ABSTRACT
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.
Subject(s)
Coronary Artery Bypass, Off-Pump , Echocardiography, Transesophageal , Monitoring, Intraoperative , Adrenergic beta-Antagonists/pharmacology , Adrenergic beta-Antagonists/therapeutic use , Adult , Aged , Aged, 80 and over , Arrhythmias, Cardiac/diagnostic imaging , Blood Volume , Cardiotonic Agents/pharmacology , Cardiotonic Agents/therapeutic use , Computer Systems , Diastole , Extracorporeal Circulation , Female , Humans , Intraoperative Complications/diagnostic imaging , Male , Middle Aged , Myocardial Contraction , Stroke VolumeABSTRACT
OBJETIVO: La ecocardiografía transesofágica intraoperatoria(ETE) puede ser un sistema de monitorización dealta utilidad durante la revascularización miocárdica sincirculación extracorpórea (CEC), ya que permite obtenerimágenes en tiempo real tanto del estado de la volemiacomo de la contractilidad segmentaria miocárdica, sininterferir en el campo quirúrgico.PACIENTES YMÉTODOS: Se estudian 25 pacientes sometidosa revascularización miocárdica por esternotomía sinCEC monitorizados con ETE durante su intraoperatorio.RESULTADOS: 18 hombres y 7 mujeres, con edad promediode 71,3 ± 8 años fueron estudiados. Un tercio de ellospresentaba hipertensión arterial y diabetes, 3 habían tenidoun accidente vascular encefálico previo y 2 eran portadoresde insuficiencia renal. Un total de 9 pacientes teníahistoria de infarto agudo al miocardio y 3 casos de elloshabían sido sometidos a angioplastias previas. A todos lospacientes se les realizó ETE basal donde seis tenían malafracción de eyección (FE) < 30%. Se detectaron alteracionesde la contractilidad segmentaria en 12 pacientes, deéstos en 11 fueron alteraciones sólo transitorias. En la evaluaciónfinal se determinó que en 6 enfermos hubo unamejoría de la FE. La ETE permitió además evaluar elestado de la volemia, el efecto de fármacos inotropos y betabloqueadores en el 83% de los pacientes.CONCLUSIÓN: La ETE es un monitor mínimamenteinvasivo y en tiempo real que permite evaluar en formadirecta, segura y precisa al corazón latiendo durante larevascularización miocárdica sin CEC con buena calidadde imágenes
OBJECTIVE: Intraoperative transesophageal echocardiographycan be a highly useful monitoring techniqueduring myocardial revascularization surgery whenextracorporeal circulation (ECC) is not being used.Transesophageal echocardiography provides real-timeimages on both volume status and segmental myocardialcontractility without interfering with the surgicalfield.PATIENTS AND METHODS: A total of 25 patients undergoingmyocardial revascularization by sternotomy withoutECC were monitored by transesophageal echocardiographyduring surgery.RESULTS: The 18 men and 7 women studied had amean (SD) age of 71.3 (8) years. A third of them hadhypertension and diabetes, 3 had suffered a cerebrovascularaccident, and 2 had renal failure. Nine patientshad a history of acute myocardial infarction and 3 hadundergone angioplasty. Baseline echocardiograms on allpatients established that 6 had a low ejection fraction(<30%). Twelve had altered segmental contractility,which was transient in 11 cases. Six patients had improvedejection fraction at the final assessment. Transesophagealelectrocardiography also monitored volumestatus and the effects of inotropic drugs and ß-blockersin 83% of the patients.CONCLUSION: Transesophageal electrocardiography isa minimally invasive, safe, and precise way to directlymonitor the beating heart in real time during myocardialrevascularization without ECC. Image quality isgood
