Immediate improvement of dysfunctional myocardial segments after coronary revascularization: Detection by intraoperative transesophageal echocardiography

To ascertain the immediate effects of coronary artery bypass grafting on regional myocardial function, intraoperative transesophageal two-dimensional echocardiograms were obtained in 20 patients using a 3.5 MHz phased array transducer at the tip of a flexible gastroscope. Cross-sectional images of the left ventricle were obtained at multiple levels before skin incision and were repeated serially before and immediately after cardiopulmonary bypass. Using a computer-aided contouring system, percent systolic wall thickening was determined for eight anatomic segments in each patient at similar loading conditions (four each at mitral and papillary muscle levels). Of the 152 segments analyzed, systolic wall thickening improved from a prerevascularization mean value (± SEM) of 42.7 ± 2.9% to a postrevascularization mean value of 51.6 ± 2.6% (p < 0.001). Thickening improved most in those segments with the worst preoperative function (p < 0.001). Chest wall echocardiograms obtained 8.4 ± 2.3 days after operation showed no deterioration or further improvement in segmental motion compared with transesophageal echocardiograms obtained after revascularization. Thus: 1) regional myocardial function frequently improves immediately after bypass grafting, with increases in regional thickening being most marked in those segments demonstrating the most severe preoperative dysfunction, and this improvement appears to be sustained; and 2) in some patients, chronic subclinical ischemic dysfunction is present which can be improved by revascularization.