147 Hemodynamic and Transesophageal Echocardiographic Analysis of Global and Regional Myocardial Functions, Before and Immediately After Coronary Artery Bypass Surgery Mustafa Mavi, M.D., ∗ M. Adnan Celkan, M.D.,† B¨ ulent Il ¸ col, M.D.,‡ Tamer Turk, M.D., ∗ Senol Yavuz, M.D., ∗ and Ayhan Ozdemir, M.D. ∗ ∗ Department of Cardiovascular Surgery, Y ¨ uksek Ihtisas Hospital, Bursa, Turkey; †Department of Cardiovascular Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey; ‡Department of Cardiology, Y ¨ uksek Ihtisas Hospital, Bursa, Turkey ABSTRACT Aim: We investigated the effect of coronary artery bypass grafting (CABG) surgery on global and regional myocardial function; before and immediately after coronary artery bypass grafting and 1 month after the operation. Methods: Twenty-five patients who were undergoing elective CABG were evaluated. Transesophageal echocardiography (TEE) was used to evaluate both global and regional myocardial func- tion. Intraoperative TEE images of the left ventricle were obtained after cannulation but before cardiopul- monary bypass (CPB), 5 and 30 minutes after the termination of CPB. Same time, hemodynamic parameters were recorded. Transesophageal echocardiography evaluation was repeated one month after the operation. Results: Global left ventricular function was significantly depressed 5 minutes after CPB. At the 30 minutes after CPB, left ventricular function has returned to pre-CPB baseline levels. Global left ventricular function was significantly increased at 30 days following CABG surgery. The myocardial segments that were normal before CABG had reduced contractile functions at 5 minutes after CABG but normal segments showed a significant improvement from 5 to 30 minutes. The function of this region could not reach its initial status. The segments that had severe impairments of contractile function before the revascularization showed significant improvements at 30 minutes following CABG. Conclusions: In conclusion, a successful coronary revascularization provides an improvement in contractility in cases with chronic regional left ventricular dysfunction that is not related to irreversible necrosis. (J Card Surg 2005;20:147-152) Coroner artery bypass grafting (CABG) surgery im- proves global left ventricular (LV) function immediately. It is well recognized that an early consequence of a de- crease in coronary blood flow to the myocardium is the depression of regional function. 1 After CABG restora- tion of adequate blood supply, recovery of myocardial function might be expected. 2 On the other hand, global ischemia and superimposed reperfusion injury might have a deleterious effect on the heart. 2 Some previous studies have shown improvements on postoperative myocardial regional function, 3 whereas others have not found any improvement in segmental wall motion after revascularization. 4 Intraoperative TEE is a valuable monitoring and di- agnostic technology used in cardiac surgery that is ca- pable of direct assessment of the global and regional functions of the LV. 5 Smith et al. also demonstrated that using regional wall motion abnormalities to detect myocardial ischemia by intraoperative TEE was more sensitive than the use of the ECG. 5 Address for correspondence: Dr. M. Adnan Celkan, Atat¨ urk Bulvarı , Asaf Erkılı ¸ c Apt. No: 94/7 S ¸ ahinbey 27090, Gaziantep, Turkey. Fax: +90- 342-3603928; e-mail: celkan@superonline.com In this study, we investigated the effect of CABG surgery on global and regional myocardial function; be- fore and immediately after CABG and 1 month after the operation. Evaluation was made by utilizing intraopera- tive and postoperative TEE. In addition, we evaluated the hemodynamic parameters during CABG surgery. MATERIALS AND METHODS Twenty-five patients who were undergoing elective CABG were evaluated. There were 16 men and 9 women with an average age of 55.4 ± 7.2 years (range 40-68). The details of patient characteristics are shown in Table 1. The study protocol was approved by the institutional human research committee, and written informed consent was obtained from all par- ticipating patients. Patients with a history or evidence of esophageal disease or acute LV dysfunction that re- quired inotropic or vasodilator support before surgery were excluded from the study. Before the operation, all patient’s angiographies and ventriculograms were evaluated at least by two cardi- ologists. Thirteen patients had two-vessel disease, 12