McConnell's sign in intra-operative acute right ventricle ischaemia: An under-recognized aetiology
Longo SA ()1, Echegaray A (2), Acosta CM (3), Rinaldi LI (2), Cabrera Schulmeyer MC (4), Olavide Goya I (5).
(1) Servicio de Anestesiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
(2) Servicio de Anestesiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
(3) Servicio de Anestesiología, Hospital Privado de Comunidad, Mar del Plata, Buenos Aires, Argentina.
(4) Departamento de Anestesiología, Universidad de Valparaíso, Valparaíso, Chile.
(5) Servicio de Anestesiología y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España.
Transoesophageal echocardiography (TEE) has become a fundamental tool in modern cardiothoracic anaesthesia. It has an indisputable role in coronary valve surgery and revascularisations with severe impairment of ventricle function. It helps in making diagnoses that can optimise the surgical strategy and to minimal invasively dynamically monitor volaemia and cardiac function during the post-operative period, detecting complications unobservable by other methods.
The McConnell sign, visualised using TEE as an akinesis of the right ventricular free wall, with a normal apex motility and enlargement of the right cavities, is characteristic of right ventricular (RV) dysfunction. This sign has a 77% sensitivity and 94% specificity for the diagnosis of acute pulmonary embolism (APE).
The case is presented of a 53-year-old man scheduled for aortic valve and ascending aorta replacement surgery, with a history of severe valve aortic stenosis, aortic root and arch aneurysm, and with normal coronary arteries.
Post-cardiopulmonary bypass (CBP), the patient presented with haemodynamic instability, with the TEE showing a typical image of the McConnell sign, with no pulmonary hypertension. This enabled making an early diagnosis of acute RV ischaemia, that led to a change in the surgical plan, the performing of coronary revascularisation surgery. As a result, the McConnell sign, which describes the characteristics of RV dysfunction, led to making a differential diagnosis between APE, RV infarction and acute myocardial ischaemia.
CITATION Rev Esp Anestesiol Reanim. 2016 Apr 5. pii: S0034-9356(16)00048-7. doi: 10.1016/j.redar.2016.02.003