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European Heart Journal 1986 7(12):1053-1061;
Copyright © 1986 by the European Society of Cardiology.
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© 1986 The European Society of Cardiology

The value of cross-sectional echocardiography in detecting perioperative myocardial infarction following coronary artery bypass graft surgery

P. A. RIBEIRO, R. A. FOALE, P. NIHOYANNOPOULOS, S. WESTABY, D. W. MOSS and C. M. OAKLEY

Departments of Clinical Cardiology, Chemical Pathology and Cardiothoracic Surgical Unit, Royal Postgraduate Medical School Hammersmith Hospital Du Cane Road, London W12 OSH, U.K.

revised 4 June 1986; accepted 6 February 1985.

Address for correspondence: Dr Paulo Ribeiro,239, Riyahd Armed Forces Hospital, P.O. Box 7897, Riyadh 11159. Kingdom of Saudi Arabia.

Abstract

Detection of perioperative myocardial infarction following coronary artery bypass graft surgery may be difficult. To assess the value of cross-sectional echocardiography in detecting perioperative infarction, 45 patients were studied by this technique to assess left ventricular regional wall motion before and eight to ten days after cardiac surgery. Deterioration in septal, antero-lateral, apical, inferior and posterior segments was correlated with Q-wave change in the ECG and with CK-MB taken at pre, 4, 7, 21, 48 and 72 hours post surgery. Echocardiographic regional wall motion was asessed semiquantitatively by a point score system (3=normal, 2=hypokinetic, 1=akinetic, 0=dyskinetic). Sixeen patients showed deterioration in regional wall motion ≥ 1 point. Eleven of these patients had new hypokinetic abnormalities of 1 point in the previously normal septal segment, but no ECG infarction. Three of the 11 had raised CK-MB and only one fulfilled the CK-MB criteria for perioperative infarction. Four other patients showed new akinetic segments (deterioration of two points). All four had CK-MB criteria for perioperative infarction and three had new ECG Q-wave. Three other patients showed ECG infarction without echo or CK-MB changes. Thus the development of a new akinetic segment on cross-sectional echocardiographic analysis of regional wall motion is a good marker of perioperative myocardial infarction. However, the great majority of new septal hypokinetic segments do not result from this operative complication.

Key Words: Perioperative infarction • echocardiography


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