Relation of aneurysmectomy in patients with advanced left ventricular remodeling to postoperative left ventricular filling pressure, redilatation with ischemic mitral regurgitation.

Left ventricular (LV) volume, mitral E deceleration time, and mitral regurgitation (MR) fraction were measured by echocardiography in 14 patients with surgical LV aneurysmectomy. Late MR developed 3 to 6 months after surgery in 5 of the 14 patients (36%). Compared with patients without late MR, those with late MR had a significantly greater preoperative LV end-diastolic volume index (LVEDVI) (134 +/- 21 vs 93 +/- 19 ml/m(2), p <0.01), surgical reduction in LVEDVI (-51 +/- 14 vs -20 +/- 16 ml/m(2), p <0.01), early postoperative LV diastolic dysfunction with shortened mitral E deceleration time (106 +/- 23 vs 141 +/- 24 ms, p <0.01), and a late postoperative reincrease in LVEDVI (+28 +/- 4 vs +3 +/- 8 ml/m(2), p <0.01), suggesting that surgical LV aneurysmectomy in patients with advanced preoperative LV remodeling may result in postoperative LV diastolic dysfunction, promoting later LV redilation with ischemic MR.

Noninvasive prediction of complications with anteroseptal acute myocardial infarction by left ventricular Tei index.

BACKGROUND: Tei index has been proposed as a noninvasive and simple index that enables the evaluation of global left ventricular (LV) function and prediction of patient prognosis. However, its use to predict complications with acute myocardial infarction (AMI) is not fully investigated. Therefore, the purpose of this study was to investigate whether or not LV Tei index allows noninvasive prediction of complications with AMI. METHODS: In all, 80 consecutive patients with anteroseptal AMI were enrolled. LV Tei index was measured at the time of admission as (a - b)/ b , where a is the interval between cessation and onset of mitral filling flow and interval b is the aortic flow ejection time. Subsequent complications including cardiac death, shock, congestive heart failure, ventricular tachycardia/fibrillation, paroxysmal atrial fibrillation/flutter, advanced atrioventricular block requiring pacing, pericardial effusion, and LV aneurysm during the 30 days after the onset of AMI were prospectively evaluated and compared with the initial Tei index at admission. RESULTS: Complications developed in 31 of 80 (39%) patients with AMI. The Tei index was significantly increased for patients with complications compared with those without them (0.69 +/- 0.16 vs 0.50 +/- 0.11, P < .0001). When Tei index > or = 0.59 was used for the criteria, the sensitivity, specificity, and overall accuracy to predict subsequent complications were 77%, 86%, and 85%, respectively. CONCLUSION: In patients with anteroseptal AMI, LV Tei index at arrival to the hospital in the acute phase allows noninvasive prediction of subsequent complications.

Evaluation of left ventricular ejection fraction by tissue locus imaging.

The newly developed echocardiographic technique called "tissue locus imaging" (TLI) can visualize temporal series of images in a single picture by maintaining the display of previous images with a shading function; therefore, it can display the whole systolic shift of the mitral leaflets toward the apex in a single picture and can potentially offer useful information on left ventricular (LV) function. In 36 consecutive patients with varying degrees of LV dysfunction (15 with coronary artery disease, 9 with cardiomyopathy, 3 with hypertension, 2 with aortic stenosis, 1 with aortic regurgitation, and 6 controls), the systolic shift of the mitral leaflets (X) by TLI showed a significant correlation with the LV ejection fraction (Y) by 2-dimensional echocardiography (Y = 7.2 x+13, r(2) = 0.83, p <0.01). TLI enables the evaluation and visualization of LV systolic function by displaying the whole systolic shift of the mitral leaflets toward the apex.

[Perioperative management for cesarean section in a patient with corrected transposition of the great arteries].

We report anesthetic management for cesarean section in a pregnant (36 weeks) woman with corrected transposition of the great arteries, associated with Ebstein's anomaly and atrial septal defect. She had not received any surgical procedure, and had orthopnea and chest pain which were the signs of congestive heart failure before pregnancy. Her heart failure was ongoing through 34 th week of gestation. Central venous pressure and invasive arterial pressure were monitored perioperatively. A low-dose of fentanyl (3.5 micrograms.kg-1) was injected intravenously 5 minutes before induction, followed by anesthesia induced by thiamylal and suxamethonium chloride. Continuous infusion of propofol and continuous epidural anesthesia were started after delivery, supplemented by isoflurane. No significant cardiovascular changes were observed in the mother during the operation. The infant showed no respiratory dysfunction at birth.

Pseudonormalized Doppler total ejection isovolume (Tei) index in patients with right ventricular acute myocardial infarction.

The Doppler total ejection isovolume (Tei) index is useful for estimating global cardiac function. However, the relation between the right ventricular (RV) Tei index and RV infarction has not been investigated. The relation between the RV Tei index and severity of RV infarction was evaluated in 25 patients with inferior wall acute myocardial infarction (13 with and 12 without RV infarction). RV infarction was diagnosed when right atrial pressure was > or = 10 mm Hg or when right atrial pressure/pulmonary capillary wedge pressure was >0.8 by catheterization. The RV Tei index was significantly increased in patients with RV infarction compared with those without (0.53 +/- 0.15 vs 0.38 +/- 0.14, p <0.05). The RV Tei index in patients with severe RV infarction (right atrial pressure > or = 15 mm Hg) was significantly smaller compared with those with mild/moderate RV infarction (right atrial pressure <15 mm Hg) and showed no significant difference in patients with myocardial infarction but without RV infarction (0.44 +/- 0.09 vs 0.61 +/- 0.16 vs 0.38 +/- 0.14, severe RV infarction vs mild/moderate RV infarction vs no RV infarction, p <0.01). The RV Tei index is generally increased in patients with RV infarction; however, severe RV infarction can be manifested with limited or no increase in the Tei index (pseudonormalization).