Intra-operative myocardial ischaemia detected by biplane transoesophageal echocardiography during transurethral
C F Heyns1, D Rittoo, G R Sutherland
1Department of Surgery/Urology, Western General Hospital, Edinburgh.
Insights
Transurethral prostatectomy can cause myocardial ischemia, indicated by changes in heart muscle function during surgery. This study found 27% of patients experienced ischemia, linked to blood pressure drops and surgery extent.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Cardiology
Background:
- Transurethral prostatectomy is associated with increased late cardiovascular mortality compared to open prostatectomy.
- Hemodynamic changes during transurethral prostatectomy may lead to ischemic myocardial injury.
Purpose of the Study:
- To investigate the occurrence and potential predictors of intraoperative myocardial ischemia during prostatectomy using transesophageal echocardiography.
Main Methods:
- Transesophageal echocardiography was used to monitor 26 patients undergoing prostatectomy under general anesthesia.
- Myocardial ischemia was identified by new regional wall motion abnormalities of the left ventricle.
Main Results:
- Myocardial ischemia occurred in 4 of 22 patients during transurethral prostatectomy and 3 of 4 during retropubic prostatectomy.
- Significant intraoperative hypotension (systolic and diastolic blood pressure fall) was observed in most patients.
- Greater blood pressure falls and larger prostatic tissue removal were associated with myocardial ischemia.
Conclusions:
- 27% of patients showed evidence of intraoperative myocardial ischemia during prostatectomy.
- The extent of surgery and degree of hypotension appear related to intraoperative myocardial ischemia.
- The long-term link between intraoperative ischemia and late cardiovascular mortality remains unclear.
Abstract:
Recent studies have shown an increased late mortality rate due to cardiovascular causes after transurethral compared with open prostatectomy. This has been linked to the demonstration of haemodynamic changes during transurethral prostatectomy, which may cause ischaemic myocardial injury. We used transoesophageal echocardiography (currently the most sensitive modality for detecting myocardial ischaemia) to study 26 patients during prostatectomy under general anaesthesia. Evidence of myocardial ischaemia (as shown by the development of new regional wall motion abnormalities of the left ventricle) occurred in 4 of 22 patients during transurethral and in 3 of 4 patients during retropubic prostatectomy. An intra-operative fall in systolic as well as diastolic blood pressure occurred in 21 of 22 patients during the transurethral procedure and in all 4 patients during retropubic prostatectomy. The duration of anaesthesia and the operation, and the intra-operative blood loss did not differ significantly between patients with and without evidence of intra-operative myocardial ischaemia. However, the maximum intra-operative fall in systolic and diastolic blood pressure, as well as the mass of the prostatic tissue removed, were significantly greater in patients with than in those without evidence of intra-operative myocardial ischaemia, suggesting that the latter may be related to the extent of surgery and the degree of intraoperative hypotension. In this study, 7 of 26 patients (27%) showed evidence of myocardial ischaemia during prostatectomy. However, it remains difficult to explain why intra-operative myocardial ischaemia should result in an increased cardiovascular mortality rate several years after the operation.
More Related Videos
04:48Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
08:19Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs
Published on: July 12, 2022