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BJA Advance Access published online on March 4, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei112
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted October 22, 2004

Clinical Investigation

Relationship between intraoperative transoesophageal echocardiography findings and perfusion lung scintigraphy results on first postoperative day

M. Moriyama 1, S. Watanabe 1*, T. Hiraki 1, T. Kano 1, T. Okawa 2, and M. Ishibashi 3

1 Department of Anaesthesiology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan
2 Department of Orthopaedic Surgery, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan
3 Department of Radiology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan

* To whom correspondence should be addressed.
S. Watanabe, E-mail: watanabe{at}med.kurume-u.ac.jp


  Abstract

Background. Although intraoperative transoesophageal echocardiography (TOE) has been used to detect the occurrence of echogenic macro- and/or microembolic phenomena during total hip arthroplasty (THA), no direct correlation between macroembolism and the formation of pulmonary embolism (PE) has been conclusively determined in early postoperative periods after THA.

Methods. Sixty-two patients scheduled for primary THA were enrolled in this study. Intraoperative TOE images were continuously recorded on videotape and the echogenic events were evaluated throughout surgery. Perfusion lung scintigraphy was performed on the first postoperative day (POD1).

Results. Perfusion lung scintigraphy revealed the existence of PE in nine (15%) of the 62 patients who underwent THA: five (25%) of 20 patients with cemented THA and four (10%) of 42 patients with non-cemented THA. The grading score of intraoperative TOE findings, including the amount of echogenic particles in right atrium, the longest time of echogenesis and the diameter of the largest echogenic particles, did not differ between the groups with and without PE. The sensitivity, specificity, and positive and negative predictive values for the detection of echogenic macroemboli for the prediction of the development of PE on POD1 were 0.78, 0.60, 0.25 and 0.94, respectively.

Conclusion. Intraoperative TOE monitoring did not predict the occurrence of PE on POD1.

Keywords: embolism, pulmonary; measurement techniques, perfusion lung scintigraphy; monitoring, transoesophageal echocardiography; surgery, total hip arthroplasty.
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