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Mitral annulus distortion during beating heart surgery: a potential cause for hemodynamic disturbance--a
Shane J George1, Sharif Al-Ruzzeh, Mohamed Amrani
1Department of Anaesthesia, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Middlesex, United Kingdom. s.george@rbh.nthames.nhs.uk
Background:
Positioning for access to the coronary arteries leads to hemodynamic instability during off-pump cardiac surgery. External changes have been well described, but a description of the intracardiac structures in humans has not been described.
Methods:
With multiplane intraoperative echocardiography, the mitral annulus at end diastole was reconstructed in the different positions and correlated with hemodynamic changes in the right heart and left atrium.
Results:
Significant distortion of the mitral annulus with enlargement of the left atrium and pulmonary veins was demonstrated, which correlated with high left atrial pressures.
Conclusions:
Mitral valve distortion can significantly contribute to hemodynamic instability during positioning for off-pump cardiac surgery.