Pre-operative Focused Transthoracic Echocardiography for Prediction of Post-operative Cardiac Complications
Conditions: Diastolic Dysfunction
Sponsor: South Egypt Cancer Institute

PRE-OPERATIVE FOCUSED TRANSTHORACIC ECHOCARDIOGRAPY FOR 
PREDICTION OF POST-OPERATIVE CARDIAC COMPLICATIONS 
 
 
 
Study Protocol 
 
All patients were first assessed in the anesthesia clinic of Qena university hospital by clinical 
examination and routine investigations regarding Detailed History taking including: Age, Sex, 
Work, Address, previous Operations ,Smoking, Diabetes, Past history and Family 
history,Clinical Examination of the chest and heart all patients were investigated for complete 
blood picture, prothrombin concentration and time ,INR ,ECG  
According to the surgery plan the responsible anesthesiologist was asked to write his anesthetic 
management protocol of the patient in special sheet then TTE (Vivid I echocardiography 
machine General Electric Healthcare, Milwaukee, WI, USA) with 
a 3S-RS (1.5–3.6 MHz) transthoracic probe).  was done by professional anesthesiologist 
following the :Hemodynamic Echocardiography Assessment in Real Time ( HEART) protocol. 
According to the clinical findings of TTE patients may be either free or have one or more of the 
following haemodynamic states normal, empty, vasodilated ,left ventricular systolic or  diastolic 
failure, left ventricular systolic and diastolic failure, and right ventricular failure,  valve stenosis 
or regurgitation of at least moderate severity, A pericardial effusion greater than 0.5 cm; or 
pulmonary hypertension (estimated pulmonary artery systolic pressure > 60 mmHg). Non-
hemodynamically significant findings on clinical or TTE examination included mild valvular 
stenosis or regurgitation, and normal haemodynamic state. 
According to the data found by TEE examination the anesthesia plan was re- discussed with the 
attending anesthesiologist to be compared with the one put in the anesthesia clinic before TEE 
was performed to record any change in that plan of anesthesia. All modifications of anesthetic 

management as well as any intra-operative hemodynamic changes were recorded for further 
analysis. 
 
Statistical Analysis Plan
 
The required sample size was calculated using Epi Info software version 7 (CDC, 2012) ®. 
Using post hoc power analysis with accuracy mode calculations with VAS as the primary 
objective and therefore, it was estimated that minimum sample size of 29 patients in each study 
group would a chive a power of 80% to detect an effect size of 0.8 in the outcome measures of 
interest, assuming a type I error of 0.05. 
 
Results:  our results showed changes in clinical diagnosis in the form of reporting 26% of 
patients with impaired ejection fraction of left ventricle, 18% valve lesions , diastolic 
dysfunction in 40 % of patients . Accordingly 4% of patients were canceled and the anesthetic 
management was changed in 20% of patients  
 
 
All analyses were performed with the SPSS 20.0 ® software. Categorical variables were described 
by number and percent (N, %), where continuous variables described by mean and standard 
deviation (Mean, SD). And Mann–Whitney test were used to compare between two groups while Chi 
square test was used for qualitative data. Where compare between continuous variables by t-test. P 
was considered significant if <.05 at confidence interval 95%.