ECHOCARDIGRAPHY DURING OPCAB

by Jack Shanewise, MD
Emory University School of Medicine,
Atlanta, Georgia

The anesthesiologist's role is vastly different in OPCAB surgery compared to conventional bypass. In conventional bypass surgery when the patient is placed on pump, the Anesthesiologist becomes an observer and a consultant to the perfusionist. With OPCAB surgery the Anesthesiologist becomes the second most important practitioner in the room. Your expert guidance, diligence and abilities offer your patient hemodynamic stability and ensure the success of the case–especially during the distal anastomosis.

TEE

Initially, a base line exam is done to assess five major functions of the heart.38

• LV global function: assess what you are starting with prior to operation.
• LV regional wall function: note any or no abnormalities.
• Mitral regurgitation (MR).
• RV function and tricuspid regurgitation (TR).
• Aortic valve: check for regurgitation, calcification or abnormalities.
• Aorta: assess its health in case you need an IABP at the end of the case, or for any unforeseen plaque.

LV Segment Anatomy

Figure 13. LV Segmental Anatomy

 

The model presented here will specify a naming process, and will allow anesthesiologists to be able to more uniformly convey anatomy on a segmental nomenclature.

Three levels are defined first.

1. Basal level

- defined as mitral valve area to the tip of the papillary muscles. There are six separate segments, anterior, lateral, posterior, inferior, septal and anteroseptal.

 

2. Mid level

-The level of the papillary muscles. Divided into six segments: anterior, lateral, posterior, inferior, septal, anteroseptal.

 

3. Apical level

-The level distal to the papillary muscles. This is divided into four segments: anterior, lateral, inferior and septal.

Views During Graft Construction

Mid-esophageal views - Four chamber, two chamber, and long axis.

Figure 14. Mid-esophageal Two Chamber