Left ventricular (LV) wall motion abnormalities (WMA) are associated with myocardial ischemia and can be generalized or regional. In this transgastric mid-papillary short axis view of the LV, one sees a clear difference in how the inferior and lateral walls are contracting compared to the septal and anterior walls. Decreased inward motion of the endocardium in conjunction with decreased thickening of the myocardium during systole are very suggestive of ischemia.
Using intraoperative transesophageal echocardiography (TEE), EKG, and information from a cardiac catheterization (ie, understanding the patient’s unique coronary anatomy and flow), I have a pretty good idea which vessel(s) might be involved. For example, ST elevations in leads II, III, and aVF coupled with wall motion abnormalities in the inferior wall suggest right coronary artery pathology in most individuals. More lateral ischemia could suggest problems with a fresh graft to the left circumflex artery. This real-time information in the operating room provides invaluable information to detect ischemia EARLY before postoperative infarction ensues.
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