Advertisement

Perioperative myocardial ischemia

  • Nikolai Kolev
  • Günter Huemer
  • Michael Zimpfer

Abstract

Coronary artery disease (CAD) continues to be one of the most significant diseases confronting the anesthetist. The incidence of CAD in surgical patients is high, and perioperative myocardial ischemia remains the most important cause of cardiac morbidity and mortality, particularly in the increasing subset of older patients who undergo major general surgical procedures. Intra- and postoperative myocardial ischemia has been found to occur in 40–60% of echocardiographically monitored patients with CAD undergoing noncardiac surgery.1–6 Although the estimated prevalence of cardiovascular disease in Western industrialized countries is approximately 25%, patients requiring surgical procedures are more likely to have cardiovascular disease than the average person.7 It has been established that approximately 25% of all noncardiac surgical patients require major intraabdominal, thoracic, vascular, neurosurgical or orthopedic procedures, and underlying cardiac conditions (coronary artery disease) may be even more common in this group. Therefore, perioperative cardiac assessment and perioperative cardiac management for patients having noncardiac surgery are common concerns for surgeons and anesthetists.

Keywords

Myocardial Perfusion Myocardial Ischemia Wall Motion Coronary Blood Flow Wall Motion Abnormality 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Massie BM, Mangano DT. Assessment of perioperative risk: Have we put the cart before the horse? J Am Coll Cardiol 21: 1353 - 1356, 1993PubMedGoogle Scholar
  2. 2.
    Hollenberg M, Mangano DT, Browner WS, London MJ, Tubau JF, Tateo IM. Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery. JAMA 268: 205 - 209, 1992PubMedGoogle Scholar
  3. 3.
    Raby KE, Barry J, Creager MA, Cook F, Weisberg MC, Goldman L. Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. JAMA 268: 222 - 227, 1992PubMedGoogle Scholar
  4. 4.
    Abraham SA, Coles A, Coley CM, Strauss HW, Boucher CA, Eagle K. Coronary risk of noncardiac surgery. Progr Cardiovasc Dis 34: 205 - 234, 1991Google Scholar
  5. 5.
    Mangano DT, Browner WS, Holloenberg MH, London MJ, Tubau JF, Tateo IM. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 323: 1781 - 1788, 1990PubMedGoogle Scholar
  6. 6.
    Ouyang P, Gerstenblith G, Furman WR, Gloueke PJ, Gottlieb SO. Frequency and significance of early postoperative silent myocardial ischemia in patients having peripheral vascular surgery. Am J Cardiol 64: 1113 - 1116, 1989PubMedGoogle Scholar
  7. 7.
    Wong T, Detsky AS. Perioperative cardiac risk assessment for patients having peripheral vascular surgery. Ann Int Med 116: 743 - 753, 1992PubMedGoogle Scholar
  8. 8.
    American Society of Anesthesiologists. New classification of physical status. Anesthesiology 24: 111–119, 1963Google Scholar
  9. 9.
    Criteria Committee of the NYHA. Diseases of the Heart and Blood Vessels: Nomenclature and Criteria for Diagnosis. 6th ed. Little, Brown, Boston, 1964Google Scholar
  10. 10.
    Coronary Artery Surgery Study (CASS). Manual of Operations II: Data collecting and storage. Collaborative studies in coronary artery surgery. Washington, DC: National Heart, Lung, Institute. Prepared by the CASS Coordinating Center, 1978Google Scholar
  11. 11.
    Goldman L, Caldera DL, Nussbaum SR. Multifactoral index of cardiac risk in noncardiac surgical procedures. N Engl J Med 297: 845 - 848, 1977PubMedGoogle Scholar
  12. 12.
    Roizen MF. Anesthetic implications of concurrent diseases. In: Miller RD, ed. Anesthesia. 3rd ed. Churchill Livingstone, New York, pp 793 - 893, 1990Google Scholar
  13. 13.
    Mangano DT. Perioperative cardiac morbidity. Anesthesiology 72: 153 - 157, 1990PubMedGoogle Scholar
  14. 14.
    Boucher CA, Brewser DC, Darling C, Okada RD, Strauss HW, Pohost GM. Determination of cardiac risk by dipyridamole thallium imaging before peripheral vascular surgery. N Engl J Med 312: 389 - 392, 1985PubMedGoogle Scholar
  15. 15.
    McEnroe CS, O’Donnel TF Jr, Yeager A. Comparison of ejection fraction and Goldman risk factors analysis to dipyridamole-thallium 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery. J Vase Surg 11: 497 - 502, 1990Google Scholar
  16. 16.
    Coriat P. Dipyridamole-thallium imaging—no routine test prior to vascular surgery. Society of Cardiovascular Anesthesiologists, 13th Annual Meeting, 1991Google Scholar
  17. 1.
    Massie BM, Mangano DT. Assessment of perioperative risk: Have we put the cart before the horse? J Am Coll Cardiol 21: 1353 - 1356, 1993Google Scholar
  18. 2.
    Hollenberg M, Mangano DT, Browner WS, London MJ, Tubau JF, Tateo IM. Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery. JAMA 268: 205 - 209, 1992PubMedGoogle Scholar
  19. 3.
    Raby KE, Barry J, Creager MA, Cook F, Weisberg MC, Goldman L. Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. JAMA 268: 222 - 227, 1992PubMedGoogle Scholar
  20. 4.
    Abraham SA, Coles A, Coley CM, Strauss HW, Boucher CA, Eagle K. Coronary risk of noncardiac surgery. Progr Cardiovasc Dis 34: 205 - 234, 1991Google Scholar
  21. 5.
    Ouyang P, Garstenblith G, Furman WR, Gloueke PJ, Gottlieb SO. Frequency and significance of early postoperative silent myocardial ischemia in patients having vascular surgery. Am J Cardiol 64: 1113 - 1116, 1989PubMedGoogle Scholar
  22. 6.
    Mangano DT, Browner WS, Hollenberg MH, London MJ, Tubau JF, Tateo IM. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 323: 1781 - 1788, 1990PubMedGoogle Scholar
  23. 7.
    Cason BA, Demas KA, Mazer CD. Effects of nitrous oxide on coronary pressure and regional contractile function in experimental myocardial ischemia. Anesth Analg 72: 604 - 611, 1991PubMedGoogle Scholar
  24. 8.
    Nathan HJ. Nitrous oxide worsens myocardial ischemia in isoflurane-anesthetized dogs. Anesthesiology 68: 707 - 715, 1988Google Scholar
  25. 9.
    Cahalan MC, Prakash O, Rulf ENR. Addition of nitous oxide to fentanyl anesthesia does not induce myocardial ischemia in patients with ischemic heart disease. Anesthesiology 67: 925 - 927, 1987PubMedGoogle Scholar
  26. 10.
    Mitchell MM, Prakash O, Rulf ENR. Nitrous oxide does not induce myocardial ischemia in patients with ischemic heart disease and poor ventricular function. Anesthesiology 71: 526–534, 1989PubMedGoogle Scholar
  27. 11.
    Bosnjak ZJ, Aggarwal A, Turner LA. Differential effects of halothane, enflurane and isoflurane on Ca++ transients and papillary muscle tension in guinea pigs. Anesthesiology 76: 123–131, 1992PubMedGoogle Scholar
  28. 12.
    Leone BJ, Philbin DM, Lehhot JJ. Gradual or abrupt nitrous oxide administration in a canine model of critical coronary stenosis induces regional myocardial dysfunction that is worsened by halothane. Anesth Analg 67: 814–822, 1988PubMedGoogle Scholar
  29. 13.
    Tatekawa S, Traber KB, Hantier CB. Effects of isoflurane on myocardial blood flow, function and oxygen consumption in the presence of critical coronary stenosis in dogs. Anesth Analg 66: 1073–1082, 1987PubMedGoogle Scholar
  30. 14.
    Tarnow J, Markschies-Hornung A, Schulte-Sasse U. Isoflurane improves the tolerance to pacing-induced myocardial ischemia. Anesthesiology 64: 147–156, 1986PubMedGoogle Scholar
  31. 15.
    Stowe DF, Marijic J, Bosnjiak ZJ. Direct comparative effects of halothane, enflurane and isoflurane on oxygen supply and demand in isolated hearts. Anesthesiology 74: 1087–1095, 1991PubMedGoogle Scholar
  32. 16.
    Conzen PF, Vollmar B, Habazett I. Systemic and regional hemodynamic effects of isoflurane and sevoflurane in rats. Anesth Analg 74: 79–88, 1992PubMedGoogle Scholar
  33. 17.
    Kenny D, Proctor LT, Schmeling WT, Kampine JP, Warltier DC. Isoflurane causes only minimal increases in coronary blood flow independent of oxygen demand. Anesthesiology 75: 640–649, 1991PubMedGoogle Scholar
  34. 18.
    Boban M, Stowe DF, Buljubasic N. Direct comparative effects of isoflurane and desflurane in isolated guinea pig hearts. Anesthesiology 76: 775–789, 1992PubMedGoogle Scholar
  35. 19.
    Merin RG, Bernard JM, Doursout MF. Comparison of the effects of isoflurane and desflurane on cardiovascular dynamics and regional blood flow in the chronically instrumented dog. Anesthesiology 74: 568–574, 1991PubMedGoogle Scholar
  36. 20.
    Bernard JM, Wouters PF, Doursout MF. Effects of sevoflurane on cardiac and coronary dynamics in chronically instrumented dogs. Anesthesiology 72: 659–662, 1990PubMedGoogle Scholar
  37. 21.
    Braunwald E, Sobel BE. Coronary blood flow and myocardial ischemia. In: Braunwald E, ed. Heart disease. 4th ed. WB Saunders, Philadelphia, pp 1162–1198, 1992Google Scholar
  38. 22.
    Kolev N, Zimpfer M. Impact of myocardial ischemia on diastolic function. Clinical relevance and recent Doppler echocardiographic results. Eur J Anaesth (in press), 1994Google Scholar
  39. 23.
    Priebe HJ. Isoflurane causes more severe regional myocardial dysfunction than halothane in dogs with a critical coronary artery stenosis. Anesthesiology 69: 72–83, 1988PubMedGoogle Scholar
  40. 24.
    Cohen MV. Coronary steal in awake dogs: a real phenomenon. Cardiovasc Res 16: 339–349, 1982PubMedGoogle Scholar
  41. 25.
    Epstein SE, Cannon RO, Talbot TL. Hemodynamic principles in the control of coronary blood flow (Abstr). Am J Cardiol 56: 4E, 1985Google Scholar
  42. 26.
    Brown BG, Bolson EL, Dodge HT. Dynamic mechanism in human coronary stenosis. Circulation 70: 917–922, 1984PubMedGoogle Scholar
  43. 27.
    Picano E, Simonetti I, Massini M. Transient myocardial dysfunction during pharmacologic vasodilation as an index of reduced coronary reserve: A coronary hemodynamic and echocardiographic study. Am J Coll Cardiol 8: 84–89, 1986Google Scholar
  44. 28.
    Picano E, Lattanzi F, Masisni M, Distante A. Dipyridamole-echocardiography: An alternative form of stress testing for coronary artery disease. In: Kerber RE, ed. Echocardiography in coronary artery disease. Futura, Mount Kisko, p 144, 1988Google Scholar
  45. 29.
    Khambatta HJ, Sonntag H, Larsen R. Global and regional blood flow and metabolism during equipotent halothane and isoflurane anesthesia in patients with coronary artery disease. Anesth Analg 67: 936–942, 1988PubMedGoogle Scholar
  46. 30.
    Diana P, Tullock WC, Gorcsan J, Ferson PF, Arvan S. Myocardial ischemia: A comparison between isoflurane and enflurane in coronary artery bypass patients. Anesth Analg 77: 221–226, 1993PubMedGoogle Scholar
  47. 31.
    Inoue K, Reichelt W, El-Banayosy A, Minami K, Dallman G, Hartmann N, Windeler J. Does isoflurane lead to a higher incidence of myocardial infarction and perioperative death than enflurane in coronary artery surgery? A clinical study of 1178 patients. Anesth Analg 71: 469–474, 1990PubMedGoogle Scholar
  48. 32.
    Leung JM, Coehner P, O’Kelly BF. Isoflurane anesthesia and myocardial ischemia: Comparative risk versus sufentanil anesthesia in patients undergoing coronary artery bypass graft surgery. Anesthesiology 74: 938–947, 1991Google Scholar
  49. 33.
    Slogoff S, Keats AS, Dear WE. Steal-prone coronary anatomy and myocardial ischemia associated with four primary anesthetics in humans. Anesth Analg 72: 22–27, 1991PubMedGoogle Scholar
  50. 34.
    Davis RF, Sidi A. Effect of isoflurane on the extent of myocardial necrosis and on systemic hemodynamics, regional metabolism in dogs after coronary artery occlusion. Anesth Analg 69: 575–586, 1989PubMedGoogle Scholar
  51. 35.
    Warltier DC, Al-Wathiqui MH, Kampine JP. Recovery of contractile function of stunned myocardium in chronically instrumented dogs is enhanced by halothane or isoflurane. Anesthesiology 69: 552–565, 1988PubMedGoogle Scholar
  52. 36.
    Little WC, Constantinescu M, Applegate RJ, Kutcher MA, Barrows MT, Kahl FR, Santamore WP. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation 78: 1157–1166, 1988Google Scholar
  53. 1.
    Tennant R, Wiggers G. The effect of coronary occlusion on myocardial contraction. Am J Physiol 112: 351–361, 1935Google Scholar
  54. 2.
    Forrester JS, Wyatt HL. Functional significance of regional ischemic contraction abnormalities. Circulation 54: 64–71, 1976PubMedGoogle Scholar
  55. 3.
    Waters DD, da Luz P, Wyatt HL, Swan HLC, Forrester JS. Early changes in regional and global left ventricular function induced by graded reduction in regional coronary perfusion. Am J Cardiol 39: 537–543, 1977PubMedGoogle Scholar
  56. 4.
    Tomoike H, Franklin D, Ross J Jr. Detection of myocardial ischemia by regional dysfunction during and after rapid pacing in conscious dogs. Circulation 58: 48–56, 1978PubMedGoogle Scholar
  57. 5.
    Battler A, Froelicher VF, Gallagher KP. Dissociation between regional myocardial dysfunction and ECG changes during ischemia in the conscious dog. Circulation 62: 735–739, 1980PubMedGoogle Scholar
  58. 6.
    Hauser AM, Gangadharan V, Ramos RG. Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: echocardio- graphic observation during coronary angioplasty. J Am Coll Cardiol 5: 193–205, 1985PubMedGoogle Scholar
  59. 7.
    Wohlgelernter D, Cleman M, Highman H. Regional myocardial dysfunction during coronary angioplasty: evaluation by two-dimensional echocardiography and 12-lead electrocardiography. J Am Coll Cardiol 7: 1245–1249, 1986PubMedGoogle Scholar
  60. 8.
    Smith JS, Cahalan MK, Benefiel DJ, Byrd BF, Lurz FW, Shapiro WA, Roizen MF, Bouchard A, Schiller NB. Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography. Circulation 72: 1015–1021, 1985PubMedGoogle Scholar
  61. 9.
    Abel MD, Nishimura RA, Callahan MJ, Rehder K, Ilstrup DM, Taijik J. Evaluation of intraoperative transesophageal two-dimensional echocardiography. Anesthesiology 66: 64–68, 1987PubMedGoogle Scholar
  62. 10.
    Leung JM, O’Kelly B, Browner WS, Tubau J, Hollenberg M, Mangano DT, SPI Research Group. Prognostic importance of postbypass regional wall motion abnormalities in patients undergoing coronary artery bypass graft surgery. Anesthesiology 71: 16–25, 1989PubMedGoogle Scholar
  63. 11.
    Leung JM, O’Kelly BF, Mangano DT, SPI Research group. Relationship of regional wall motion abnormalities to hemodynamic indices of myocardial oxygen supply and demand in patients undergoing CABG surgery. Anesthesiology 73: 802–814, 1990PubMedGoogle Scholar
  64. 12.
    Voici P, Bilotta F, Aronson S, Scibilia G, Caretta Q, Mercanti C, Marino B, Thisted R, Roizen MF, Reale A. Echocardiographic analysis of dysfunctional and normal myocardial segments before and immediately after coronary artery bypass graft surgery. Anesth Analg 75: 213–218, 1992Google Scholar
  65. 13.
    Owal A, Echrenberger J, Brodin A. Myocardial ischaemia as judged from transesophagealechocardiography and ECG in the early phase after coronary artery bypass surgery. Acta Anaesth Scand 37: 92–96, 1993Google Scholar
  66. 14.
    Harris SN, Gordon MA, Urban MK, O’Konor TZ, Barash PG. The pressure rate quotient is not an indicator of myocardial ischemia in humans. An echocardiographic study. Anesthesiology 78: 242–250, 1993PubMedGoogle Scholar
  67. 15.
    Roizen MF, Beapue NP, Alpert RA. Monitoring with two-dimensional transesophageal echocardiography. J Vase Surg 1: 300–307, 1984Google Scholar
  68. 16.
    Rafferty T. Intraoperative monitoring of ischemia and systolic cardiac function. In: Missiri J, ed. Transesophageal echocardiography. Clinical and intraoperative applications. Churchill Livingstone, New York, p 184, 1993Google Scholar
  69. 17.
    London MJ, Tubau JF, Wong MG, Layug E, Mangano DT. The “natural history” of segmental wall motion abnormalities detected by intraoperative transesophageal echocardiography: A clinically blinded, prospective approach (Abstr). Anesthesiology 69: A79, 1988Google Scholar
  70. 18.
    Hollenberg M, Mangano DT, Browner WS, London MJ, Tubau JF, Tateo IM, SPI Research Group. Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery. JAMA 268: 205–209, 1992PubMedGoogle Scholar
  71. 19.
    Fleischer LA, Rosenbaum SH, Nelson AH, Barash PG. The predictive value of perioperative silent ischemia for postoperative ischemic cardiac events in vascular and nonvascular surgery. Am Heart J 122: 980–986, 1991Google Scholar
  72. 20.
    Raby KE, Barry J, Creager MA, Cook F, Weisberg MC, Goldman L. Detection and significance of intraoperative and postoperative myocardial ischemia in peripherial vascular surgery. JAMA 268: 222–227, 1992PubMedGoogle Scholar
  73. 21.
    Force TL, Parisis AF. Quantitative methods for analyzing regional systolic function with two-dimensional echocardiography. In: Kerber RE, ed. Echocardiography in coronary artery disease. Futura, Mount Kisko, p 193, 1988Google Scholar
  74. 22.
    Nishimura RA, Reeder GS, Miller FA. Prognostic value of predischarge 2-dimensional echocardiography after acute myocardial infarction. Am J Cardiol 53: 429–434, 1984PubMedGoogle Scholar
  75. 23.
    Bhatnagar SK, Moussa MAA, Al-Yusut G. The role of prehospital discharge two-dimensional echocardiography in determining the prognosis of survivors of the first myocardial infarction. Am Heart J 109: 472–476, 1985PubMedGoogle Scholar
  76. 24.
    Clements FM, de Bruijn NP. Perioperative evaluation of regional wall motion by transesophageal two-dimensional echocardiography. Anesth Analg 66: 249–261, 1987PubMedGoogle Scholar
  77. 25.
    Schiller N, Shah P, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittiger I, Silverman NH. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echocard 2: 358–367, 1989Google Scholar
  78. 26.
    Cahalan MK. Intraoperative monitoring for myocardial ischemia with two-dimensional echocardiography. Anesth Cin North Am 9: 581–590, 1991Google Scholar
  79. 27.
    Van Daele MERM, Roelandt JRTC. Intraoperative monitoring. In: Sutherland GR, Roelandt JRTC, Fraser A, Anderson RH, eds. Transesophageal echocardiography in clinical practice. Cower, London, New York, pp 12.1–12. 9, 1991Google Scholar
  80. 28.
    Stanley TE. Quantitative echocardiography. In: deBruijn NP, Clements FM, eds. Intraoperative use of echocardiography. Lippincott, Philadelphia, pp 77–91, 1991Google Scholar
  81. 29.
    Huemer G, Kolev N, Zimpfer M. Comparisons of Doppler transmitral diastolic parameters and systolic wall motion abnormalities during perioperative ischemia (Abstr). Anesthesiology 81: A107, 1994Google Scholar
  82. 30.
    Haendchen RV, Wyatt HI, Maurer J, Zwehl W, Baer M, Merbaum S, Corday E. Quantitation of regional cardiac function by two-dimensional echocardiography. I. Pattern of contraction in the normal left ventricle. Circulation 67: 1234–1245, 1983PubMedGoogle Scholar
  83. 31.
    Huemer G, Kolev N, Kurz A, Zimpfer M. Influence of positive end-expiratory pressure on right and left ventricular performance assessed by Doppler two-dimensional echo-cardiography. Chest 106: 67–73, 1994PubMedGoogle Scholar
  84. 32.
    Schnittger I, Fitzgerald PJ, Gordon EP, Alderman EL, Popp RL. Computerized quantitative analysis of left ventricular wall motion by two-dimensional echocardiography. Circulation 70: 242–254, 1984PubMedGoogle Scholar
  85. 33.
    Force T, Bloomfeld P, O’Boyle JE, Khuri SF, Josa M, Parisis AF. Quantitative two-dimensional echocardiographic analysis of regional wall motion in patients with perioperative myocardial infarction. Circulation 70: 233–241, 1984PubMedGoogle Scholar
  86. 34.
    Leung JM, Schiller NB, Mangano DT. Assessment of left ventricular function using two-dimensional echocardiography. In: deBrujin NP, Clements FM. Intraoperative use of echocardiography. Lippincott, Philadelphia, pp 59–74, 1991Google Scholar
  87. 35.
    Parisi AF, Moynihan PF, Folland ED, Feldman CL. Quantitative detection of regional left ventricular contraction abnormalities by two-dimensional echocardiography. II. Accuracy in coronary artery disease. Circulation 63: 761–767, 1981PubMedGoogle Scholar
  88. 36.
    Pandin NC, Kerber RE. Two-dimensional echocardiography in experimental coronary stenosis. I. Sensitivity and specificity in detecting transient myocardial dyskinesis: Comparison with sonomicrometers. Circulation 66: 597–601, 1982Google Scholar
  89. 37.
    Pearlman JD. Echocardiographic definition of the left ventricular centroid: I. Analysis of methods for centroid calculation from a single tomogram. J Am Coll Cardiol 19: 993–999, 1990Google Scholar
  90. 38.
    Moynihan PF, Parisis AF, Feldman CL. Quantitative detection of regional left ventricular contraction abnormalities by two-dimensional echocardiography. I. Analysis of methods. Circulation 63: 752–760, 1981PubMedGoogle Scholar
  91. 39.
    Ihra G, Bacher A, Kolev N, Huemer G, Illievich UM, Spiss CK. Effect of hypothermia (32° C body temperature) on left ventricular systolic wall motion during neurosurgery (Abstr). Anesthesiology 81: A250, 1994Google Scholar
  92. 40.
    Lieberman AN, Weiss JL, Jugdutt. Two-dimensional echocardiography and infarct size: relationship of regional wall motion and thickening to the extent of myocardial infarction in dogs. Circulation 63: 739–743, 1981PubMedGoogle Scholar
  93. 41.
    Lima JAC, Becker LC, Melin J A. Impaired thickening of nonischemic myocardium during acute regional ischemia in dogs. Circulation 71: 1048 — 1054, 1985PubMedGoogle Scholar
  94. 42.
    Fed el F, Penco M, Dagianti A. Quantification of left ventricular regional wall thickening in two-dimensional echocardiography. Analysis of a new semiautomated method. J Cardiovasc Ultras 4: 201–206, 1985Google Scholar
  95. 43.
    Konstandt SN, Abrahams HP, Nejat M, Reich DL. Are wall thickening measurements reproducible? Anesth Analg 78: 619–623, 1994Google Scholar
  96. 44.
    Sheechan FH, Feneley MP, DeBruijn NP. Quantitative analysis of regional wall thickening by transesophageal echocardiography. J Thorac Cardiovasc Surg 103: 347–354, 1992Google Scholar
  97. 45.
    Kavanaugh KM, Brenner HM, Gallagher KP, Buda AJ. Effects of afterloads on the functional border zone measured with two-dimensional echocardiography during acute coronary occlusion. Am Heart J 116: 942–953, 1988PubMedGoogle Scholar
  98. 46.
    Braunwald E, Sobel BE. Coronary blood flow and myocardial ischemia. In: Braunwald E, ed. Heart disease. 4th ed. WB Saunders, Philadelphia, pp 1176–1178, 1992Google Scholar
  99. 47.
    Kolev N, Zimpfer M. Impact of ischemia on diastolic function: Clinical relevance and recent Doppler echocardiographic insights. Eur J Anaesth (in press), 1994Google Scholar
  100. 48.
    Braunwald E. The stunned myocardium: Newer insights into mechanisms and clinical applications. J Thorac Cardiovasc Surg 100: 310–315, 1990PubMedGoogle Scholar
  101. 49.
    Kolev N, Ihra G, Leitner K, Spiss CK, Zimpfer M. Improved detection of perioperative myocardial ischemia with multiplane (Hewlett Packard) transesophageal scanning: Two-dimensional biplane and transmitral Doppler echocardiography. J Cardiovasc Diag Proc (NY) (in press), 1994Google Scholar
  102. 50.
    Rouine-Rapp K, Cahalan MK, Ionesku P, Muhiudeen I, Foster E. Detection of wall motion abnormalities: Biplane transesophageal echocardiography vs multiplane transverse cross sections (Abstr). Anesthesiology 77: A481, 1992Google Scholar
  103. 51.
    Shah PM, Kyo S, Matsumura M, Omoto R. Utility of biplane transesophageal echocardiography in left ventricular wall motion analysis. J Cardiothorac Vase Anesth 5: 316–319, 1991Google Scholar
  104. 52.
    Chung F, Seyone C, Rakowski H. Transesophageal echocardiography may fail to diagnose perioperative myocardial infarction. Can J Anaesth 38: 98–101, 1991PubMedGoogle Scholar
  105. 53.
    Koide Y, Long T, Nomura T, Oka Y. Efficacy of biplane TEE in detecting regional wall motion abnormalities in patients undergoing coronary artery bypass graft (Abstr). Anesthesiology 79: A71, 1993Google Scholar
  106. 54.
    Hegger JJ, Weyman AL, Wann LS, Dilon JC, Feigenbaum H. Cross sectional echocardiography in acute myocardial infarction: detection and localization of regional left ventricular asynergy. Circulation 60: 531–538, 1979Google Scholar
  107. 55.
    Sheehan FH, Steward AK, Dodge HT. Variability in the measurement of regional left ventricular wall motion from contrast angiogram. Circulation 68: 550–559, 1983PubMedGoogle Scholar
  108. 56.
    Erbel R, Schweizer P, Lamberz H. Echoventriculography—A simultaneous analysis of two-dimensional echocardiography and cineventriculography. Circulation 67: 205–209, 1983PubMedGoogle Scholar
  109. 57.
    Cahalan MC, Lurz FC, Schiller NB. Transesophageal two-dimensional echocardiographic evaluation of anaesthetic effects on left ventricular function. Br J Anaesth 60: 99S–106S, 1988PubMedGoogle Scholar
  110. 58.
    Saada M, Cahalan MK, Lee E, Schiller NB. Real-time evaluation of segmental wall motion abnormalities (Abstr). Anesth Analg 68: S242, 1989Google Scholar
  111. 1.
    Voci P, Billotta S, Aronson S, Scibilia G, Caaretta Q, Mercanti C, Marino B, Thisted R, Roizen MF, Reale A. Echocardiographic analysis of dysfunctional and normal myocardialsegments before and immediately after coronary artery bypass graft surgery. Anesth Analg 75: 213–218, 1992PubMedGoogle Scholar
  112. 2.
    Owall A, Ehrenberg J, Brodin LA. Myocardial ischemia as judged from transoesophageal echocardiography and ECG in the early phase after coronary artery bypass surgery. Acta Anaesth Scand 37: 92–96, 1993PubMedGoogle Scholar
  113. 3.
    Clements FM, de Bruijn NP. Perioperative evaluation of regional wall motion by transesophageal two-dimensional echocardiography. Anesth Analg 66: 249–261, 1987PubMedGoogle Scholar
  114. 4.
    Harris SN, Gordon MA, Urban MK, O’Konor TZ, Barash PG. The pressure rate quotient is not an indicator of myocardial ischemia in humans. An echocardiographic study. Anesthesiology 78: 242–250, 1993PubMedGoogle Scholar
  115. 5.
    Cahalan M. Intraoperative monitoring for myocardial ischemia with two-dimensional echocardiography. Anesth Clin North Am 9: 581–590, 1991Google Scholar
  116. 6.
    Leung JM, O’Kelly BF, Mangano DT, SPI Research Group. Relationship of regional wall motion abnormalities to hemodynamic indices of myocardial oxygen supply and demand in patients undergoing CABG surgery. Anesthesiology 73: 802–814, 1990PubMedGoogle Scholar
  117. 7.
    Bosch JG, Reiber JNC, van Burken G. Developments towards real time frame-to-frame automatic contour detection on echocardiograms. In: Computers in cardiology. Proc 16th Computers in Cardiology Meeting, Long Beach, CA, pp 435–438, 1990Google Scholar
  118. 8.
    Mulleneers RGA, Cheriex EC, Dassen WRM, Beleijlevens BB, Wellens Hjj, Meester GT. The cardiac echostorage and retrieval network system. In: Computers in cardiology. Proc 16th Computers in Cardiology Meeting, Long Beach, CA, pp 211–217, 1990Google Scholar
  119. 9.
    Kisslo J, Sheikh KH. Assessment of wall motion by two-dimensional echocardiography. Should it be qualitative? In: Iliceto S, Rizzon P, Roelandt JRTC, eds. Ultrasound in coronary artery disease. Kluwer, Dordrecht, pp 15–20, 1991Google Scholar
  120. 10.
    Bosch HG, Reiber JHC, van Burken G, Gerbrands JJ, Roelandt JRTC. Automated contour detection on short axis transesophageal echocardiography. In: Erbel R, ed. Transesophageal echocardiography. Springer, Berlin Heidelberg, pp 253–259, 1989Google Scholar
  121. 11.
    Force LT, Parisi AF. Quantitative methods for analyzing regional systolic function with two-dimensional echocardiography. In: Kerber RE, ed. Echocardiography in coronary artery disease. Futura, Mount Kisko, pp 193–220, 1988Google Scholar
  122. 1.
    Kolev N, Zimpfer M. Impact of myocardial ischemia on diastolic function. Clinical relevance and recent Doppler echocardiographic insights. Eur J Anaesth 11 (in press), 1994Google Scholar
  123. 2.
    Braunwald E, Sonnenblick EH, Ross J Jr. Mechanisms of cardiac contraction and relaxation. In: Braunwald E ed, Heart disease, 4th ed. WB Saunders, Philadelphia, pp 370–373, 1992Google Scholar
  124. 3.
    Roelandt JRTC,. Principles of Doppler assessment of diastolic left ventricular function. In: Roelandt JRTC, Sutherland GR, Iliceto S, Linker DT, eds. Cardiac ultrasound. Churchhill Livingstone, Edinburgh, London, pp 233–239, 1993Google Scholar
  125. 4.
    Apstein CS, Grossman W. Opposite initial effects of supply and demand ischemia on left ventricular diastolic compliance: the ischemia diastolic paradox. J Mol Cell Cardiol 19: 119–128, 1987PubMedGoogle Scholar
  126. 5.
    Iskandrian AS, Heo J, Segal BL, Askenase A. Left ventricular diastolic function: Evaluation by radionuclide angiography. Am Heart J 115: 924–929, 1988PubMedGoogle Scholar
  127. 6.
    Pearson AC, Nelson J, Kanter J. Effect of sample volume location on pulsed Dopplerevaluation of leftventricular filling. Am J Cardiac Imaging 2: 40–45, 1988Google Scholar
  128. 7.
    Quinones MA. Doppler assessment of left ventricular diastolic function. In: Nanda NC, ed. Doppler echocardiography, 2nd ed. Lea & Febiger, Philadelphia, pp 197–215, 1993Google Scholar
  129. 8.
    Kolev N. Assessment of left ventricular function in ischemic heart disease using pulsed Doppler transmitral flow during exercise. J Cardiovasc Diag Proc (NY) 11: 15–18, 1990Google Scholar
  130. 9.
    Huemer G, Kolev N, Kurz A, Zimpfer M. Influence of positive end-expiratory pressure on right and left ventricular performance assessed by Doppler two-dimensional echocardiography. Chest 106: 67–73, 1994PubMedGoogle Scholar
  131. 10.
    Galderisi M, Benjiamin EJ, Eraus JC. Intra- and interobserver reproducibility of Doppler assessed indexes of left ventricular diastolic function in a population-based study (the Framingham Heart Study). Am J Cardiol 70: 1341–1345, 1992PubMedGoogle Scholar
  132. 11.
    Iskandrian AS, Hakki AH, Heo J, Bemis CE, Kane S, Mandler J. Effect of intraaortic balloon pumping on left ventricular ejection fraction, systolic ejection rate and peak filling rate. J Appl Cardiol 1: 271–283, 1986Google Scholar
  133. 12.
    Kolev N, Romoda T. Clinical value of calibrated and differentiated displacement apexcardiography in ischemic heart disease. Cardiology (Basel) 69: 343–352, 1982Google Scholar
  134. 13.
    Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 12: 426–430, 1988PubMedGoogle Scholar
  135. 14.
    Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Effects of different loading conditions. Circulation 81: 1488–1497, 1990PubMedGoogle Scholar
  136. 15.
    Zoghbi WA, Habib GB, Quinones MA. Doppler assessment of right ventricular filling in a normal population: Comparison with left ventricular filling dynamics. Circulation 82: 1316–1320, 1990PubMedGoogle Scholar
  137. 16.
    Downes TR, Nomeir A, Stewart K. Effect of alteration in loading conditions on both normal and abnormal patterns of left ventricular filling in healthy individuals. Am J Cardiol 65: 377–381, 1990PubMedGoogle Scholar
  138. 17.
    Mulvagh S, Qinones MA, Kleiman NS, Cherif J, Zoghbi WA. Estimation of left ventricular end-diastolic pressure from Doppler transmitral flow velocity in cardiac patients independent of systolic performance. J Am Coll Cardiol 20: 112–119, 1992PubMedGoogle Scholar
  139. 18.
    Pandin N, Funai J, Wang SS, Lowell B. Effect of regional ischemia on diastolic left ventricular flow vortex - color Doppler and contrast echocardiographic studies. J Am Coll Cardiol 7: 147A–151A, 1986Google Scholar
  140. 19.
    Rinder ML, Courtis MR, Perez JE, Brasiliai B, Ludbrook PA. Alterations in Doppler indexes of diastolic function following coronary artery reperfusion. Circulation 7411: 47–53, 1986Google Scholar
  141. 20.
    Fischer DC, Voyles W, Sikes W, Greene ER. Left ventricular filling patterns during ischemia: An echo/Doppler study in open chest dogs. J Am Coll Cardiol 5: 426A–431A, 1985Google Scholar
  142. 21.
    Fujii J, Yazaki H, Sawada H, Aizawa T, Watanabe H, Kato K. Noninvasive assessment of left ventricular diastolic filling in ischemic heart disease. J Am Coll Cardiol 5: 1155–1160, 1985PubMedGoogle Scholar
  143. 22.
    Vissner CA, Koning H, Delmarre B, Koolen JJ, Dunning AJ. Pulsed Doppler derived mitral inflow velocity in acute myocardial infarction: An early prognostic indication. J Am Coll Cardiol 7: 136A–141A, 1986Google Scholar
  144. 23.
    Labovitz AJ, Lewen MK, Kern M, Vandormael M, Deligional U, Kennedy HL, Habermechl K, Morsek D. Evaluation of left ventricular systolic and diastolic function during transient myocardial ischemia produced by angioplasty. J Am Coll Cardiol 10: 478–755, 1987Google Scholar
  145. 24.
    De Bruyne B, Lerch R, Meyer B, Schlaepfer H, Gabathauer J, Rutischause W. Doppler assessment of left ventricular filling during brief coronary occlusion. Am Heart J 117: 629–634, 1989PubMedGoogle Scholar
  146. 25.
    Wind BE, Sinder AJ, O’Neill WW, Topol EJ, Dilworth RL. Pulsed Doppler assessment of left ventricular filling in coronary artery disease before and immediately after coronary angioplasty. Am J Cardiol 59: 1041–1046, 1987PubMedGoogle Scholar
  147. 26.
    Moscarelli E, Distante A, Rovai D, Lombardi M, Morals A. Changes in mitral flow induced by transient myocardial ischemia in man. Circulation 7411: 230–237, 1986Google Scholar
  148. 27.
    Iliseto S, Amico A, Marangelli V. Doppler echocardiographic evaluation of pacing-induced ischemia on left ventricular filling in patients with coronary artery disease. J Am Coll Cardiol 11: 953–961, 1989Google Scholar
  149. 28.
    Iskandrian AS, Jaekyeong H, Segal BL, Askenase A. Left ventricular diastolic function: Evaluation by radionuclide angiography. Am Heart J 115: 924–928, 1986Google Scholar
  150. 29.
    Appleton CP, Gonzales MS, Basnight MA. Relationship of left atrial pressure and pulmonary venous flow velocities: Importance of baseline mitral and pulmonary venous flow velocities patterns studied in lightly sedated dogs. J Am Soc Echocardiogr 7: 264–275, 1994PubMedGoogle Scholar
  151. 30.
    Appleton CP, Hatle LK. The natural history of left ventricular filling abnormalities: assessment by two-dimensional and Doppler echocardiography. Echocardiography 9: 437–457, 1992Google Scholar
  152. 31.
    Nishimura RA, Abel MA, Tajik AJ. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part II. Clinical studies. Mayo Clin Proc 64: 181–204, 1989PubMedGoogle Scholar
  153. 32.
    Huemer G, Kolev N, Spiss CK, Zimpfer M. Comparison of Doppler transmitral diastolic parameters and systolic wall motion abnormalities during perioperative myocardial ischemia (Abstr). Anesthesiology 81: A105, 1994Google Scholar
  154. 33.
    Elkayam U, Amin J, Mechra A, Vaques J, Weber L, Rachimtoola SH. A prospective, randomized double-blind, crossover study to compare the efficacy and safety of nifidipine therapy with that of isosorbide dinitrate and their combination in the treatment of ischemic heart disease and congestive heart failure. Circulation 82: 1954–1961, 1990PubMedGoogle Scholar
  155. 34.
    Krams R, McFalls E, Van der Giessen WJ, Serruyis PW, Verdoun PD, Roelandt J. Does intravenous milrinone have a direct effect on diastolic function? Am Heart J 121: 1951–1955, 1991Google Scholar
  156. 35.
    Klocke RK, Mager G, Kux A, Hopp HW, Hilger HH. Effects of a twenty-four-hour milrinone infusion in patients with severe heart failure and cardiogenic shock as a function of the hemodynamic initial condition. Am Heart J 121: 1965–1973, 1991PubMedGoogle Scholar
  157. 1.
    Shapiro JR, Xie F, Meltzer RS. Myocardial contrast two-dimensional echocardiography: Dose-myocardial effect relations of intracoronary microbubbles. J Am Coll Cardiol 12: 765–771, 1988PubMedGoogle Scholar
  158. 2.
    Keller MK, Segal SS, Kaul S, Duling B. The behavior of sonicated albumin micro-bubbles within the microcirculation: a basis for their use during myocardial contrast echocardiography. Circ Res 65: 458–463, 1989PubMedGoogle Scholar
  159. 3.
    Meltzer RS, Amico AF, Reisner SA, Shapiro JR. Contrast agents for myocardial perfusion studies: Mechanisms, state of the art and future prospects. In: Iliceto S, Rizzon P, Roelandt JRTC, eds. Ultrasound in coronary artery disease. Kluwer, Dordrecht, pp 351–363, 1991Google Scholar
  160. 4.
    Halmann M, Beyar R, Rinkevich D, Shapiro JR, Sidemann S, Markiewicz W, Meltzer RS, Reisner SA. Digital subtraction myocardial contrast echocardiography: Design and application of a new analysis program for myocardial contrast perfusion imaging. J Am Soc Echocardiogr 7: 355–362, 1994PubMedGoogle Scholar
  161. 5.
    Rovai D, L’Abbate A. Application of indicator dilution principles to perfusion imaging. In: Roelandt JRTC, Sutherland GR, Iliceto S, Linker DT, eds. Cardiac ultrasound. Churchill Livingstone, Edinburgh, pp 513–551, 1973Google Scholar
  162. 6.
    Feinstein SB. Myocardial perfusion: Contrast echocardiography perspectives. Am J Cardiol 69: 36H–41H, 1992PubMedGoogle Scholar
  163. 7.
    Wiencek JG, Feinstein SB, Walker R, Aronson S. Pitfalls in quantitative contrast echocardiography: the steps to quantitation of perfusion. J Am Soc Echocardiogr 6: 395–416, 1993PubMedGoogle Scholar
  164. 8.
    Heidenreich PA, Wiencek JG, Zaroff JG. In vitro calculation of flow using contrast ultrasonography. J Am Soc Echocardiogr 6: 51–61, 1993PubMedGoogle Scholar
  165. 9.
    Rovai D, Ghelardini G, Trivella MG. Difference between myocardial transit time of sonicated albumin microspheres and radionuclide labelled albumin (Abstr). Eur Heart J 12 [Suppl]: 221, 1992Google Scholar
  166. 10.
    Walker R, Wiencek JG, Aronson S. The influence of intravenous Albunex injection on pulmonary hemodynamics, gas exchange, and left ventricular peak intensity. J Am Soc Echocardiogr 5: 462–470, 1992Google Scholar
  167. 11.
    Rasmussen CM, Mizoguchi AH, Markovitz PA, Bruns DE, Armstrong WF, Dittrich HC. Albunex during dobutamine stress echocardiography: improved transpulmonary passage and lowered dose requirements (Abstr). J Am Soc Echocardiogr 7: 1A, 1994Google Scholar
  168. 12.
    Mor-Avi V, Cholley B, Robinson K, Ng A, Sandelsky J, Marcus R, Lang RM, ShroffS. Albunex microspheres and left ventricular contractility: load and heart rate independent analysis using an isolated rabbit heart (Abstr). J Am Soc Echocardiogr 7: 31B, 1994Google Scholar
  169. 13.
    Kaul S. Clinical application of myocardial contrast echocardiography. Am J Cardiol 69: 36H - 41H, 1992Google Scholar
  170. 14.
    I to H, Tomooka T, Sakai N, Yu H, Higashino Y, Fujii K, Masuyama T, Kitabatake A, Minamino T. Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 85: 1699–1705, 1992PubMedGoogle Scholar
  171. 15.
    Lim YJ, Nanto S, Masuyama T, Kodama K, Ikeda T, Kitabatake A, Kamada T. Visualization of subendocardial myocardial ischemia with contrast echocardiography in humans. Circulation 79: 233–244, 1989PubMedGoogle Scholar
  172. 16.
    Melzer RS, Ohad D, Reisner S, Sucher E, Kaplinsky E, Motro M, Battler A, Vered Z. Quantitative myocardial ultrasonic integrated backscatter measurements during contrast injections. J Am Soc Echocardiogr 7: 1–8, 1994Google Scholar
  173. 17.
    Sakamaki T, Tei C, Meerbaum S, Shimoura K, Kondo S, Fishbein MC, Y-Rit J, Shah PM, Corday E. Verification of myocardial contrast two-dimensional echocardiographic assessment of perfusion defects in ischemic myocardium. J Am Coll Cardiol 3: 34 - 38, 1984PubMedGoogle Scholar
  174. 18.
    Kemper A, O’Boyle JE, Sharma S, Cohen CA, Cloner RA, Kituri S, Parisis AF. Hydrogen peroxide contrast-enhanced two-dimensional echocardiography: real time in-vivo determination of regional myocardial perfusion. Circulation 68: 603–6011, 1983PubMedGoogle Scholar
  175. 19.
    Kaul S, Pandian NC, Weymann AE. Contrast echocardiography in acute myocardial ischemia: I. In-vivo determination of total left ventricular “area at risk. ” J Am Coll Cardiol 6: 825–830, 1985PubMedGoogle Scholar
  176. 20.
    Marcus ML. Effects of corornary occlusion on myocardial perfusion. In: The coronary circulation in health and disease. McGraw-Hill, New York, p 221, 1993Google Scholar
  177. 21.
    Jugdutt BI, Hutchins GM, Bulkley BH, Becker LC. Myocardial infarction in the conscious dogs: three dimensional mapping of infarct, collateral flow, and region at risk. Circulation 60: 1141–1147, 1979PubMedGoogle Scholar
  178. 22.
    Kaul S, Pandian NG, Weyman AE. The effects of selectively altering the collateral driving pressure on regional perfusion and function in the occluded coronary bed in the dogs. Circ Res 61: 77–83, 1987PubMedGoogle Scholar
  179. 23.
    Cohen MV. Morphological consideration of the coronary collateral circulation in man. In: Coronary collaterals. Clinical and experimental observations. Futura, New York, pp 1–11, 1985Google Scholar
  180. 24.
    Smucker ML, Beller GA, Watson DD, Kaul S. Left ventricular dysfunction in excess of the size of infarction: a possible management strategy. Am Heart J 115: 749–754, 1988PubMedGoogle Scholar
  181. 25.
    Wyatt WH. Contrasting effects of alterations in ventricular preload and afterload upon systemic hemodynamics, function, and metabolism of ischemic myocardium. Circulation 55: 318–324, 1975Google Scholar
  182. 26.
    Kaul S, Glasheen W, Ruddy TD, Pandian NG, Weyman AE, Okada RD. The importance of defining left ventricular area at risk in vivo during acute myocardial infarction: an experimental evaluation with myocardial contrast two-dimensional echocardiography. Circulation 75: 1249–1260, 1987PubMedGoogle Scholar
  183. 27.
    Grondin CM, Helias J, Vouhe PR, Robert P. Influence of a critical coronary artery bypass stenosis on myocardial protection though cold potassium cardioplegia. J Thorac Cardiovasc Surg 82: 608–613, 1981PubMedGoogle Scholar
  184. 28.
    Massie BM, Mangano DT. Assessment of perioperative risk: have we put the card before the horse? J Amer Coll Cardiol 21: 1353–1356, 1993Google Scholar
  185. 29.
    Braunwald E, Sobel BE. Coronary flow and myocardial ischemia. In: Braunwald E, ed. Heart disease, 4th ed. WB Saunders, Philadelphia, pp 1161–1197, 1992Google Scholar
  186. 30.
    Khuri SF. Intraopertaive assessment of the physiological significance of coronary stenosis in humans. J Thorac Cardiovasc Surg 92: 71–78, 1986Google Scholar
  187. 31.
    Hiratzka LF. Inrtraoperative evaluation of coronary artery bypass graft anastomoses with high frequency epicardial echocardiography: experimental evaluation and initial patient studies. Circulation 73: 1199–1204, 1986PubMedGoogle Scholar
  188. 32.
    Greene ER, Reilly PR, Myrands IP, Doppler ecocardiographic assessment of the left internal mamary grafts in humans (Abstr). Circulation 74 [Suppl 2] II: 308, 1986Google Scholar
  189. 33.
    Aronson S, Lee BK, Wiencek JG, Feinstein SB, Roizen MF, Karp RB, Ellis JE. Assessment of myocardial perfusion during CABG surgery with two-dimensional transesophageal contrast echocardiography. Anesthesiology 75: 433–440, 1991PubMedGoogle Scholar
  190. 34.
    Villanueva PS. Assessment of myocardial distribution of coronary sinus retrograde cardioplegia using myocardial contrast echocardiography. Circulation 82 [Suppl 3] II: 26, 1990Google Scholar
  191. 35.
    Villanueva. Successful and reproducible myocardial opacification during two-dimensional echocardigraphy from right heart injection of contrast. Circulation 85: 1557–1562, 1992PubMedGoogle Scholar
  192. 36.
    Amico AF, Iliceto S, Saponetti LS, Memmola C, Rizzon P. Myocardial contrast echocardiography for the evaluation of coronary flow reserve. In: Illiceto S, Rizzon P, Roelandt JRTC, eds, Ultrasound in Coronary Artery Disease. Kluver, Dordrecht, pp 389–393, 1991Google Scholar
  193. 36a.
    Meza MF, Greener Y, Perry B, Hunt R, Bales G, Revall S, Murgo JP, Cheirif J. Myocardial contrast echocardiography: successful transpulmonary myocardial opacification in a canine model of occlusion-perfusion (Abstr). J Am Soc Echocardiogr 7 [Suppl 2]: S2, 1994Google Scholar
  194. 37.
    Dittrich HC. Bales GL; Hunt RM, McFerran BA, Kuvelas T, Widder KJ, Greenr Y. Myocardial perfusion by intravenously administrated novel ultrasound contrast agents in canine (Abstr). J Am Soc Echocardiog 7 [Suppl 2]: S36, 1994Google Scholar
  195. 38.
    Kaul S, Kelly P, Oliver JD, Glasherrn WP, Keller MW, Watson DD. Assessment of regional myocardial blood flow with myocardial contrast two-dimensional echocardiography. J Am Coll Cardiol 8: 143–149, 1986Google Scholar
  196. 39.
    Takeuchi M, Araki M, Nakashima Y, Kurowa A. Comparison of dobutamine stress echocardiography and stress thallium-201 single-photon emission computed tomography for detecting coronary artery disease. J Am Soc Echocardiogr 6: 593–602, 1994Google Scholar
  197. 40.
    Cheirif J, Zoghbi WA, Raizner AE, Minor ST, Winters WL, Klein MS, DeBauche TL. Lewis JM, Roberts R, Quinones MA. Assessment of myocardial perfusion in humans by contrast echocardiography. I. Evaluation of regional coronary reserve by peak contrast intensity. J Am Coll Cardiol 11: 735–743, 1988PubMedGoogle Scholar
  198. 41.
    Keller MW, Glasheen W, Smucker ML, Burwell LR, Watson DD, Kaul S. Myocardial contrast echocardiography in humans. II. Assessment of coronary blood flow reserve. J Am Coll Cardiol 12: 925–934, 1988PubMedGoogle Scholar
  199. 42.
    Reisner SA, Shapiro JR, Amico AF, Meltzer RS. Myocardial contrast echo washout curves: the influence of ischemia and hyperemia (Abstr). J Am Coll Cardiol 13: 115, 1989Google Scholar

Copyright information

© Springer-Verlag/Wien 1995

Authors and Affiliations

  • Nikolai Kolev
    • 1
  • Günter Huemer
    • 1
  • Michael Zimpfer
    • 2
  1. 1.Department of Anesthesiology and General Intensive CareUniversity of ViennaAustria
  2. 2.University of ViennaAustria

Personalised recommendations