RESUMEN
BACKGROUND: The index E/e' derived from tissue Doppler imaging and pulsed Doppler is the ratio of the early transmitral flow velocity and the early mitral annular velocity and it correlates with left ventricular filling pressure. The purpose of this study was to investigate the relationship between intraoperative E/e' and postoperative cardiovascular complications and length of ICU and hospital stays after a non cardiac surgery. METHODS: This observational study investigated a total of 82 patients with cardiac disease undergoing non cardiac surgery. Diastolic function was evaluated by conventional echocardiographic pulsed-wave Doppler and TDI. The early peak (E) as well as the late peak (A) filling velocity of the left ventricle (LV) were measured at the mid-esophageal four-chamber at the mitral leaflet tips. Early Peak diastolic filling velocity (e'), Late peak diastolic filling velocity (a') and systolic velocity (s') were obtained from the mid-esophageal four-chamber view placed in the septal and lateral mitral annular sites. RESULTS: Patients were divided into three groups: E/e'<8 (normal LV filling pressure= 24 patients), E/e' 8-15 (moderately increased =35 patients) and E/e'>15 (severely increased = 23 patients). An elevated E/e' ratio was significantly associated with increased postoperative cardiovascular events, pulmonary congestion (P<0.05) arrhythmias (P<0.05) and with longer ICU and hospital stays (P<0.05). CONCLUSION: This data suggests that the tissue Doppler index E/e' may be a useful indicator for predicting morbid events after non-cardiac surgery. Furthermore, patients with an elevated intraoperative E/e' may need more careful postoperative management.
Asunto(s)
Arritmias Cardíacas/epidemiología , Velocidad del Flujo Sanguíneo , Ecocardiografía Doppler/métodos , Cardiopatías/fisiopatología , Válvula Mitral/fisiopatología , Complicaciones Posoperatorias/epidemiología , Edema Pulmonar/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea , Cuidados Críticos , Diástole , Ecocardiografía Doppler de Pulso , Ecocardiografía Transesofágica , Femenino , Humanos , Periodo Intraoperatorio , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pronóstico , Método Simple Ciego , Procedimientos Quirúrgicos Operativos , Función Ventricular IzquierdaRESUMEN
OBJECTIVE: Intraoperative transesophageal echocardiography can be a highly useful monitoring technique during myocardial revascularization surgery when extracorporeal circulation (ECC) is not being used. Transesophageal echocardiography provides real-time images on both volume status and segmental myocardial contractility without interfering with the surgical field. PATIENTS AND METHODS: A total of 25 patients undergoing myocardial revascularization by sternotomy without ECC were monitored by transesophageal echocardiography during surgery. RESULTS: The 18 men and 7 women studied had a mean (SD) age of 71.3 (8) years. A third of them had hypertension and diabetes, 3 had suffered a cerebrovascular accident, and 2 had renal failure. Nine patients had a history of acute myocardial infarction and 3 had undergone angioplasty. Baseline echocardiograms on all patients established that 6 had a low ejection fraction (<30%). Twelve had altered segmental contractility, which was transient in 11 cases. Six patients had improved ejection fraction at the final assessment. Transesophageal electrocardiography also monitored volume status and the effects of inotropic drugs and beta-blockers in 83% of the patients. CONCLUSION: Transesophageal electrocardiography is a minimally invasive, safe, and precise way to directly monitor the beating heart in real time during myocardial revascularization without ECC. Image quality is good.
Asunto(s)
Puente de Arteria Coronaria Off-Pump , Ecocardiografía Transesofágica , Monitoreo Intraoperatorio , Antagonistas Adrenérgicos beta/farmacología , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas/diagnóstico por imagen , Volumen Sanguíneo , Cardiotónicos/farmacología , Cardiotónicos/uso terapéutico , Sistemas de Computación , Diástole , Circulación Extracorporea , Femenino , Humanos , Complicaciones Intraoperatorias/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Volumen SistólicoRESUMEN
INTRODUCTION: Intraoperative transesophageal echocardiography is used to study cardiac structure and function. Cardiac output is measured by calculating the velocity with which a volume of blood travels a predetermined area. Output can be assessed at the mitral valve by parallel alignment of the Doppler transducer to measure flow velocity. OBJECTIVE: To compare cardiac output measurements from transesophageal echocardiography with measurements performed by the standard clinical technique of thermodilution. PATIENTS AND METHODS: Cardiac output measurements obtained by thermodilution and by echocardiography at the mitral valve were compared in a prospective study during 34 cardiac surgery procedures. RESULTS: Cardiac output measurements ranged from 2.3 L min(-1) to 7.8 L min(-1) (mean 4.27 +/- 0.125 L min(-1) for measurements made by Doppler echocardiography and from 1.9 L min(-1) to 8.1 L min(-1) (mean 4.36 +/- 0.124 L min(-1)) for measurements made by thermodilution. The correlation between the methods was high (r = 0.926, p = 0.00001). CONCLUSION: Intraoperative measurement of cardiac output by transesophageal Doppler echocardiography at the mitral valve is easy and correlates highly with the clinical method of thermodilution used at present. Use of the technique will widen the spectrum of information provided by echocardiography, which is a safe, minimally invasive technique.