Acute diastolic dysfunction in thoracoabdominal aortic aneurysm surgery

Abstract

Purpose: To report transesophageal echocardiographic (TEE) findings consistent with intraoperative acute diastolic dysfunction in a series of patients undergoing thoracoabdominal aortic aneurysm (TAAA) repair.Methods: A series of nine consecutive patients underwent TAAA repair with intraoperative TEE monitoring. Surgical repair was performed with the adjunct of a left atrio-femoral bypass. Invasive arterial and venous pressures were monitored. Intraoperative TEE was utilized to assess the diastolic function before, and during aortic cross clamping. Diastolic dysfunction was defined as a mitral inflow pulsed wave Doppler (E: A ratio) < 1.Results: All patients demonstrated an E: A ratio > 1 (1.3 ± 0.08) before aortic cross clamping. During cross clamp, the E: A ratio decreased to < 1 (0.75 ± 0.05) in six of nine patients consistent with diastolic dysfunction. The three patients who did not develop E: A changes were receiving ß-blockers preoperatively. Patients with diastolic dysfunction were treated with nitroglycerin infusions, which resulted in restoration of their E: A ratios > 1 (1.2 ± 0.09). Three of the patients with intraoperative diastolic dysfunction developed postoperative myocardial infarction. Conclusions:Chronic diastolic dysfunction is a well-known entity. This report describes acute diastolic dysfunction, which was observed frequently in patients undergoing TAAA during aortic cross clamp. Further research is required to confirm this phenomenon and determine its possible association with increased postoperative cardiac morbidity. Objectif

Case Scenario

“…18 Using transesophageal echocardiography, Fayad et al demonstrated acute diastolic dysfunction upon aortic cross clamping in two thirds of patients undergoing TAAA repair. 20 Thus, the presence of coronary artery disease, valvular function, and overall heart function should be assessed preoperatively, 21 and if possible, significant cardiac issues should be corrected before surgery. Pulmonary.…”

Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor?

“…In addition, preoperative DD was found to be a significant marker of in-hospital mortality after cardiac surgery and is independent of systolic function or the type of cardiac procedure [113]. Intraoperative acute DD is a new entity, which was observed by our research group during thoracoabdominal aortic aneurysm surgery [114]. In that study, postoperative myocardial infarction was significantly higher in patients who developed intraoperative acute DD.…”

Anesthesia for Open Abdominal Aortic Aneurysm Repair

“…62 Fayed et al reported acute diastolic dysfunction after high aortic clamping in six of nine patients with normal E/A ratios before clamping in thoracoabdominal surgery and three of those patients developed myocardial infarction. 63 The level of aortic cross clamp again has an influence on diastolic dysfunction and its effect on outcome.…”