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Updated: Aug 15, 2026
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Left ventricular diastolic function after coronary artery bypass grafting: a correlative study with three different
P A Casthely1, C Shah, H Mekhjian
1Seton Hall University, Paterson, N.J. 07503, USA.
Insights
Myocardial protection methods significantly impact diastolic function recovery after cardiac surgery. Ventricular fibrillation with intermittent aortic crossclamping offers better diastolic function preservation compared to cardioplegia techniques.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiology
Background:
- Assessing myocardial protection strategies is crucial for post-cardiac operation recovery.
- Diastolic function is a key indicator of cardiac health following surgery.
Purpose of the Study:
- To evaluate the impact of different myocardial protection techniques on left ventricular diastolic function after coronary artery bypass grafting.
- To compare the efficacy of anterograde cardioplegia, combined anterograde and retrograde cardioplegia, and ventricular fibrillation with intermittent aortic crossclamping.
Main Methods:
- Patients with normal preoperative diastolic function undergoing coronary artery bypass grafting were divided into three groups based on myocardial protection strategy.
- Left ventricular diastolic function was assessed using transesophageal echocardiography and Doppler analysis of mitral valve and pulmonary vein flow.
- Ejection fraction was calculated using transesophageal echocardiography.
Main Results:
- Diastolic function was significantly impaired in all groups immediately after cardiopulmonary bypass.
- Recovery to baseline diastolic function occurred by 1 hour post-operation only in the group utilizing ventricular fibrillation and intermittent aortic crossclamping.
- The group with ventricular fibrillation and intermittent aortic crossclamping experienced a higher incidence of supraventricular arrhythmias, with no significant hemodynamic differences observed between groups.
Conclusions:
- Cardiopulmonary bypass severely impairs left ventricular diastolic function.
- The choice of myocardial protection strategy significantly influences the degree and recovery of diastolic dysfunction.
- Ventricular fibrillation with intermittent aortic crossclamping demonstrated superior preservation of diastolic function compared to cardioplegia methods.
Background:
This study was designed to examine the effect of myocardial protection on diastolic function after cardiac operations.
Methods:
Subjects were patients with normal preoperative diastolic function who were scheduled for coronary artery bypass grafting. Group I received anterograde cardioplegia; group II received anterograde and retrograde cardioplegia; and group III was protected with ventricular fibrillation and intermittent aortic crossclamping. Operations were performed with mild hypothermia and ventricular venting through the left superior pulmonary vein in all cases. Left ventricular diastolic function was evaluated with pulsed-wave Doppler transesophageal echocardiography (samples at the mitral valve leaflet: four-chamber view) and left superior pulmonary vein flow velocity. The flow patterns were stored on videotape and sent to an independent investigator for analysis. Left ventricular ejection fraction was calculated with transesophageal echocardiography (short-axis view, two-dimensional and M-mode).
Results:
Left ventricular diastolic function, as measured by the ratio between the peak velocities during early filling and atrial contraction and by systolic diastolic superior pulmonary venous flow ratio, was significantly impaired in all three groups 5 minutes after discontinuation of cardiopulmonary bypass. At 1 hour after operation, these values had returned to control levels only in group III. There was an increased incidence of supraventricular arrhythmias in group III. There were no significant hemodynamic differences among the three groups.
Conclusions:
Left ventricular diastolic function was severely impaired after cardiopulmonary bypass. The degree of impairment depended on the myocardial protection used. The impairment in diastolic function was less when ventricular fibrillation and intermittent aortic crossclamping were used, and greater when anterograde and retrograde cardioplegia were used.
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