Ann Thorac Surg 1995;60:665-668
© 1995 The Society of Thoracic Surgeons
Aortic regurgitation in coronary artery bypass grafting: Implications for cardioplegia administration
MD Robbin Bura Moisa,
MD Steven M. Zeldis*,
PA-C Steven A. Alper,
MD William C. Scott
Division of Cardiology, Departments of Medicine and Thoracic and Cardiovascular Surgery, Winthrop-University Hospital, Mineola, New York and School of Medicine, Health Sciences Center, SUNY at Stony Brook, Stony Brook, New York, USA
Accepted for publication March 21, 1995.
* Address reprint requests to Dr Zeldis, Division of Cardiology, Winthrop-University Hospital, 259 First St, Mineola, NY 11501.
Background.: Echocardiography can detect aortic regurgitation (AR) that may interfere with the adequate delivery of cardioplegia solution to the myocardium during cardiac operation. When aware of this lesion, the surgeon can modify the operative technique accordingly. We sought to evaluate the ability of intraoperative transesophageal echocardiography to detect AR and to correlate the severity of the lesion with the need for retrograde cardioplegia administration.
Methods.: Eighty-four consecutive patients undergoing coronary artery bypass grafting were evaluated. When AR was noted by intraoperative transesophageal echocardiography, a cannula was placed in the coronary sinus for possible retrograde cardioplegia administration. The surgeon was unaware of the severity of AR. After operation, the severity of AR was quantitated using the ratio of the regurgitation jet width to the left ventricular outflow tract diameter.
Results.: The AR patients who required retrograde cardioplegia had a significantly higher ratio of regurgitation jet width to left ventricular outflow tract diameter than those AR patients who did not (0.36 ± 0.06 versus 0.19 ± 0.06, p < 0.005).
Conclusions.: Transesophageal echocardiography can provide accurate information regarding the presence and severity of AR. The calculated severity of AR on transesophageal echocardiography is associated with the need for retrograde cardioplegia administration.
Presented at the Sixth International Symposium on Echocardiography in Cardiac Surgery, Washington, DC, Nov 9–11, 1994. Received the Doppler Award for best paper presented at the symposium.
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