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Acute diastolic dysfunction in thoracoabdominal aortic aneurysm surgery

[Dysfonction diastolique aiguë pendant l’opération d’un anévrysme aortique thoraco-abdominal]

Ashraf Fayad, MD^*, Homer Yang, MD^*, Howard Nathan, MD^*, Gregory L. Bryson, MD^* and Claudio S. Cina, MD

^* From the Department of Anesthesia, University of Ottawa; and the
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.

Address correspondence to: Dr. Ashraf Fayad, Department of Anesthesia, University of Ottawa, B309, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. Phone: 613-761-4940; Fax: 613-761-5209; E-mail: afayad{at}ottawahospital.on.ca

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 pre-operatively. 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.