Japanese
Title麻酔中の心筋虚血モニターとしての経食道心エコーの有用性の検討
Subtitle原著
Authors岩出宗代*
Authors(kana)
Organization*東京女子医科大学麻酔学教室
Journal循環制御
Volume12
Number3
Page503-511
Year/Month1991/
Article原著
Publisher日本循環制御医学会
Abstract「要旨」近年, 麻酔科領域で経食道心エコー(Transesophageal echocardiography ; TEE)による心筋壁運動異常(Systolic wall motion abnormality ; SWMA)を, 心筋虚血の診断に用いることが試みられている. 今回, 予定冠血行再建術患者21例を対象とし, 心電図や血行動態モニターとともにTEE像を経時的に観察した. TEE像は, 左室短軸像乳頭筋レベルの他, 計5つの像を描出し, 評価に際してはAmerican Heart Associationによる左室造影の評価方法を参考に左室壁を7区域に区分した. 従来, 単独で用いられてきた左室短軸像乳頭筋レベルの異常検出率は全SWMA検出部位の34.5%と低く, 他の像を検索することはSWMAの検出には有用と考えられた. また心電図や血行動態の変化とSWMAとの相関は少なく, 心筋虚血のモニターとしてはTEEが有用であると考えられた.
Practice基礎医学・関連科学
KeywordsTransesophageal echocardiography, Systolic wall motion abnormality, Intraoperative myocardial ischemia
English
TitleDetection of Myocardial Ischemia during Coronary Arterial Bypass Graft Surgery by Transesophageal Echocardiography
Subtitle
AuthorsMotoyo Iwade
Authors(kana)
OrganizationDepartment of Anesthesiology Tokyo Women's Medical College
JournalCirculation Control
Volume12
Number3
Page503-511
Year/Month1991/
ArticleOriginal article
PublisherJapan Society of Circulation Control
AbstractThe effectiveness of transesophageal echocardiography (TEE) for detecting an intraoperative systolic wall motion abnormality (SWMA) has been assessed in 21 patients undergoing coronary arterial bypass graft surgery. Five TEE views, including the left ventricular short axis view at the papillary muscle level, were recorded, as well as an electrocardiogram (ECG), and the measurements of the hemodynamic parameters, i.e., the heart rate, cardiac output, and pulmonary wedge pressure. For SWMA detection, the left ventricular wall was divided into seven segments as recommended by the American Heart Association for analysis of the left ventriculogram. Previous studies used only the left ventricular short axis view at the papillary muscles to detect SWMA. In this study, the number of SWMAs detected at this level amounted to only 34.5% of the all SWMA. Therefore, obtaining multiple views is grater value for detecting SWMAs. SWMA with positive ST-T changes was seen in 21.3%, and that without ST-T changes in 23.0% of the subjects. Patients with intraoperative SWMAs did not necessarily have ST-T changes and, conversely, patients with positive ST-T changes did not necessarily reflect SWMAs. Besides, SWMA showed inflequent association with acute changes in hemodynamic parameters. Based on the obove, it appears that TEE may be a more useful monitoring method for the intraoperative myocardial ischemia than the ECG and hemodynamic parameters, and that multiple TEE views are advantageous for detecting SWMA.
PracticeBasic medicine
KeywordsTransesophageal echocardiography, Systolic wall motion abnormality, Intraoperative myocardial ischemia

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