Ischemic Heart Disease, Valvular Heart Disease
Conditions
Keywords
Isoflurane, mitral valve annular velocity, tissue Doppler imaging, Monitoring, echocardiography
Brief summary
The purpose of this study is to determine Isoflurane's dose-dependent effect on left ventricular (LV) systolic function in cardiac surgery. The change of tissue Doppler imaging (TDI) of lateral mitral valve annular systolic velocity at three different isoflurane concentrations would be analyzed by using intraoperative transesophageal echocardiography (TEE) in cardiac surgery patients.
Detailed description
Isoflurane is widely used in cardiac surgery patients due to its beneficial effects, but many studies have shown that isoflurane reduces myocardial contractility in a dose-dependent manner, and compromises left ventricular (LV) function. Tissue Doppler imaging (TDI) of mitral annular velocity during the cardiac cycle has been introduced as a reliable method for analysis of systolic and diastolic LV long-axis function. Efficacy of systolic and diastolic TDI profiles, including systole (S'), early early relaxation (E')and atrial contraction (A') have been suggested to be useful in predicting the impact of isoflurane on LV systolic and diastolic function. The investigators hypothesized that isoflurane, even at a clinical dosage, would affects intraoperative LV systolic function in a dose-dependent manner and thus produce significant changes int the TDI profiles of systolic mitral annular velocity (S'). So the investigators planned to study the changes in S' of lateral mitral annulus at the clinical isoflurane dosage during remifentanil based anesthesia for cardiac surgery.
Interventions
DRUGIsoflurane 1.0 MAC
10 min-inhalation of each concentration of isoflurane, 1.0 MAC
DRUGIsoflurane 1.5 MAC
10 min-inhalation of each concentration of isoflurane, 1.5 MAC
DRUGIsoflurane 2.0 MAC
10 min-inhalation of each concentration of isoflurane, 2.0 MAC
Sponsors
Konkuk University Medical Center
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* patients undergoing cardiac surgery
Exclusion criteria
* low ejection fraction \< 50% in preoperative transthoracic echocardiography * atrial fibrillation * pacemaker * pericardial and infiltrative myocardial disease * mitral annular calcification, surgical rings, prosthetic mitral valves * lateral left ventricular regional wall motion abnormality * esophageal spasm, stricture, laceration, perforation, and diverticulum diaphragmatic hernia * history of extensive radiation to mediastinum * upper gastrointestinal bleeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Peak mitral annular velocity during systole(S') | after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC | By using pulsed Doppler with the sample volume positioned at the lateral mitral valve (MV)ring in the midesophageal 4-chamber view, S' would be determined just after the 10 min-exposure to each concentration of isoflurane, 1.0 MAC, 1.5 MAC and 2.0 MAC (T1, T2 and T3, respectively) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Peak mitral annular velocity during atrial contraction(A') | after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC | By using pulsed Doppler with the sample volume positioned at the lateral MV ring |
| ejection fraction(EF) | after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC | By using modified Simpson technique in the midesophageal 4-chamber view, EF would be determined just after the 10 min-exposure to each concentration of isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC |
| Peak mitral annular velocity during early diastole(E') | after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC | By using pulsed Doppler with the sample volume positioned at the lateral MV ring |
| peak velocity of mitral inflow during early relaxation(E) | after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC | By using pulsed Doppler with the sample volume positioned at the IMV opening in the midesophageal 4-chamber view, E' would be determined just after the 10 min-exposure to each concentration of isoflurane, 1.0 MAC, 1.5 MAC and 2.0 MAC(T1, T2 and T3, respectively) |
| peak velocity of mitral inflow during atrial contraction(A) | after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC | By using pulsed Doppler with the sample volume positioned at the tip of MV opening in the midesophageal 4-chamber view, A would be determined just after the 10 min-exposure to each concentration of isoflurane, 1.0 MAC, 1.5 MAC and 2.0 MAC(T1, T2 and T3, respectively) |
| bispectral index(BIS) | after 10 min exposure to isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC | BIS would be determined just after the 10 min-exposure to each concentration of isoflurane 1.0 MAC, 1.5 MAC and 2.0 MAC |
Countries
South Korea
Outcome results
None listed