Circulation, Vol 72, 1015-1021, Copyright © 1985 by American Heart Association
JS Smith, MK Cahalan, DJ Benefiel, BF Byrd, FW Lurz, WA Shapiro, MF Roizen, A Bouchard and NB Schiller
Because acute segmental wall motion abnormalities (SWMAs) of the left
ventricle are highly sensitive and specific indicators of myocardial
ischemia, this study compared the incidence and significance of ischemia,
as detected by two-dimensional transesophageal echocardiography and surface
electrocardiography, during anesthesia and surgery in patients at high risk
of myocardial ischemia. During surgery, 24 of the 50 patients studied had
new SWMAs, whereas only six had ST segment changes. All patients with ST
segment changes also had new SWMAs: in three instances, SWMAs occurred
before the ST segment change, and in three instances, they occurred
simultaneously. All three patients who had intraoperative myocardial
infarctions also had persistent intraoperative SWMAs, whereas only one
patient had ST segment changes. Ten healthy patients requiring
noncardiovascular surgery were monitored similarly; none of these had
SWMAs, ST segment changes, or myocardial infarction. This study
demonstrates the superiority of two-dimensional transesophageal
echocardiography over electrocardiography for the intraoperative detection
of myocardial ischemia. Furthermore, when new SWMAs persist to the
conclusion of surgery, myocardial infarction is likely to have occurred.
ARTICLES
Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography
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