27 April 2019 : Case report
A Case of Myocardial Ischemia Detected by Global Longitudinal Strain Using Intraoperative Speckle-Tracking Echocardiography in a High-Risk Patient Undergoing Abdominal Aortic Aneurysm Repair
Challenging differential diagnosis, Management of emergency careSeth Eisenberg1ABCDEF, Theodore J. Cios1CDEF, S. Michael Roberts1ABCDEF*
Am J Case Rep 2019; 20:607-611
BACKGROUND: Global longitudinal strain (GLS) detected by echocardiography has been shown to have a prognostic role in the evaluation of myocardial ischemia in several clinical settings. A case is presented where GLS was used to detect intraoperative myocardial ischemia in a high-risk patient undergoing open abdominal aortic aneurysm repair.
CASE REPORT: A 75-year-old Caucasian man with non-insulin dependent diabetes mellitus and a 60 pack-year smoking history presented with a one-week history of exertional chest pain. Two-dimensional (2D) speckle-tracking echocardiography was used to calculate myocardial velocities and deformation parameters, including GLS. A reduced baseline GLS of –18.2% was found with dysfunction of the basal anterior, inferior, and mid anterolateral wall of the left ventricle. During aortic cross-clamping, his basal segments became mildly hypokinetic, although his ejection fraction (EF) remained unchanged at 50–55%. Despite normal left ventricular systolic function on visual assessment, his GLS decreased to –14.2% during aortic cross-clamping with similar segmental changes noted in the baseline GLS analysis. After the release of the aortic cross-clamp, his basal segments returned to normal and his left ventricular systolic function improved with an EF of 60–65% and the GLS recovered to -18.4% with improvement in the basal segmental function.
CONCLUSIONS: This case report showed that detection of GLS by echocardiography was a sensitive indicator of myocardial dysfunction that was superior to regional ventricular wall assessment. Detection of early changes in myocardial function by evaluating GLS may assist in guiding anesthetic management in high-risk patients with ischemic heart disease.
Keywords: aortic aneurysm, Echocardiography, Myocardial Ischemia, Aged, cardiac catheterization, Heart Ventricles, Vascular Surgical Procedures, Ventricular Function, Left
27 Jan 2023 : Case reportA 37-Year-Old Man with Familial Hereditary Hemorrhagic Telangiectasia and Pulmonary Arteriovenous Malformat...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938548
26 Jan 2023 : Case reportA 39-Year-Old Woman with Endometriosis Who Developed a Subcapsular Liver Hematoma Following Laparotomic Sur...
Am J Case Rep In Press; DOI: 10.12659/AJCR.938169
26 Jan 2023 : Case reportOptic Neuritis as a Consequence of Long-Term Medical Treatment Using Anastrozole: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939026
Most Viewed Current Articles
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406
23 Feb 2022 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250