Application of transesophageal echocardiography in anesthesia management in modified morrow operation

Abstract

Objective To evaluate the application of transesophageal echocardiography (TEE) in anesthesia management of obstructive hypertrophic cardiomyopathy (HOCM) during modified morrow operation and to evaluate the effect of TEE on surgical decision-making. Methods Twenty-one HOCM patients who were admitted into our hospital from March 2015 to March 2019 for TEE were selected. All patients underwent transesophageal ultrasound. The diameter of the narrowest left ventricular outflow tract, and subaortic interventricular septal thickness and length were recorded before and after operation. Continuous Doppler flow velocity was measured at the left ventricular outflow tract and the difference of transvalvular pressure was calculated. At point of mitral valve apex, peak velocity and atrial filling (A) and early filling (E) of mitral valve were recorded on four-chamber level of middle esophagus, E/A(mitral valve E peak velocity divided by A peak velocity ratio). Early diastolic (e′) phase of ventricular lateral wall of mitral annulus with tissue doppler, E/e′ (mitral valve E peak velocity divided by mitral annulus e′) were recorded. Results Intro-operative aerodynamics was stable and no malignant adverse events such as ventricular fibrillation occurred. There were 18 cases of auto-cardiac resuscitation (85%), 3 cases of temporary pacemaker use (15%), while 17 patients (81%) did not need to use positive inotropic drugs after rebound, but could successfully depart from cardiopulmonary bypass at low doses of deoxyepinephrine. The remaining four patients (19%) required low doses of milrinone or combined with deoxyepinephrine or norepinephrine. The cardiopulmonary bypass (CPB) time was (124±45) min and the aortic occlusion time was (85±21) min. The trans-valvular pressure of left ventricular outflow tract decreased to (68±8) mmHg (1 mmHg=0.133 kPa) to (16±6) mmHg by TEE after operation (P 14, and the lateral wall of ventricular septum e′ was<10 cm/s. Conclusions TEE plays an important role in anesthesia management, surgical decision-making and evaluation of operation. For patients with normal systolic function, TEE monitoring of transvalvular pressure through deep transgastric lax is consistent with intraoperative monitoring of transvalvular pressure through catheter. Key words: Transesophageal echocardiography; Modified morrow operation; Obstructive hypertrophic cardiomyopathy; Anesthesia management