The development of CD worsened significantly the outcomes of adult patients undergoing cardiac surgery. There was a greater risk of CD in patients with either mediastinitis or endocarditis. The infection was associated with a higher hospital mortality rate, longer hospital stays, and greater cost after both CABG and VS.
Although long-term effects have been studied, the immediate effect of surgery for acquired heart disease on left ventricular function is not well defined. Accordingly, 44 adults with acquired heart disease underwent intraoperative two-dimensional echocardiography with a gas-sterilized transducer before and immediately after cardiopulmonary bypass. Ejection fraction was measured by short-axis area change at the maximum left ventricular cross section (SAAC-EF) and also by a method using multiple sections. Correction of both mitral and aortic regurgitation produced a significant intraoperative decrease in ejection fraction from 0.
MethodsOperative investigation. Forty-four patients undergoing single-valve replacement or coronary artery bypass grafting were studied (table 1). The patients suffered from acquired single-valve disease or coronary artery disease. There were no cases of significant coronary artery disease coexistent with the valve lesions. No localized wall motion abnormalities were seen in the patients with valvular disease. Of 14 patients, with coronary artery disease, 10 had no wall motion abnormalities detected by standard two-dimensional echocardiographic studies performed on the day before surgery. Localized wall motion abnormalities were seen in four patients (Nos. 3,4,9,and 14). Informed consent was obtained from all patients.After general anesthesia with ketamine or morphine-nitrous oxide, endotracheal intubation, and median sternotomy, patients were cannulated for cardiopulmonary bypass. Echocardiographic studies were obtained with a gas-sterilized hand-held 3.5 mHz transducer and were recorded on videotape (V-3000 or V-3400 ultrasonograph; Diasonics, Salt Lake City). Use of intravenous vasopressors and vasodilators were generally avoided during echocardiographic studies. Short-axis sections were recorded at four levels: (1) the base of the mitral valve, (2)
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