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Left ventricular dysfunction during infrarenal abdominal aortic aneurysm repair
D L Gillespie1, G P Connelly, H M Arkoff
1Section of Vascular Surgery, Boston University Medical Center, Massachusetts 02118.
American Journal of Surgery
|August 1, 1994
Summary
Pulmonary artery occlusion pressure (PAOP) weakly correlates with left ventricular volume during abdominal aortic aneurysm (AAA) repair. Transesophageal echocardiography (TEE) is valuable for guiding fluid resuscitation in these patients.
Area of Science:
- Cardiology
- Anesthesiology
- Vascular Surgery
Background:
- Clinical observations indicate that pulmonary artery occlusion pressure (PAOP) may underestimate fluid requirements before aortic cross-clamp release.
- Accurate assessment of fluid status is critical during major vascular surgery.
Purpose of the Study:
- To investigate the relationship between PAOP and left ventricular (LV) diastolic volume during abdominal aortic aneurysm (AAA) repair.
- To evaluate the utility of transesophageal echocardiography (TEE) in guiding volume resuscitation in this patient population.
Main Methods:
- Simultaneous monitoring of PAOP using a pulmonary artery catheter (PAC) and estimation of LV diastolic volume via two-dimensional TEE.
- Data collection occurred before, during, and after aortic occlusion in 22 patients undergoing AAA repair.
- TEE images were acquired at the mid-papillary level for volume assessment.
Main Results:
- A weak overall correlation was observed between PAOP and left ventricular end-diastolic area (LVEDA) (r = 0.37).
- The correlation strength between PAOP and LVEDA decreased throughout the surgical procedure, being weakest after aortic unclamping (r = 0.25).
- Significant variation in LVEDA was noted for individual PAOP measurements.
Conclusions:
- There is a relatively weak correlation between PAOP and LVEDA during intraoperative TEE in AAA repair.
- The diminishing correlation suggests potential changes in LV compliance, impacting fluid management.
- TEE serves as a valuable adjunct for guiding volume resuscitation in patients undergoing AAA repair.