INTRAOPERATIVE MYOCARDIAL-ISCHEMIA DETECTED BY BIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURING TRANSURETHRAL PROSTATECTOMY

Recent studies have shown an increased late mortality rate due to card iovascular causes after transurethral compared with open prostatectomy . This has been linked to the demonstration of haemodynamic changes du ring transurethral prostatectomy, which may cause ischaemic myocardial injury. We used transoesophageal echocardiography (currently the most sensitive modality for detecting myocardial ischaemia) to study 26 pa tients during prostatectomy under general anaesthesia. Evidence of myo cardial ischaemia (as shown by the development of new regional wall mo tion abnormalities of the left ventricle) occurred in 4 of 22 patients during transurethral and in 3 of 4 patients during retropubic prostat ectomy. An intra-operative fall in systolic as well as diastolic blood pressure occurred in 21 of 22 patients during the transurethral proce dure and in all 4 patients during retropubic prostatectomy. The durati on of anaesthesia and the operation, and the intra-operative blood los s did not differ significantly between patients with and without evide nce of intra-operative myocardial ischaemia. However, the maximum intr a-operative fall in systolic and diastolic blood pressure, as well as the mass of the prostatic tissue removed, were significantly greater i n patients with than in those without evidence of intra-operative myoc ardial ischaemia, suggesting that the latter may be related to the ext ent of surgery and the degree of intra-operative hypotension. In this study, 7 of 26 patients (27%) showed evidence of myocardial ischaemia during prostatectomy. However, it remains difficult to explain why int ra-operative myocardial ischaemia should result in an increased cardio vascular mortality rate several years after the operation.