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Increased left ventricular diastolic chamber stiffness immediately after coronary artery bypass surgery
P A McKenney1, C S Apstein, L A Mendes
1Department of Medicine, Evans Memorial Department of Clinical Research, Boston University Medical Center Hospital, Massachusetts.
Insights
Left ventricular diastolic dysfunction worsens after coronary artery bypass surgery. Simultaneous monitoring effectively assesses this change, aiding post-cardiac surgery management.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Left ventricular diastolic dysfunction is known post-coronary artery bypass surgery.
- Previous measurements were difficult and load-dependent.
Purpose of the Study:
- To assess the incidence and severity of left ventricular diastolic dysfunction immediately after coronary artery bypass surgery.
- To utilize simultaneous transesophageal echocardiographic and hemodynamic monitoring.
Main Methods:
- Constructed end-diastolic pressure-area curves before and after surgery in 20 patients.
- Recorded transesophageal echocardiographic and hemodynamic data.
- Manipulated volume status to alter loading conditions.
Main Results:
- Diastolic function worsened in all patients, indicated by a leftward shift in end-diastolic pressure-area curves.
- Postoperatively, mean end-diastolic area decreased by 15% at comparable preload (p=0.0001).
Conclusions:
- Left ventricular diastolic chamber stiffness frequently increases immediately after coronary artery bypass surgery.
- Simultaneous hemodynamic and transesophageal echocardiographic monitoring using end-diastolic pressure-area curves is valuable for evaluating diastolic function and guiding post-cardiac surgery management.
Objectives:
The aim of this study was to assess the incidence and severity of left ventricular diastolic dysfunction immediately after coronary artery bypass surgery by utilizing simultaneous transesophageal echocardiographic and hemodynamic monitoring.
Background:
Left ventricular diastolic dysfunction has been documented after coronary bypass surgery, but its measurement has been technically difficult to acquire and limited by dependence on loading conditions.
Methods:
End-diastolic pressure-area curves were constructed before and immediately after coronary bypass surgery in 20 patients. Transesophageal echocardiographic images at the midpapillary level of the left ventricle and hemodynamic data were recorded. Volume status was manipulated to alter loading conditions, and multiple measurements were taken at each loading condition.
Results:
Diastolic function worsened in all patients, as manifested by a postoperative leftward shift of the end-diastolic pressure-area curve. At a comparable preload, mean end-diastolic area +/- SEM decreased by 15% from 17.6 +/- 0.8 to 14.9 +/- 0.8 cm2 postoperatively (p = 0.0001).
Conclusions:
Left ventricular diastolic chamber stiffness frequently increases immediately after coronary artery bypass surgery. Simultaneous hemodynamic and transesophageal echocardiographic monitoring, through the construction of end-diastolic pressure-area curves, is a useful method to evaluate diastolic function and guide management after cardiac surgery.