Transesophageal echocardiographic monitoring during coronary artery bypass surgery

To demonstrate serial changes of left ventricular (LV) function during coronary artery bypass grafting surgery, transesophageal echocardiography (TEE) was used in 17 patients. The cross-sectional image of the left ventricle at the level of the papillary muscles was monitored, and was analyzed immediately in the operating room using a computer-assisted cine-memory function. Global LV function was evaluated by measuring LV end-diastolic and end-systolic area and computing the fractional area change (FAC). Segmental wall motion abnormalities (SWMA) were graded according to a scoring system. During the operative procedure before sternal closure, 5 patients showed SWMA with a simultaneous decrease in FAC to under 40%, and 9 patients showed SWMA without FAC depression. Two-thirds of new SWMA improved after myocardial revascularization. All 17 patients showed a change of interventricular septal movement at the end of the operation. FAC improved from a mean value (+/- SD) after intubation of 47.6 +/- 10.7% to a mean value after revascularization of 58.5 +/- 13.0% (p less than 0.05) and to a mean value at the end of the operation of 55.9 +/- 12.2% (p less than 0.05). Thus: 1) global and regional LV function improved immediately after myocardial revascularization with administration of inotropic agents; 2) a significant change of interventricular septal movement occurred after sternal closure; and 3) intraoperative TEE monitoring is a safe, simple, and effective method for evaluating LV global and regional function.