Review

Left ventricular diastolic dysfunction of the cardiac surgery patient; a point of view for the cardiac surgeon and cardio-anesthesiologist

Efstratios E Apostolakis¹ , Nikolaos G Baikoussis^1,2 , Haralabos Parissis³ , Stavros N Siminelakis² and Georgios S Papadopoulos⁴

¹  Cardiothoracic Surgery Department, University of Patras, School of Medicine, Patras, Greece

²  Cardiac Surgery Department, University of Ioannina, School of Medicine, Ioannina, Greece

³  Basildon & Thurrock University Hospital NHS FT, Basildon, Essex, UK

⁴  Department of Clinical Anesthesiology and Intensive Postoperative Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece

author email corresponding author email

Journal of Cardiothoracic Surgery 2009, 4:67doi:10.1186/1749-8090-4-67

Published:	24 November 2009

Abstract

Background

Left ventricular diastolic dysfunction (DD) is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both during exercise as well as at rest, while left atrial pressure does not exceed 12 mm Hg. We examined the concept of left ventricular diastolic dysfunction in a cardiac surgery setting.

Materials and methods

Literature review was carried out in order to identify the overall experience of an important and highly underestimated issue: the unexpected adverse outcome due to ventricular stiffness, following cardiac surgery.

Results

Although diverse group of patients for cardiac surgery could potentially affected from diastolic dysfunction, there are only few studies looking in to the impact of DD on the postoperative outcome; Trans-thoracic echo-cardiography (TTE) is the main stay for the diagnosis of DD. Intraoperative trans-oesophageal (TOE) adds to the management. Subgroups of DD can be defined with prognostic significance.

Conclusion

DD with elevated left ventricular end-diastolic pressure can predispose to increased perioperative mortality and morbidity. Furthermore, DD is often associated with systolic dysfunction, left ventricular hypertrophy or indeed pulmonary hypertension. When the diagnosis of DD is made, peri-operative attention to this group of patients becomes mandatory.