A Quantitative Study On Left Ventricular Global Function Before And After Off-pump Coronary Artery Bypass Simultaneously Using Transesophageal Doppler Echocardiography And Cardiac Catheterization

Objective To investigate the changes of left ventricular global function quantitatively before and after off-pump coronary artery bypass(OPCAB) treating myocardial ischemia simultaneously using transesophageal Doppler echocardiography(TEE) and cardiac catheterization. Methods 42 patients determining to accept OPCAB were enrolled among whom there was 1 patient with 1 lesion in left main coronary artery, 1 patient with a long lesion in right coronary artery, 12 patients with 2 lesions and 28 patients with 3 or more lesions in coronary artery proved by coronary angiography. All patients were deficient in cardiac function among whom there were 28 patients with NYHAII class, 12 patients with NYHA III class and 1 patient with NYHA IV class and the patients with mitrial valve stenosis and severe regurgitation, atrial fibrillation, atrioventricular block and those changed to conventional coronary artery byoass(cCABG) for all kinds of causes were excluded. Pulmonary vein flow(PVF), mitral valve flow(MVF), coronary sinus flow(CSF), end-diastolic volume(EDV), end-systolic(ESV), stroke volume(SV), cardiac output(CO), cardiac index(CI) and left ventricular ejection fraction(LVEF) were measured by TEE before and after OPCAB. At the same time pulmonary capillary wedge pressure(PCWP), pulmonary artery pressure(PAP) and central vein pressure(CVP) were detected during OPCAB by cardiac catheter simultaneously. All the measurements were compared between pre- and immediately post-OPCAB and were correlation-analyzed with indices measured by cardiac catheter. Results (1)MVe, VTImve, PVs, PVd, VTIpvs, VTIpvd, CSs, CSd, VTIcss, VTIcsd, LVEF, CO, CI, SV, Tpvat-mvat and Tpvadt-mvadt had increased significantly (P<0.05~0.0001) and Mva, VTImva, MVedt, Pva, VTIpva, PVadt. EDV, ESV, PAP and PCWP had decreased obviously (P<0.05~0.001) post-OPCAB. There was no significant difference in other indices between pre- and post-OPCAB. (2)PCWP was highly correlated with MVat, MVe/Mva, Pva, VTIpva, PVadt, Tpvadt-mvadt and Tpvat-mvat, among which the correlations between PCWP and Pva, VTIpva, Tpvadt-mvadt and Tpvat-mvat were better than others (r=0.64~0.86, P<0.001). There was poor negative correlation between PCWP and MVedt and MVadt(r= -0.35--0.58, P<0.001-0.05) and good positive correlation between CVP and CSa,VTIcsa too(r=0.69~0.78, P<0.001). Conclusions (1)MVF, PVF, EDV, ESV, LVEF, SV, CO and CI measured by TEE can accurately reflect left ventricular diastolic and systolic function and the changes of cardiac pressure. (1)Measurements detected by TEE highly correlated with the pressures measured by cardiac catheter and PVa. VTIpva, Tpvat-mvat and Tpvadt-mvadt can be used to calculate and reflect PCWP. (3)Revascularizaton of coronary artery can be assessed by detection of CSF. (4)OPCAB can improve left ventricular performance significantly immediately after the procedure, which perhaps attributes to left ventricular remodeling, saving viable myocardium and avoiding ischemia-reperfusion injury and myocardial stunning. (5)TEE is a reliable technology to assess OPCAB. especially in the supervision and evaluation during coronary artery surgery,...