Yamaura Ken, Hoka Sumio, Okamoto Hirotsugu, Takahashi Shosuke
Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
J Cardiothorac Vasc Anesth. 2003 Dec;17(6):703-8. doi: 10.1053/j.jvca.2003.09.005.
The authors aimed to establish a technique for quantitative analysis of regional wall motion abnormality (RWMA) using color kinesis (CK) of transesophageal echocardiography (TEE) in surgical patients. This technique was used to determine whether RWMAs develop de novo after infrarenal aortic cross-clamping in patients undergoing vascular surgery with a preoperative dipyridamole thallium stress test (DTST).
An observational study.
University hospital.
Thirty-eight patients undergoing infrarenal abdominal aortic aneurysm resection or aortofemoral bypass.
CK images of the left ventricle (LV) were obtained from the midventricular transgastric short-axis view before and after infrarenal aortic cross-clamping using TEE and analyzed off-line using custom software. The predictive value of the category "reversible perfusion defect" (RD) was also estimated from DTST for predicting new RWMAs with CK. CK analysis is suitable for clinical use based on the comparison with conventional two-dimensional echocardiogram measurements and interobserver variability. CK analysis showed all 7 patients with persistent perfusion defects on DTST had RWMAs. New RWMAs occurred in 2 of 9 patients with RD and in 2 of 15 patients with normal DTST, indicating that there was no significant difference between RD and normal DTST in the incidence of new RWMAs.
A new method is available for clinical use, which is capable of visualizing RWMAs. These results suggest that new RWMAs introduced by aortic cross-clamping occur irrespective of the risk as assessed by preoperative DTST. CK with the new analysis method might be a useful tool to quantitatively evaluate RWMAs during surgery.
作者旨在建立一种利用经食管超声心动图（TEE）的彩色室壁运动分析（CK）技术对手术患者的局部室壁运动异常（RWMA）进行定量分析的方法。该技术用于确定接受术前双嘧达莫铊负荷试验（DTST）的血管手术患者在肾下腹主动脉交叉阻断后是否会新发RWMA。
一项观察性研究。
大学医院。
38例接受肾下腹主动脉瘤切除术或主动脉股动脉旁路移植术的患者。
使用TEE在肾下腹主动脉交叉阻断前后从胃中部短轴观获取左心室（LV）的CK图像，并使用定制软件进行离线分析。还从DTST中评估“可逆灌注缺损”（RD）类别对预测CK新发现的RWMA的预测价值。基于与传统二维超声心动图测量结果及观察者间变异性的比较，CK分析适用于临床应用。CK分析显示，DTST上所有7例存在持续性灌注缺损的患者均有RWMA。9例RD患者中有2例出现新的RWMA，15例DTST正常的患者中有2例出现新的RWMA，这表明RD组和DTST正常组在新发RWMA的发生率上无显著差异。
一种可用于临床的新方法可用于可视化RWMA。这些结果表明，主动脉交叉阻断导致的新发RWMA的出现与术前DTST评估的风险无关。采用新分析方法的CK可能是术中定量评估RWMA的有用工具。
