Anesth Analg 2005;100:294-296
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000141276.91658.25
LETTERS TO THE EDITOR
ECG Monitoring Is Essential for Echocardiographic Analysis
Karim Bendjelid, MD
Chef de Clinique Scientifique, Division of Surgical Intensive Care, Geneva University Hospitals, Geneva, Switzerland, karim.bendjelid@hcuge.ch
To the Editor:
We have read with great interest the case report published by Glas et al. (1), concerning an unusual cause of left ventricular outflow tract obstruction after mitral valve repair diagnosed using transesophageal echocardiography (TEE). Indeed, a such technique would be a precious tool in order to evaluate, in real time, the dynamic working heart in the postsurgical scene.
I was surprised not to see a recorded electrocardiogram (ECG) in the illustrations of the TEE, assuming that Figure 4 in their article was documented during end systole. This observation concerns many published manuscripts involving echocardiographic data. Indeed, even when the patient has an open chest, ECG may be documented. Moreover, it has been demonstrated that left ventricular outflow tract obstruction diagnosis requires an adequate timing information in order to establish the sequence of cardiac events (2).
We therefore suggest to all the authors and expert reviewers publishing in this field to require ECG recording during echocardiography practice (2). It is important to remember that, the beating heart being a nonstatic structure, it is essential to locate images not only within space but also within time of their acquisition during the cardiac cycle.
References
- Glas KE, Shanewise JS, Guyton RA. An unusual cause of left ventricular outflow tract obstruction after mitral valve repair. Anesth Analg 2004; 99: 38–40.[Abstract/Free Full Text]
- Weyman AE. Principles and practice of echocardiography. 2nd ed. New York: Lippincott Williams & Wilkins, 1994.
Response
Kathryn E. Glas, MD, and
Jack S. Shanewise, MD
Department of Anesthesiology, Director, Perioperative Echocardiography Services, Emory University School of Medicine, Atlanta, GA, kathryn_glas@emoryhealthcare.org
Director, Cardiothoracic Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY
In Response:
We thank Dr. Bendjelid for his kind comments. We agree that ECG should be recorded routinely for all echocardiography exams. It is our practice to do this for all intraoperative TEEs, and the ECG was recorded with the echocardiographic images in the case we presented. We cropped the 2D images to maximize their size in the publication, not feeling that the ECG was critical to their points. The ECG is visible in the spectral Doppler display in Figure 3 of our article, but difficult to see in the publication due to its size. In Figure 4, the aortic valve is open and the mitral valve is closed, indicating systole. Our case did not involve a dynamic outflow tract obstruction due to systolic anterior motion of the mitral valve, so we did not believe documenting an image at end systole was necessary.
It is easy to set up a system to send ECG data from the anesthesia machine to the echo machine, and we encourage all practitioners to do so. Timing of the cardiac cycle from the ECG can be critical in making the proper interpretation of an echocardiogram, especially with spectral Doppler displays.
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C. Kim, A. Sakamoto, and R. Ogawa
Effect of Landiolol on Nonsustained Ventricular Tachycardia During Electroconvulsive Therapy
Anesth. Analg.,
October 1, 2005;
101(4):
1247 - 1247.
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