Shane J George1, Sharif Al-Ruzzeh, Mohamed Amrani. 1. Department of Anaesthesia, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Middlesex, United Kingdom. s.george@rbh.nthames.nhs.uk
Abstract
BACKGROUND: Positioning for access to the coronary arteries leads to hemodynamic instability during off-pump cardiac surgery. External changes have been well described, but a description of the intracardiac structures in humans has not been described. METHODS: With multiplane intraoperative echocardiography, the mitral annulus at end diastole was reconstructed in the different positions and correlated with hemodynamic changes in the right heart and left atrium. RESULTS: Significant distortion of the mitral annulus with enlargement of the left atrium and pulmonary veins was demonstrated, which correlated with high left atrial pressures. CONCLUSIONS: Mitral valve distortion can significantly contribute to hemodynamic instability during positioning for off-pump cardiac surgery.
BACKGROUND: Positioning for access to the coronary arteries leads to hemodynamic instability during off-pump cardiac surgery. External changes have been well described, but a description of the intracardiac structures in humans has not been described. METHODS: With multiplane intraoperative echocardiography, the mitral annulus at end diastole was reconstructed in the different positions and correlated with hemodynamic changes in the right heart and left atrium. RESULTS: Significant distortion of the mitral annulus with enlargement of the left atrium and pulmonary veins was demonstrated, which correlated with high left atrial pressures. CONCLUSIONS: Mitral valve distortion can significantly contribute to hemodynamic instability during positioning for off-pump cardiac surgery.