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Left ventricular dysfunction after non-cardiac surgical procedures in patients with ischemic heart disease
Insights
This study shows that prolonged peroperative myocardial ischemia, detected by ECG, can cause postoperative left ventricular dysfunction. Radionuclide imaging confirmed these changes in patients with angina pectoris undergoing non-cardiac surgery.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Surgery
Background:
- Post-ischemic ventricular dysfunction can occur after non-cardiac surgery.
- Patients with angina pectoris are at risk for myocardial ischemia during surgery.
Purpose of the Study:
- To demonstrate post-ischemic ventricular dysfunction following non-cardiac surgical procedures.
- To correlate peroperative myocardial ischemia with postoperative cardiac function.
Main Methods:
- Myocardial perfusion scintigraphy with thallium-201 and radionuclide ventriculography were performed pre- and post-surgery.
- Long-term ECG monitoring was used to detect peroperative myocardial ischemia.
Main Results:
- 14 out of 20 patients showed no changes in radionuclide imaging.
- Five patients developed increased perfusion deficits and/or decreased ejection fraction post-surgery.
- These five patients had evidence of peroperative ST segment depression on ECG.
Conclusions:
- Prolonged peroperative myocardial ischemia plays a significant role in the development of postoperative left ventricular dysfunction.
- Radionuclide imaging and ECG monitoring are valuable tools for assessing cardiac function after surgery.
Abstract:
In order to demonstrate the presence of postischemic ventricular dysfunction after non-cardiac surgical procedures, myocardial perfusion scintigraphy with thallium 201 and radionuclide ventriculography were performed before and 24 h after intervention in 20 patients suffering from angina pectoris. A long-term ECG recording was used in all patients to detect peroperative myocardial ischemia. In 14 of the 20 patients studied, both ventriculography and thallium scintigraphy were unchanged at the postoperative study. Comparison of pre- and postoperative radionuclide data revealed an increased deficit in one patient, both increased deficit and decreased ejection fraction in four others and a decreased ejection fraction in one other. In these five last patients, continuous ECG recording demonstrated the occurrence of peroperative ST segment depression. These results underline the part played by prolonged peroperative episodes of myocardial ischemia in the occurrence of postoperative left ventricular dysfunction.