Acute diastolic dysfunction in thoracoabdominal aortic aneurysm surgery

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 (1.3 ± 0.08) before aortic cross clamping. During cross clamp, the E: A ratio decreased to 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. Objectif : Presenter les resultats de l’echocardiographie transœsophagienne (ETO) compatibles avec une dysfonction peroperatoire diastolique aigue chez une serie de patients operes pour un anevrysme aortique thoraco-abdominal (AATA). Methode : Neuf patients consecutifs ont subi la reparation d’un AATA sous monitorage peroperatoire avec ETO. Une derivation auriculo-femorale gauche et un monitorage endovasculaire des pressions arterielle et veineuse ont ete utilises. L’ETO peroperatoire a servi a evaluer la fonction diastolique avant et pendant le clampage de la crosse aortique. La dysfonction diastolique etait une onde Doppler pulsee d’entree mitrale (ratio E : A) < 1.