1995.29.3.351

Abstract

BACKGROUND
; Regional wall motion abnormalities(RWMA) detected by intraoperative transesophageal echocardiography(TEE) are thought to be sensitive indicators of myocardial ischemia. The present study was undertaken to elucidate management of RWMA with an immediate regraft in the area of RWMA or conventional drug therapy. METHOD; Twenty-six patients undergoing coronary artery bypass graft surgery were examined with TEE. After induction of anesthesia, TEE probe was inserted into esophagus and connected to Echo system. LV short axis views at the mid-papillary muscle level were viewed and recorded. TEE showed postbypass RWMA in 6 cases and one patient who did not have the TEE developed postbypass RWMA viewed by the epicardial echocardiography. Regraft was performed at the area of RWMA in 3 patients. The remainder was treated with intraaortic balloon pump(IABP) and/or inotropics. RESULTS; The patients with regraft showed an immediate improvement of the new RWMAs. The patients treated with IABP and/or inotropics had improvement of hemodynamics but did not show any improvement of the RWMAs. All seven patients developed hypotension and ST segment changes. All patients with the conventional treatment and two out of 3 regraft patients developed the postoperative myocardial infarctions. CONCLUSIONS; In conclusion this study demonstrated that patients experiencing persistent RWMA would be more likely to have myocardial infarction than those having only transient changes and that TEE would be an excellent tool for early detection of myocardial ischemia and might improve treatment of ischemic events.

Keyword

Myocardial ischemia; Transesophageal echocardiograph; Regional wall motion abnormality; Coronary artery bypass graft

MeSH Terms

Anesthesia
Axis, Cervical Vertebra
Coronary Artery Bypass
Drug Therapy
Echocardiography
Echocardiography, Transesophageal*
Esophagus
Hemodynamics
Humans
Hypotension
Myocardial Infarction
Myocardial Ischemia*
Transplants