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Acute diastolic dysfunction in thoracoabdominal aortic aneurysm surgery.

Ashraf Fayad1, Homer Yang, Howard Nathan

  • 1Department of Anesthesia, University of Ottawa, B309, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. afayad@ottawahospital.on.ca

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|January 26, 2006
PubMed
Summary

This study observed acute diastolic dysfunction during thoracoabdominal aortic aneurysm repair, often reversed with nitroglycerin. Further research is needed to explore its link to postoperative cardiac issues.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Anesthesiology

Background:

  • Diastolic dysfunction is a known cardiac condition.
  • Acute diastolic dysfunction during surgery is less understood.
  • Thoracoabdominal aortic aneurysm (TAAA) repair is a complex procedure with potential cardiac risks.

Purpose of the Study:

  • To identify transesophageal echocardiographic (TEE) findings of acute diastolic dysfunction during TAAA repair.
  • To describe the incidence and characteristics of intraoperative diastolic dysfunction in TAAA patients.

Main Methods:

  • Nine patients undergoing TAAA repair were monitored with intraoperative TEE.
  • Diastolic function was assessed using mitral inflow pulsed wave Doppler (E:A ratio) before and during aortic cross-clamping.

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  • Diastolic dysfunction was defined as an E:A ratio < 1.

    • Main Results:

    • Before aortic cross-clamping, all patients had an E:A ratio > 1.
    • During aortic cross-clamping, six of nine patients developed an E:A ratio < 1, indicating diastolic dysfunction.
    • Nitroglycerin infusion restored normal E:A ratios in affected patients.
    • Preoperative beta-blocker use was associated with preserved diastolic function.
    • Three patients with intraoperative diastolic dysfunction experienced postoperative myocardial infarction.

    Conclusions:

    • Acute diastolic dysfunction frequently occurs during TAAA repair with aortic cross-clamping.
    • This condition appears reversible with nitroglycerin.
    • Further investigation is warranted to confirm this phenomenon and its association with postoperative cardiac morbidity.