1. Transesophageal Echocardiography during Abdominal Aortic Surgery
- Author
-
Arend J. Dunning, Harry B. van Wezel, Jan G. Kromhout, Jacques J. Koolen, Cees A. Visser, and Joseph A. Odoom
- Subjects
medicine.medical_specialty ,Aorta ,business.industry ,Ischemia ,Hemodynamics ,Aortic surgery ,medicine.disease ,Afterload ,Internal medicine ,medicine.artery ,cardiovascular system ,Cardiology ,Medicine ,cardiovascular diseases ,Myocardial infarction ,business ,Pulmonary wedge pressure ,Cause of death - Abstract
Patients requiring abdominal aortic surgery are a high-risk group for several reasons: their advanced age, the presence of generalized atherosclerosis—especially of the coronary arteries—and the nature of surgery with aortic cross-clamping (AoX) inducing sudden and major hemadynamic changes [1–3]. AoX is associated with a rise in the afterload and in left ventricular wall tension leading to increased oxygen demand [4, 5]. Myocardial infarction is the leading cause of death after surgery of the aorta and its great branches [6, 8]. Early identification of intraoperative myocardial ischemia might therefore reduce morbidity and mortality. Traditional methods of intraoperative hemodynamic monitoring, i.e., pulmonary capillary wedge pressure and the standard surface electrocardiogram, are rather specific; the sensitivity for the detection of myocardial ischemia, however, is poor [8–10]. Transmural ischemia may even be missed when a single electrocardiographic lead is monitored [11].
- Published
- 1988