Document Detail


Transesophageal echocardiography in hypotensive patients after cardiac operations. Comparison with hemodynamic parameters.
MedLine Citation:
PMID:  1495293     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Because it is sometimes difficult to determine the cause of hypotension in patients after cardiac operations, we assessed the value of transesophageal echocardiography in this respect, and we studied 60 consecutive patients who had hypotension despite positive inotropic medication and, in some patients, mechanical support. Echocardiographic diagnoses were compared with diagnoses based on hemodynamic parameters. Follow-up examinations were completed in all patients to confirm the final diagnoses. Echocardiographic signs of hypovolemia were present in 14 patients, tamponade in six, left ventricular failure in 16, right ventricular failure in 11, and biventricular failure in eight. Echocardiographic examination proved to be inconclusive in five patients. Comparison with hemodynamic parameters showed agreement on diagnoses (hypovolemia versus tamponade versus cardiac failure) in 30 patients (50%). Echocardiography correctly identified two patients with tamponade and six with hypovolemia; these conditions were not suspected by standard hemodynamic data; in five patients unnecessary reoperation was prevented, although hemodynamic values were suggestive of tamponade. Echocardiography also identified subcategories of patients at high risk of death (those with signs of right ventricular and biventricular failure). These findings suggest that transesophageal echocardiography performed on patients after cardiac operations, at the bedside in the intensive care unit, can readily elucidate the cause of hypotension in the large majority of patients and is a valuable adjunct to hemodynamic evaluation in patient management. Furthermore, it appears to be possible to identify subcategories of high-risk patients, based on these echocardiographic findings.
Authors:
C L Reichert; C A Visser; J J Koolen; R B vd Brink; H B van Wezel; N G Meyne; A J Dunning
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  104     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1992 Aug 
Date Detail:
Created Date:  1992-09-04     Completed Date:  1992-09-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  321-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Output, Low / complications,  ultrasonography*
Cardiac Surgical Procedures*
Cardiac Tamponade / complications,  ultrasonography*
Echocardiography / methods*
Female
Follow-Up Studies
Hemodynamics / physiology*
Humans
Hypotension / etiology,  ultrasonography*
Male
Postoperative Complications / ultrasonography*
Shock / complications,  ultrasonography*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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