1/64. Intraoperative monitoring of regional wall motion abnormalities for detecting myocardial ischemia by transesophageal echocardiography.Transesophageal two-dimensional echocardiography has been used for intraoperative monitoring of regional wall motion of the left ventricle. Regional wall motion abnormality is a sensitive indicator of myocardial ischemia and the use of two-dimensional transesophageal echocardiography may have a substantial advantage for early detection of myocardial infarction and thus for initiating timely and appropriate therapy in preventing postoperative myocardial ischemia. With an expected increase in the use of intraoperative transesophageal echocardiography for monitoring regional wall motion, we described the practical aspects of transesophageal echocardiography: (1) insertion technique of transesophageal echocardiographic probe; (2) the technique for obtaining an optimal short-axis view of the left ventricle; and (3) the method for evaluating regional wall-motion abnormality and myocardial ischemia. Regional wall motion abnormality is best monitored at the mid-papillary muscle level where all three coronary arteries meet. In obtaining this view, the transesophageal echocardiographic probe was found to be predominantly located in the stomach. Failure in obtaining short-axis view of the left ventricle at this level occurred in patients with left ventricular dilatation or obesity. Because of the anatomical reason, the echocardiographic transducer cannot reach a proper plane. In anesthetized patients, air can be pushed into the stomach during induction and may disturb the visualization. The pitfalls in examining regional wall motion abnormalities include: (1) shifting of the center of left ventricular contraction; (2) inadequate direction of the scanning plane; and (3) paradoxical septal movement. Three cases are presented to demonstrate the usefulness of transesophageal echocardiography in managing coronary artery surgical patients.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/64. Apical hypokinesis in a patient with hypertrophic cardiomyopathy and myocardial bridging: reversal with beta-blockade--a case report.A 42-year-old man presented with effort angina pectoris of 20 minutes' duration. Hypertrophic obstructive cardiomyopathy, severe myocardial bridging involving the midleft anterior descending coronary artery, and apical hypokinesis were identified. Regional wall motion normalized following the initiation of beta blockade.- - - - - - - - - - ranking = 0.1keywords = motion (Clic here for more details about this article) |
3/64. Coronary artery spasm after coronary artery bypass grafting.We report a case of a 62-year-old man with severe manifestations of postoperative coronary artery spasm following effective coronary artery bypass grafting. The coronary artery spasm was manifested by ST segment elevation, hypotension and wall motion abnormalities on echocardiography. Urgent angiography confirmed the diagnosis and intracoronary infusion of nitroglycerine and verapamil relieved the coronary spasm.- - - - - - - - - - ranking = 0.1keywords = motion (Clic here for more details about this article) |
4/64. Intraoperative localisation and management of coronary artery fistula using transesophageal echocardiography.Coronary artery fistula is a rare congenital malformation that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, coronary aneurysm and sudden death. Clinical symptomatology depends upon the underlying anatomy and the size of the fistulous connection between the left or right side of the heart. We report the successful management of a giant right coronary artery with fistulization into the right atrium. Intraoperative transesophageal echocardiography with colour flow Doppler was used for precise location of the fistulous communication, selective demonstration of vessels feeding the fistula and documentation of abolition of fistulous flow all without the need for cardiopulmonary bypass. Furthermore the effect of shunt occlusion on regional wall motion was documented which facilitated the successful ligation of the fistula.- - - - - - - - - - ranking = 0.1keywords = motion (Clic here for more details about this article) |
5/64. Early deterioration followed by improvement in contractility during dobutamine stress echocardiography: An unusual response.In 2 patients with severe proximal coronary artery stenosis and normal wall motion in this territory, we observed marked wall motion abnormalities with low and intermediate doses of dobutamine, followed by marked improvement with continued dobutamine infusion. This unusual response suggests ischemic preconditioning and recruitment of coronary collaterals and would be recognized only by monitoring of images obtained at all stages of dobutamine infusion.- - - - - - - - - - ranking = 0.2keywords = motion (Clic here for more details about this article) |
6/64. Segmental degradation of left ventricular wall motion after persistent coronary fistula in a posttransplantation patient: a case report and short review of literature.A 50-year-old man received an orthotopic heart transplant because of severe coronary heart disease and congestive heart failure. Two years after the transplantation, a continuous murmur occurred at the left sternal edge after repeated endomyocardial biopsies. echocardiography and coronary angiography revealed a dilated left anterior descending artery with a fistula to the right ventricle. The circumflex was large with an equally postero-lateral branch, and the right coronary artery was rather small with collaterals to the distal part of the left anterior descending branch. The patient had refused any intervention to close the fistula. The left ventricular levogram was normal. Two years later, in a follow-up angiogram, the left ventricular ejection fraction had decreased as a result of hypo- and akinesis of the apex and posterior wall. We suggest that this local wall motion disturbance derives from a steal phenomenon rather than being a sequela of rejection. The decrease in left ventricular ejection fraction was associated with shortness of breath upon moderate exercise. Standard heart failure medication relieved the patient's symptoms. The observation of local wall motion disturbances in this case, as well as conflicting views in the literature, raises the question whether postbiopsy coronary fistulas in transplant patients should be closed.- - - - - - - - - - ranking = 0.6keywords = motion (Clic here for more details about this article) |
7/64. Minimally invasive direct coronary artery bypass grafting using the saphenous vein in redo CABG.We describe a patient who underwent minimally invasive direct coronary artery bypass (MIDCAB), who had previously undergone coronary artery bypass grafting (CABG) through a median sternotomy with a left internal mammary artery (LIMA) graft to the left anterior descending artery (LAD) and a right gastroepiploic artery (GEA) graft to the posterior descending artery. MIDCAB was less invasive and was an effective alternative procedure for the second operation. Because the patient had no LIMA or GEA available for a graft because of prior use, we used a saphenous vein graft (SVG) for bypassing from the left subclavian artery to the coronary artery by MIDCAB via a left minithoracotomy. The left subclavian artery was selected as the proximal anastomotic site because this artery was less diseased and was easier to reach. The SVG-to-coronary artery anastomosis was facilitated by firm adhesion between the epicardium and the pericardium, which reduced the motion of the epicardium itself. These results suggest that the procedure is safe and promising in selected cases of redo CABG.- - - - - - - - - - ranking = 0.1keywords = motion (Clic here for more details about this article) |
8/64. Reversible left ventricular systolic dysfunction--reversibility of coronary microvascular abnormality.Reversible left ventricular wall motion abnormalities mimicking myocardial infarction have been reported in patients with a noncardiac illness. Their coronary angiograms do not demonstrate organic stenosis or epicardial coronary vasospasm. In this article, two cases of reversible left ventricular contraction abnormality are presented. electrocardiography showed deep inverted T waves in precordial leads, and the echocardiography revealed diffuse akinesis of the apical region in the acute phase. coronary angiography showed no significant stenosis or occlusion in either patient. thallium scintigraphy showed no defect, while the metaiodobenzylguanidine scintigraphy demonstrated significant defects in the apex. The relative coronary flow reserve ratio, measured with an intracoronary Doppler flow wire, was significantly reduced in both patients. Myocardial contrast echocardiography revealed a reversible perfusion defect in the apex in the acute phase in case 2. Transiently impaired coronary microcirculation was thought to be involved in the pathogenesis of the reversible left ventricular dysfunction observed in these patients.- - - - - - - - - - ranking = 0.1keywords = motion (Clic here for more details about this article) |
9/64. Acute ST-segment elevation in Neisseria meningitis.meningitis due to neisseria meningitidis occurred in a young man. On admission, he was in septic shock and the electrocardiogram revealed convex upwards ST-segment elevation in inferior and lateral leads. Rapid and complete normalisation of the ECG was observed and the patient had a favourable evolution with intensive therapy.The mechanisms of the ECG abnormalities in this disease are unclear. In this patient, ST-segment elevation was probably related to severe transmural ischaemia or prolonged coronary artery spasm as suggested by increase and decrease of cardiac enzymes and transient echocardiographic wall motion abnormalities without pericarditis. However, myocarditis could not be completely ruled out.- - - - - - - - - - ranking = 0.1keywords = motion (Clic here for more details about this article) |
10/64. Surgical management of a gigantic circumflex coronary artery aneurysm with fistulous connection to the coronary sinus.We report the successful management of a gigantic circumflex coronary artery aneurysm with fistulisation into the coronary sinus. Transoesophageal echocardiography allowed continuous visualisation of ventricular wall motion during dissection and closure of the aneurysm whilst operating on cardiopulmonary bypass on the beating heart.- - - - - - - - - - ranking = 0.1keywords = motion (Clic here for more details about this article) |
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