Ischemic Heart Disease Clinical Trial
Official title:
Sevoflurane Effect on Left Atrial Performance: A Transoesophageal Echocardiographic Study on Patients Undergoing Coronary Artery Bypasses Grafting
The left atrial performance is affected by the preload as well as the afterload. The LA active pumping is increased by stretching of the LA but within limits, after which the active pumping declines. The LV stiffness acts as the LA afterload. Whenever the LV stiffness increases, the overall emptying fraction becomes more pumpdependent
The echocardiographic assessment of the LA was frequently overlooked. While left atrial
performance reflects both systolic and diastolic functions of the LV, it looks like more
studies are being conducted to detect the effect of different interventions on the left
atrial size and function. Other studies focus on the prognostic value and the ability to risk
stratify different cohorts of patients, based on the early recognition of deranged LA
performance.
Many studies were conducted on the effect of inhalational anesthetics on the left atrial
function. Yet the results are inconclusive and sometimes contradictory. In a study on dogs,
Gare Meir and his colleagues proved that desflurane, sevoflurane, and isoflurane depress left
atrial contractility, delay relaxation, reduce chamber stiffness, preserve reservoir and
conduit function, and impair left atrial-left ventricular coupling in vivo. Volatile
anesthetics may cause impairment of both left atrial (LA) and left ventricular (LV)
contractility. The mechanisms suggested were a decrease in the influx of calcium via voltage
gated calcium channels as well as a decrease in calcium availability from sarcoplasmic
reticulum.Echocardiographic assessment of the LA volumetric measures is comparable to that of
Cardiovascular Magnetic Resonance (CMR) with clinically irrelevant difference. This makes
echocardiographic assessment of LA volumes reliable, cheaperand easier to obtain.
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