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European Journal of Echocardiography Advance Access published online on November 7, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen300
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Improving cardiac function after cardiac surgery by biventricular pacing in patient selected by three-dimensional echocardiography

Stéphane Combes1,*, Nicolas Combes2, Etienne Geoffroy1, Romain Eschalier1, Kasra Azarnoush1, Lionel Camilleri1 and Charles De Riberolles1

1 Department of Cardiac Surgery, CHU Gabriel Montpied, 58 Rue Montalembert, BP 69, 63003 Clermont Ferrand, France
2 Electrophysiology and Pacing/Defibrillation Department, Clinique Pasteur, Toulouse, France

Received 3 August 2008; accepted after revision 10 October 2008.

* Corresponding author. Tel: +33 4 73 75 15 77; fax: +33 4 73 75 15 79. E-mail address: combesstephane{at}voila.fr


  Abstract

We present the case of a 57-year-old woman with severe aortic regurgitation and ventricular dysfunction (ejection fraction 34%) requiring surgical intervention. In pre-operative period, no left ventricular (LV) asynchrony was detected by QRS duration and current echocardiographic techniques, including tissue Doppler imaging. A new echocardiographic technology, the timing of regional volumetric changes by three-dimensional echocardiography (3DEcho), demonstrated an intraventricular mechanical asynchrony. Indeed, during surgery, epicardial leads were attached to the right atrium and the right ventricle as part of the standard management. Two additional epicardial leads were attached to the left ventricle on the most delayed wall localized precisely by 3DEcho on the inferolateral wall. In post-operative period, biventricular (BiV) pacing showed improvement in the LV mechanical synchronization, resulting in improvement in the LV systolic function compared with right ventricular pacing or no pacing. This case shows the potential utility of 3DEcho in prediction of favourable response of the BiV pacing in patients with depressed LV systolic function ongoing cardiac surgery.

Keywords: Biventricular pacing; Cardiac surgery; Three-dimensional echocardiography


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