-Original-

Repair of an Infrarenal Abdominal Aortic Aneurysm is Associated with Persistent Left Ventricular Diastolic Dysfunction

Hiroyasu Bitoh^1,2, Kazuhiro Nakanishi¹, Shinhiro Takeda¹, Chol Kim¹, Masaki Mori¹ and Atsuhiro Sakamoto¹

¹Department of Anesthesia and Pain Control, Graduate School of Medicine, Nippon Medical School
²Department of Anesthesiology, Nippon Medical School Musashi Kosugi Hospital

Background: Left ventricular (LV) diastolic function has received much attention recently. However, few studies have evaluated LV diastolic function in the perioperative period. The aim of this study was to elucidate perioperative changes in diastolic function using tissue Doppler imaging (TDI) in patients undergoing repair of an infrarenal abdominal aortic aneurysm (AAA).
Methods: Eight patients undergoing repair of an infrarenal AAA were studied prospectively using transesophageal echocardiography. Doppler echocardiographic examinations were performed before the surgical procedure (T1), immediately before aortic unclamping (T2), 30 minutes after aortic unclamping (T3), and at the end of surgery (T4).
Results: Pulmonary edema developed in two patients on postoperative day 1. These two patients had the lowest early diastolic mitral annular velocity (Ea) of the study group at the end of surgery. The ratio of the peak velocity of early mitral inflow (E) to the peak velocity of atrial inflow was significantly decreased at T3 and T4. The systolic ejection velocity was significantly decreased at T3, but returned to the baseline value at T4. The Ea was significantly decreased at T3 and T4. The E/Ea ratio showed a progressive rise and was significantly increased at T3 and T4.
Conclusions: In patients undergoing repair of an infrarenal AAA, the Ea derived using TDI decreases at T3 and is still reduced at T4. The E/Ea ratio, which is used to estimate LV filling pressures, is significantly increased at T3 and T4. Further research is required to confirm the development of diastolic dysfunction and determine its possible association with increased postoperative morbidity and mortality.

J Nippon Med Sch 2007; 74: 393-401

Keywords
left ventricular diastolic function, tissue Doppler imaging, infrarenal abdominal aortic aneurysm repair, early diastolic mitral annular velocity

Correspondence to
Kazuhiro Nakanishi, Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
n-kazu@nms.ac.jp

Received, June 6, 2007
Accepted, September 13, 2007