Immediate improvement of dysfunctional myocardial segments after coronary revascularization: detection by intraoperative transesophageal echocardiography
EJ Topol,
JL Weiss,
PA Guzman,
S Dorsey-Lima,
TJ Blanck,
LS Humphrey,
WA Baumgartner,
JT Flaherty,
and
BA Reitz
To ascertain the immediate effects of coronary artery bypass grafting on regional myocardial function, intraoperative transesophageal two-dimensional echocardiograms were obtained in 20 patients using a 3.5 MHz phased array transducer at the tip of a flexible gastroscope. Cross-sectional images of the left ventricle were obtained at multiple levels before skin incision and were repeated serially before and immediately after cardiopulmonary bypass. Using a computer-aided contouring system, percent systolic wall thickening was determined for eight anatomic segments in each patient at similar loading conditions (four each at mitral and papillary muscle levels). Of the 152 segments analyzed, systolic wall thickening improved from a prerevascularization mean value (+/- SEM) of 42.7 +/- 2.9% to a postrevascularization mean value of 51.6 +/- 2.6% (p less than 0.001). Thickening improved most in those segments with the worst preoperative function (p less than 0.001). Chest wall echocardiograms obtained 8.4 +/- 2.3 days after operation showed no deterioration or further improvement in segmental motion compared with transesophageal echocardiograms obtained after revascularization. Thus: regional myocardial function frequently improves immediately after bypass grafting, with increases in regional thickening being most marked in those segments demonstrating the most severe preoperative dysfunction, and this improvement appears to be sustained; and in some patients, chronic subclinical ischemic dysfunction is present which can be improved by revascularization.
This article has been cited by other articles:
|
|
|
|
 
F Alamanni, A Parolari, A Repossini, E Doria, F Bortone, J Campolo, M Pepi, E Sisillo, M Naliato, R Bigi, et al.
Coronary blood flow, metabolism, and function in dysfunctional viable myocardium before and early after surgical revascularisation
Heart,
November 1, 2004;
90(11):
1291 - 1298.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Singh and H. K. Saini
Resident Cardiac Mast Cells and Ischemia-Reperfusion Injury
Journal of Cardiovascular Pharmacology and Therapeutics,
June 1, 2003;
8(2):
135 - 148.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. Ceconi, G. La Canna, O. Alfieri, A. Cargnoni, G. Coletti, S. Curello, M. Zogno, G. Parrinello, S. H. Rahimtoola, and R. Ferrari
Revascularization of hibernating myocardium. Rate of metabolic and functional recovery and occurrence of oxidative stress
Eur. Heart J.,
December 1, 2002;
23(23):
1877 - 1885.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Firstenberg, N. G. Smedira, N. L. Greenberg, D. L. Prior, P. M. McCarthy, M. J. Garcia, and J. D. Thomas
Relationship Between Early Diastolic Intraventricular Pressure Gradients, an Index of Elastic Recoil, and Improvements in Systolic and Diastolic Function
Circulation,
September 18, 2001;
104
(2009):
I-330 - I-335.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Haas, L. Jennen, U. Heinzmann, N. Augustin, M. Wottke, M. Schwaiger, and R. Lange
Ischemically compromised myocardium displays different time-courses of functional recovery: correlation with morphological alterations?
Eur. J. Cardiothorac. Surg.,
August 1, 2001;
20(2):
290 - 298.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Haas, N. Augustin, K. Holper, M. Wottke, C. Haehnel, S. Nekolla, H. Meisner, R.u. Lange, and M. Schwaiger
Time course and extent of improvement of dysfunctioning myocardium in patients with coronary artery disease and severely depressed left ventricular function after revascularization: correlation with positron emission tomographic findings
J. Am. Coll. Cardiol.,
November 15, 2000;
36(6):
1927 - 1934.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Nakabayashi, T. Hayashi, Y. Inoue, A. Ikeda, H. Morii, N. Naito, K. Ishikawa, and K. Kanamasa
Percutaneous Transluminal Coronary Angioplasty Performed 24-48 Hours After the Onset of Acute Myocardial Infarction Improves Chronic-Phase Left Ventricular Regional Wall Motion
Angiology,
April 1, 2000;
51(4):
281 - 288.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. M. Hollenberg, C. J. Kavinsky, and J. E. Parrillo
Cardiogenic Shock
Ann Intern Med,
July 6, 1999;
131(1):
47 - 59.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Lucchetti, F. Capasso, M. Caputo, G. Grimaldi, M. Capece, G. Brando, S. Caprio, and G.D. Angelini
Intracoronary shunt prevents left ventricular function impairment during beating heart coronary revascularization
Eur. J. Cardiothorac. Surg.,
March 1, 1999;
15(3):
255 - 259.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. Kitsiou, G. Srinivasan, A. A. Quyyumi, R. M. Summers, S. L. Bacharach, and V. Dilsizian
Stress-Induced Reversible and Mild-to-Moderate Irreversible Thallium Defects : Are They Equally Accurate for Predicting Recovery of Regional Left Ventricular Function After Revascularization?
Circulation,
August 11, 1998;
98(6):
501 - 508.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Wijns, S. F. Vatner, and P. G. Camici
Hibernating Myocardium
N. Engl. J. Med.,
July 16, 1998;
339(3):
173 - 181.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Kloner, R. Bolli, E. Marban, L. Reinlib, and E. Braunwald
Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning : An NHLBI Workshop
Circulation,
May 19, 1998;
97(18):
1848 - 1867.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Heusch, R. Ferrari, D. J Hearse, T. J.C Ruigrok, and R. Schulz
'Myocardial hibernation'--questions and controversies
Cardiovasc Res,
December 1, 1997;
36(3):
301 - 309.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. G. Camici, W. Wijns, M. Borgers, R. De Silva, R. Ferrari, J. Knuuti, A. A. Lammertsma, A. J. Liedtke, G. Paternostro, and S. F. Vatner
Pathophysiological Mechanisms of Chronic Reversible Left Ventricular Dysfunction due to Coronary Artery Disease (Hibernating Myocardium)
Circulation,
November 4, 1997;
96(9):
3205 - 3214.
[Full Text]
|
|
|
|
|
|
|
P. A. Casthely, C. Shah, H. Mekhjian, D. Swistel, T. Yoganathan, C. Komer, R. A. Miguelino, and R. Rosales
LEFT VENTRICULAR DIASTOLIC FUNCTION AFTER CORONARY ARTERY BYPASS GRAFTING: A CORRELATIVE STUDY WITH THREE DIFFERENT MYOCARDIAL PROTECTION TECHNIQUES
J. Thorac. Cardiovasc. Surg.,
August 1, 1997;
114(2):
254 - 260.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J.-L. J. Vanoverschelde, W. Wijns, M. Borgers, G. Heyndrickx, C. Depre, W. Flameng, and J. A. Melin
Chronic Myocardial Hibernation in Humans: From Bedside to Bench
Circulation,
April 1, 1997;
95(7):
1961 - 1971.
[Full Text]
|
|
|
|
|
|
|
M. J. London
Ventricular Function and Myocardial Ischemia: Is Transesophageal Echocardiography a Good Monitor?
Seminars in Cardiothoracic and Vascular Anesthesia,
March 1, 1997;
1(1):
61 - 70.
[PDF]
|
|
|
|
|
|
|
G. Ambrosio, S. Betocchi, L. Pace, M. A. Losi, P. Perrone-Filardi, A. Soricelli, F. Piscione, J. Taube, F. Squame, M. Salvatore, et al.
Prolonged Impairment of Regional Contractile Function After Resolution of Exercise-Induced Angina: Evidence of Myocardial Stunning in Patients With Coronary Artery Disease
Circulation,
November 15, 1996;
94(10):
2455 - 2464.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
A. J. Bryan, B. Barzilai, and N. T. Kouchoukos
Transesophageal Echocardiography and Adult Cardiac Operations
Ann. Thorac. Surg.,
March 1, 1995;
59(3):
773 - 779.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. A. Panza, V. Dilsizian, J. M. Laurienzo, R. V. Curiel, and P. T. Katsiyiannis
Relation Between Thallium Uptake and Contractile Response to Dobutamine : Implications Regarding Myocardial Viability in Patients With Chronic Coronary Artery Disease and Left Ventricular Dysfunction
Circulation,
February 15, 1995;
91(4):
990 - 998.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
I. Afridi, N. S. Kleiman, A. E. Raizner, and W. A. Zoghbi
Dobutamine Echocardiography in Myocardial Hibernation : Optimal Dose and Accuracy in Predicting Recovery of Ventricular Function After Coronary Angioplasty
Circulation,
February 1, 1995;
91(3):
663 - 670.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
R. Seitelberger, W. Hannes, M. Gleichauf, M. Keilich, M. Christoph, R. Fasol, Sponsored by, and E. Wolner
Effects of diltiazem on perioperative ischemia, arrhythmias, and myocardial function in patients undergoing elective coronary bypass grafting
J. Thorac. Cardiovasc. Surg.,
March 1, 1994;
107(3):
811 - 821.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. J. Eisenberg, M. J. London, J. M. Leung, W. S. Browner, M. Hollenberg, J. F. Tubau, I. M. Tateo, N. B. Schiller, D. T. Mangano, the Study of Perioperative Ischemia Research Group, et al.
Monitoring for Myocardial Ischemia During Noncardiac Surgery: A Technology Assessment of Transesophageal Echocardiography and 12-Lead Electrocardiography
JAMA,
July 8, 1992;
268(2):
210 - 216.
[Abstract]
[PDF]
|
|
|
|
|
|
|
E. A. Fisher and M. E. Goldman
Transesophageal Echocardiography: A New View of the Heart
Ann Intern Med,
July 15, 1990;
113(2):
91 - 93.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. S. ISKANDRIAN, J. HEO, R. H. HELFANT, and B. L. SEGAL
Chronic Myocardial Ischemia and Left Ventricular Function
Ann Intern Med,
December 1, 1987;
107(6):
925 - 927.
[Abstract]
[PDF]
|
|
|
|
