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[Real-time 3 dimensional full volume data set : benefits in problem focused intraoperative transesophageal echocardiography]. Anaesthesist 2012; 61:875-82. [PMID: 23080355 DOI: 10.1007/s00101-012-2088-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 08/31/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Comprehensive intraoperative transesophageal echcardiography (TEE) includes various measurements for quantification of cardiac chambers and valves based on multiple two dimensional (2D) standard views. Due to shortness of time during cardiac surgery most centres in Germany only carry out problem focussed intraoperative examinations which does not allow the complete repertoire of measurements to be exhausted. The aim of this study was to investigate which measurements for cardiac chamber and valve quantification can be performed with the acquisition of a real-time 3D full volume (RT-3D-FV) data set and to compare these measurements with those based on standard 2D views. MATERIALS AND METHODS In patients undergoing elective surgical mitral valve repair a comprehensive 2D TEE examination according to the guidelines of the American Society of Echocardiography (ASE) and the Society of Cardiovascular Anesthesiologists (SCA) was performed after induction of anesthesia. Additionally, a RT-3D-FV TEE data set based on the midesophageal four chamber view was recorded (iE 33, Philips, Netherlands). All measurements of the 2D TEE and the RT-3D-FV dataset (Qlab) were performed offline by two independent examiners. RESULTS After approval by the local ethic committee and obtaining written informed consent 50 patients (31 male and 19 female) with a mean age of 59.4 ± 11.5 years were enrolled in this study. All measurements recommended for chamber and valve quantification could be performed on the basis of the RT-3D-FV data set except for measurements of the sinus of Valsalva and the sinotubular junction. There was good correlation between the results of the two methods. CONCLUSIONS For intraoperative problem focussed TEE examinations the acquisition of an additional RT-3D-FV TEE data set allows accurate measurement of most of the recommended chamber and valve quantification parameters.
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Abstract
Monitors in the intensive care unit are imperative to taking adequate care of these critically ill patients. Cardiovascular, pulmonary, and neurologic monitors are key to performing these tasks. This article gives an overview of the most common monitors that are used in the intensive care unit.
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Affiliation(s)
- Todd Neideen
- Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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103
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Mahmood F, Hess PE, Matyal R, Mackensen GB, Wang A, Qazi A, Panzica PJ, Lerner AB, Maslow A. Echocardiographic Anatomy of the Mitral Valve: A Critical Appraisal of 2-Dimensional Imaging Protocols With a 3-Dimensional Perspective. J Cardiothorac Vasc Anesth 2012; 26:777-84. [DOI: 10.1053/j.jvca.2012.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Indexed: 11/11/2022]
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Royse CF, Canty DJ, Faris J, Haji DL, Veltman M, Royse A. Core review: physician-performed ultrasound: the time has come for routine use in acute care medicine. Anesth Analg 2012; 115:1007-28. [PMID: 23011559 DOI: 10.1213/ane.0b013e31826a79c1] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The use of ultrasound in the acute care specialties of anesthesiology, intensive care, emergency medicine, and surgery has evolved from discrete, office-based echocardiographic examinations to the real-time or point-of-care clinical assessment and interventions. "Goal-focused" transthoracic echocardiography is a limited scope (as compared with comprehensive examination) echocardiographic examination, performed by the treating clinician in acute care medical practice, and is aimed at addressing specific clinical concerns. In the future, the practice of surface ultrasound will be integrated into the everyday clinical practice as ultrasound-assisted examination and ultrasound-guided procedures. This evolution should start at the medical student level and be reinforced throughout specialist training. The key to making ultrasound available to every physician is through education programs designed to facilitate uptake, rather than to prevent access to this technology and education by specialist craft groups. There is evidence that diagnosis is improved with ultrasound examination, yet data showing change in management and improvement in patient outcome are few and an important area for future research.
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Affiliation(s)
- Colin F Royse
- Department of Surgery, The University of Melbourne, 245 Cardigan St., Carlton, Victoria, Australia, 3053.
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105
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Peng YG, Janelle GM. Emergent limited perioperative transesophageal echocardiography: should new guidelines exist for limited echocardiography training for anesthesiologists? Front Med 2012; 6:332-7. [PMID: 22837064 DOI: 10.1007/s11684-012-0212-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 06/12/2012] [Indexed: 11/29/2022]
Abstract
Bedside limited echocardiography, or focused cardiac ultrasound, continues to gain popularity in many emergency rooms, intensive care units, and operating rooms as a rapid method of assessing unstable patients. Effective monitoring of cardiovascular function in conditions like cardiac arrest or near-arrest is the crucial step to guide successful resuscitative efforts. Transesophageal echocardiography (TEE) has emerged as one of the preferred cardiac diagnostic and monitoring modalities in the intraoperative setting due to the fact that it is less invasive than many other monitors, is immediately accessible, and allows for continuous real-time monitoring of cardiac function. However, the minimum training requirements needed for the anesthesia provider to obtain the competency, knowledge, and skills for basic certification in perioperative TEE far exceed those developed for other medical specialties. We believe there is an urgent need to develop (1) practical guidelines for emergent perioperative TEE use for anesthesiologists and (2) a requisite educational curriculum to teach the basic skills necessary to aid in the diagnosis and treatment of cardiac arrest or near-arrest scenarios. The measures elucidated in this report summarize the efforts of the Department of Anesthesiology at the University of Florida in establishing the necessary steps to make this process not only practical, but accessible to all trainees.We hope that these collective efforts will provide more trainees the confidence in utilizing TEE to aid in establishing a diagnosis in critical situations.
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Affiliation(s)
- Yong G Peng
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254 JHMHSC, Gainesville, FL 32610-0254, USA.
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106
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Stanczak LJ, Bertog SC, Wunderlich N, Franke J, Sievert H. PFO closure with the Premere PFO closure device: acute results and follow-up of 263 patients. EUROINTERVENTION 2012; 8:345-51. [DOI: 10.4244/eijv8i3a53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Heß H, Eibel S, Mukherjee C, Kaisers UX, Ender J. Quantification of mitral valve regurgitation with color flow Doppler using baseline shift. Int J Cardiovasc Imaging 2012; 29:267-74. [PMID: 22752361 DOI: 10.1007/s10554-012-0084-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/11/2012] [Indexed: 11/27/2022]
Abstract
Vena contracta width (VCW) and effective regurgitant orifice area (EROA) are well established methods for evaluating mitral regurgitation using transesophageal echocardiography (TEE). For color-flow Doppler (CF) measurements Nyquist limit of 50-60 cm/s is recommended. Aim of the study was to investigate the effectiveness of a baseline shift of the Nyquist limit for these measurements. After a comprehensive 2-dimensional (2D) TEE examination, the mitral regurgitation jet was acquired with a Nyquist limit of 50 cm/s (NL50) along with a baseline shift to 37.5 cm/s (NL37.5) using CF. Moreover a real time 3-dimensional (RT 3D) color complete volume dataset was stored with a Nyquist limit of 50 cm/s (NL50) and 37.5 cm/s (NL37.5). Vena contracta width (VCW) as well as proximal isovelocity surface area (PISA) derived EROA were measured based on 2D TEE and compared to RT 3D echo measurements for vena contracta area (VCA) using planimetry method. Correlation between VCA 3D NL50 and VCW NL50 was 0.29 (p < 0.05) compared to 0.6 (p < 0.05) using NL37.5. Correlation between VCA 3D NL50 and EROA 2D NL50 was 0.46 (p < 0.05) vs. 0.6 (p < 0.05) EROA 2D NL37.5. Correlation between VCA 3D NL37.5 and VCW NL50 was 0.45 (p < 0.05) compared to 0.65 (p < 0.05) using VCW NL37.5. Correlation between VCA 3D NL37.5 and EROA 2D NL50 was 0.41 (p < 0.05) vs. 0.53 (p < 0.05) using EROA 2D NL37.5. Baseline shift of the NL to 37.5 cm/s improves the correlation for VCW and EROA when compared to RT 3D NL50 planimetry of the vena contracta area. Baseline shift in RT 3D to a NL of 37.5 cm/s shows similar results like NL50.
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Affiliation(s)
- Hannah Heß
- Department of Anesthesiology and Intensive Care Medicine, Heartcenter, University Leipzig, Leipzig, Germany
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Jerath A, Roscoe A, Vegas A. Normal upper esophageal transesophageal echocardiography views. Anesth Analg 2012; 115:507-10. [PMID: 22713681 DOI: 10.1213/ane.0b013e31825e6e79] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Angela Jerath
- Department of Anesthesia, Toronto General Hospital, Toronto, Ontario, Canada
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Karhausen J, Dudaryk R, Phillips-Bute B, Rivera JD, de Lange F, Milano CA, Swaminathan M, Mackensen GB. Three-dimensional transesophageal echocardiography for perioperative right ventricular assessment. Ann Thorac Surg 2012; 94:468-74. [PMID: 22633501 DOI: 10.1016/j.athoracsur.2012.03.073] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/24/2012] [Accepted: 03/29/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND In high-risk cardiac procedures, dynamic analysis of right ventricular (RV) performance is desirable, but the geometric complexity of the RV limits the applicability of current two-dimensional echocardiographic imaging techniques. This study aimed to evaluate the utility of three-dimensional transesophageal echocardiography (TEE) for the perioperative assessment of RV function and dimensions. METHODS Patients undergoing cardiac surgical procedures with complete TEE examinations were identified and reviewed according to current guidelines to exclude patients with significant coexisting valvular regurgitation. Full-volume, three-dimensional datasets were analyzed by two independent investigators using stand-alone software, and left ventricular and RV dimensions were recorded. RESULTS Datasets from 50 patients undergoing cardiac surgical procedures were evaluated for this study. The mean RV volume was 111.7 mL (range, 37.5 to 349.7 mL) at end diastole and 67.6 mL (range, 25.5 to 274.4 mL) at end systole. Intraobserver reliability was 0.93 and 0.90 for end diastolic and 0.77 and 0.87 for end systolic volumes. The interobserver reliability for RV volumes was 0.83 at end diastole and 0.86 at end systole. The mean stroke volume was 43.6 mL (range, 12 to 111.2 mL) for the RV and 49.1 mL (range, 19.9 to 102.8 mL) for the left ventricle; the correlation coefficient between the two was 0.85. CONCLUSIONS Three-dimensional TEE volumetric measurements were reproducible across a wide range of RV dimensions. As postulated by the continuity principle, stroke volume measurements between both ventricles correlated well, supporting the validity of this approach. Therefore, our work provides preliminary evidence that three-dimensional TEE offers reproducible information about RV function and size in the dynamic and complex perioperative setting of cardiac surgical procedures.
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Affiliation(s)
- Joern Karhausen
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD, Harrington RA, Bhatt DL, Ferrari VA, Fisher JD, Garcia MJ, Gardner TJ, Gentile F, Gilson MF, Hernandez AF, Jacobs AK, Kaul S, Linderbaum JA, Moliterno DJ, Weitz HH. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv 2012; 79:1023-82. [DOI: 10.1002/ccd.24351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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111
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Abstract
Surgical replacement of aortic valves is the gold standard for therapy of high grade aortic valve stenosis. However, the changes in demography confront the responsible medical discipline with an increasingly higher risk profile of patients which necessitates the development of new less invasive alternative forms of treatment for the surgical therapy of aortic valve stenosis. This developmental process has progressed from mini-thoracotomy to transcatheter aortic valve implantation (TAVI). The TAVI procedure is a new therapeutic option for treatment of patients with high grade aortic valve stenosis and high perioperative morbidity and mortality risks with conventional aortic valve replacement. Because TAVI can be carried out while the heart is still beating and without a sternotomy or heart-lung maschine, this procedure is particularly suitable for elderly multimorbid patients and/or patients with previous cardiac surgery. The initial results of large prospective multicenter studies underline the value of TAVI in the modern treatment of high risk patients with symptomatic aortic valve stenosis. In addition to an understanding of the surgical procedure, anesthetists must have precise knowledge of the perioperative anesthesia management and possible complications of the procedure.
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112
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Couture P, Bolduc L, Demey N, Deschamps A, Pellerin M, Denault A, Tardif JC. Real-Time Compared to Off-Line Evaluation of Segmental Wall Motion Abnormalities with Transesophageal Echocardiography Using Dobutamine Stress Testing. J Cardiothorac Vasc Anesth 2012; 26:191-6. [DOI: 10.1053/j.jvca.2011.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Indexed: 11/11/2022]
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113
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Matyal R, Hess PE, Asopa A, Zhao X, Panzica PJ, Mahmood F. Monitoring the Variation in Myocardial Function With the Doppler-Derived Myocardial Performance Index During Aortic Cross-Clamping. J Cardiothorac Vasc Anesth 2012; 26:204-8. [DOI: 10.1053/j.jvca.2011.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Indexed: 11/11/2022]
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114
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Felten ML, Michel-Cherqui M, Sage E, Fischler M. Transesophageal and Contact Ultrasound Echographic Assessments of Pulmonary Vessels in Bilateral Lung Transplantation. Ann Thorac Surg 2012; 93:1094-100. [DOI: 10.1016/j.athoracsur.2012.01.070] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 01/19/2012] [Accepted: 01/23/2012] [Indexed: 11/29/2022]
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115
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2012; 93:1340-95. [PMID: 22300625 DOI: 10.1016/j.athoracsur.2012.01.084] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 12/20/2022]
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116
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De Mey N, Couture P, Laflamme M, Denault AY, Perrault LP, Deschamps A, Rochon AG. Intraoperative changes in regional wall motion: can postoperative coronary artery bypass graft failure be predicted? J Cardiothorac Vasc Anesth 2012; 26:371-5. [PMID: 22459932 DOI: 10.1053/j.jvca.2012.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the accuracy of new intraoperative regional wall motions abnormalities (RWMAs) detected by transesophageal echocardiography (TEE) to predict early postoperative coronary artery graft failure. DESIGN A retrospective study. SETTING A tertiary care university hospital. PATIENTS Five thousand nine hundred ninety-eight patients who underwent coronary artery bypass graft (CABG) surgery. INTERVENTIONS An evaluation of RWMAs recorded with intraoperative TEE before and after cardiopulmonary bypass (CPB) in patients who had coronary angiography for suspected postoperative myocardial ischemia based on electrocardiogram (ECG), CK-MB, troponin T, hemodynamic compromise, low cardiac output, and malignant ventricular arrhythmia. Sensitivity, specificity, positive and negative predictive values, odds ratio, 95% confidence interval, and chi-square analysis were used. MEASUREMENTS AND MAIN RESULTS Thirty-nine patients (0.7%) underwent early coronary angiography for the suspicion of early graft dysfunction. Of the 32 patients with diagnosed early graft dysfunction, 5 patients (15.6%) had shown new intraoperative RWMAs as detected by TEE, 21 patients (65.6%) had no new RWMAs, no report was available in 5 patients (15.6%), and 1 examination (3.1%) was excluded because of poor imaging quality. The sensitivity of TEE to predict graft failure was 15.6%, the specificity was 57.1%, and the positive predictive and negative values were 62.5% and 12.9%, respectively. The odds ratio and 95% confidence interval was 0.1190 (0.0099-1.4257) when TEE was positive compared with coronary angiography. No association was found between new RWMAs detected with TEE and graft failure as documented with coronary angiography (p = 0.106). CONCLUSIONS In this retrospective study, RWMAs detected with TEE were of limited value to predict early postoperative CABG failure.
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Affiliation(s)
- Nathalie De Mey
- Department of Anesthesiology, Montreal Heart Institute, University of Montréal, Montreal, Quebec, Canada
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117
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Abstract
Transesophageal echocardiography (TEE) plays an important role in the anatomical, functional, and hemodynamic assessment of patients with congenital heart disease (CHD). This imaging approach has been applied to both children and adults with a wide range of cardiovascular malformations. Extensive clinical experience documents significant contributions, particularly in the perioperative setting. In fact, in the current medical era, many consider this technology to be an essential adjunct to surgical and anesthetic management in CHD. This review focuses on the applications of TEE in patients with tetralogy of Fallot (TOF), the most common form of cyanotic heart disease. Emphasis is given to the perioperative use of this imaging modality and benefits derived during the prebypass and postbypass periods. Limitations and pitfalls relevant to the TEE assessment in patients with this anomaly are also addressed.
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118
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Odonkor P, Stansbury LG, Gammie JS, Rock P, Fitzpatrick M, Grigore AM. Anesthetic Management of Patients Undergoing Aortic Valve Bypass (Apicoaortic Conduit) Surgery. J Cardiothorac Vasc Anesth 2012; 26:148-60. [DOI: 10.1053/j.jvca.2011.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Indexed: 11/11/2022]
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119
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 59:1200-54. [PMID: 22300974 DOI: 10.1016/j.jacc.2012.01.001] [Citation(s) in RCA: 544] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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120
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Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, Cigarroa JE, Disesa VJ, Hiratzka LF, Hutter AM, Jessen ME, Keeley EC, Lahey SJ, Lange RA, London MJ, Mack MJ, Patel MR, Puskas JD, Sabik JF, Selnes O, Shahian DM, Trost JC, Winniford MD. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e123-210. [PMID: 22070836 DOI: 10.1016/j.jacc.2011.08.009] [Citation(s) in RCA: 576] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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121
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Ahlgren B, Puskas F, Seres T. Total Ischemia Time Alters the Longitudinal and Circumferential Shortening of the Right Ventricle in Transplanted Hearts. Semin Cardiothorac Vasc Anesth 2011; 15:163-8. [DOI: 10.1177/1089253211426936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives. Ischemia time is a risk factor for mortality and right ventricular (RV) failure after heart transplantation. The purpose of this study was to determine the effect of ischemia time on known transesophageal echocardiography (TEE) parameters of RV function and on a novel quantitative measurement of RV circumferential shortening. Methods. Right and left ventricular (LV) function was evaluated retrospectively in 20 consecutive patients after heart transplant using known TEE parameters as well as a quantitative measurement of circumferential contraction. The control group consisted of 20 patients undergoing coronary artery bypass grafting (CABG) with no documented RV dysfunction. Results. Posttransplant TEE parameters of RV function were depressed compared with post–cardiopulmonary bypass CABG patients. Significant correlation was observed between tricuspid annular planar systolic excursion, basal, mid, and global circumferential shortening and total ischemia time. Conclusion. Total ischemia time of the transplanted heart may play a role in deterioration of longitudinal and circumferential shortening of the RV.
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Affiliation(s)
| | | | - Tamas Seres
- University of Colorado Hospital, Aurora, CO, USA
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122
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Cabrera Schulmeyer MC, Farías J, De la Maza J. [Intraoperative ejection fraction: estimation with Simpson's rule vs tissue Doppler imaging]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:543-547. [PMID: 22279873 DOI: 10.1016/s0034-9356(11)70138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Transesophageal echocardiography is appropriate for intraoperative monitoring of hemodynamics. The parameter often estimated is ejection fraction (EF) by means of Simpson's rule. With the advent of tissue Doppler imaging and measurement of the systolic (S) wave, corresponding to the rate of myocardial perfusion during the systole, it is possible to estimate the EF more easily and rapidly during surgery. OBJECTIVE To compare EF estimates obtained by Simpson's rule to those based on intraoperative tissue Doppler measurements of S-wave velocity (S'). MATERIAL AND METHODS Patients with chronic cardiovascular disease undergoing scheduled cardiac and noncardiac surgery were studied. Patients in nonsinus rhythm and with mitral valve disease were excluded. To apply Simpson's rule for calculating the EF, we measured end-diastolic volume in 4- and 2-chamber views. The group was divided into patients with normal (> or = 50%) and diminished (< or = 49%) ejection fraction. Tissue Doppler imaging of the mitral annulus was then used to measure S'. Ejection fraction was calculated according to the formula EF = 5.5 x S' + 8. RESULTS Ninety-two patients were studied; in 51 (55%) the EF was normal and in 41 (45%) it was reduced. In patients whose EF was < or = 49% according to Simpson's rule, the correlation between that measurement and EF based on tissue Doppler estimate of S' was good. The correlation was lower, however, in the group with normal EF (r=0.61; P>0.5). CONCLUSIONS EF is easy to estimate with tissue Doppler imaging and the procedure is reproducible. This approach is probably more useful in patients with left ventricular dysfunction.
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Affiliation(s)
- M C Cabrera Schulmeyer
- Departamento de Anestesiología, Universidad de Valparaíso, Hospital Clínico FACH, Santiago de Chile.
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123
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Kremser J, Kleemann F, Reinhart K, Schummer W. Optimized method for correct left-sided central venous catheter placement under electrocardiographic guidance. Br J Anaesth 2011; 107:567-72. [DOI: 10.1093/bja/aer189] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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124
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Kumbharathi RB, Taneja R, Mehra R, Quantz MA, Guo LR, Bainbridge DT. Evaluation of tricuspid and pulmonary valves using epicardial and transesophageal echocardiography--a comparative study. J Cardiothorac Vasc Anesth 2011; 26:32-8. [PMID: 21889364 DOI: 10.1053/j.jvca.2011.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare measurements obtained by transesophageal echocardiography (TEE) and epicardial echocardiography (EE) for evaluation of the tricuspid valve (TV) and pulmonary valve (PV). DESIGN Prospective observational. SETTING University hospital. PARTICIPANTS Patients undergoing elective coronary artery bypass grafting with or without aortic valve replacement. INTERVENTIONS After routine intraoperative TEE, EE was performed to compare measurements obtained by the 2 methods. MEASUREMENTS AND MAIN RESULTS After institutional review board approval, 25 patients >18 years old were recruited. Biases with EE versus TEE for E and A waves were 11.9 cm/second (95% confidence interval [CI], 48.2 to -24.4) and 6.8 cm/second (95% CI, 28 to -15), respectively, and for E/A ratio was 0.08 (95% CI, 1.2 to -1). Pulmonary velocity bias was 57.94 cm/second (95% CI, 192.9 to -76.98), with higher values using EE. Bias for pulmonary trunk diameter was -0.31 cm (95% CI, 1.5 to -2.1). For quality of images, means were 2.4 (standard deviation [SD], 1.0) for EE and 2.3 (SD, 0.57) with TEE for TV and 2.4 (SD, 1.0) with EE and 2.5 (SD, 1.0) with TEE for PV. For the number of leaflets visualized, means were 2.2 (SD, 1.0) with EE and 2.5 (SD, 0.5) with TEE for TV and 2.5 (SD, 0.5) for EE and 1.3 (SD, 1.1) with TEE for PV. CONCLUSIONS There was good agreement for Doppler measurements across TVs; however, measurements across PVs were significantly higher with EE versus TEE. TV Doppler measurements were difficult to acquire even for surgeons experienced in epiaortic scanning.
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Affiliation(s)
- Ravi B Kumbharathi
- Department of Anesthesia, Thompson General Hospital, Burntwood Regional Health Authority, Thompson, Manitoba, Canada.
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125
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Tan CO. Evaluation of a Previously Undescribed Transesophageal Echocardiographic View of the Main Pulmonary Artery. J Cardiothorac Vasc Anesth 2011; 25:e29-31. [DOI: 10.1053/j.jvca.2011.03.172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Indexed: 11/11/2022]
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126
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Hirasaki Y, Seino Y, Tomita Y, Nomura M. Cardiac axis-oriented full-volume data acquisition in real-time three-dimensional transesophageal echocardiography to facilitate on-cart analysis. Anesth Analg 2011; 113:717-21. [PMID: 21788313 DOI: 10.1213/ane.0b013e3182294b91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We propose a useful method to acquire a full-volume dataset that allows for efficient assessment of cardiac structures by real-time 3-dimensional transesophageal echocardiography (3DTEE). In our method, bicommissural full-volume acquisition, the dataset is acquired with the X-Y-Z axes aligned along the lines connecting the mitral commissures, the mitral annular center to the left ventricular apex, and the mitral anterior-posterior ends, respectively. The image dataset obtained using this method not only allows for visualization of en face images of the cardiac structures, but box cropping of the dataset also provides useful sectional images that are the analogues of the standard 2DTEE views. Our method can potentially standardize 3D image orientation of the cardiac structures and facilitate intraoperative on-cart analysis in real-time 3DTEE.
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Affiliation(s)
- Yuji Hirasaki
- Department of Anesthesia, Tsukuba Memorial Hospital, 1-506-3 Owada-Cho, Minuma-Ku, Saitama-Shi, Saitama, 337-0053, Japan.
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127
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Intraoperative Monitoring with Transesophageal Echocardiography in Cardiac Surgery. Braz J Anesthesiol 2011; 61:495-512. [DOI: 10.1016/s0034-7094(11)70058-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 12/13/2010] [Indexed: 11/23/2022] Open
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128
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Sheinberg R, Brady MB, Mitter N. Intraoperative transesophageal echocardiography and ventricular assist device insertion. Semin Cardiothorac Vasc Anesth 2011; 15:14-24. [PMID: 21719549 DOI: 10.1177/1089253211411733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A decade after cardiac surgery was established, transesophageal echocardiography (TEE) was developed and used to evaluate perioperative cardiac performance. It has become an invaluable tool to provide real-time information in the cardiac operating room. TEE provides practical and useful information prior to insertion as well as after placement of the device. Additionally, during episodes of device malfunction or hemodynamic instability, TEE can be extremely useful in defining the etiology of the problem. As ventricular assist devices (VADs) have undergone evolution in design and as more VADs are being implanted, the development of specific indications for TEE use during device placement is a relevant issue. Formal guidelines for use of TEE during VAD insertion are yet to be adopted or implemented, but for now TEE remains an essential tool for managing this patient population.
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129
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Kasper J, Bolliger D, Skarvan K, Filipovic M, Seeberger M. O-33 Evaluation of additional transoesophageal echocardiographic views for comprehensive imaging of the right ventricle. J Cardiothorac Vasc Anesth 2011. [DOI: 10.1053/j.jvca.2011.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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130
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Swaminathan M, Nicoara A, Phillips-Bute BG, Aeschlimann N, Milano CA, Mackensen GB, Podgoreanu MV, Velazquez EJ, Stafford-Smith M, Mathew JP. Utility of a Simple Algorithm to Grade Diastolic Dysfunction and Predict Outcome After Coronary Artery Bypass Graft Surgery. Ann Thorac Surg 2011; 91:1844-50. [DOI: 10.1016/j.athoracsur.2011.02.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/28/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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131
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Ender J, Eibel S, Mukherjee C, Mathioudakis D, Borger MA, Jacobs S, Mohr FW, Falk V. Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography. ACTA ACUST UNITED AC 2011; 12:445-53. [PMID: 21546375 PMCID: PMC3117468 DOI: 10.1093/ejechocard/jer042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims We sought to investigate the additional value of real-time three-dimensional transoesophageal echocardiography (RT 3D TOE)-guided sizing for predicting annuloplasty ring size during mitral valve repair. Methods and results In 53 patients undergoing elective mitral valve repair, an RT 3D TOE was performed pre- and post-operatively. The digitally stored loops were imported into a software for mitral valve assessment. The annuloplasty ring size was predicted by superimposing computer-aided design (CAD) models of annuloplasty rings onto Live 3D zoom loops, measurement of the intercommissural distance, or the height of the anterior mitral leaflet. The surgeon implanted the annuloplasty ring according to the usual surgical technique and was blinded to the echocardiographic measurement results. Pre-operative correlation between the selected ring size with mitral valve assessment and the actual implanted annuloplasty ring size was 0.91. The correlation for measurement of the intercommissural distance was 0.55 and for measurement of the height of the anterior mitral leaflet 0.75. The post-operative correlation with the actual implanted ring size was 0.96 for mitral valve assessment, 0.92 for intercommissural distance, and 0.79 for the anterior mitral leaflet height. Conclusion Superimposition of annuloplasty ring CAD models on the Live 3D zoom loops of the mitral valve using mitral valve assessment is superior to two-dimensional measurements of the intercommissural distance or the height of the anterior mitral leaflet in predicting correct annuloplasty ring size.
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Affiliation(s)
- J Ender
- Department of Anaesthesiology and Intensive Care Medicine II, Leipzig Heart Center, University of Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany.
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Filho MFS, Siciliano A, Diego LA, Miana LA, Salgado J. Transesophageal Echocardiography in Ross Procedure. Rev Bras Anestesiol 2011; 61:344-50. [DOI: 10.1016/s0034-7094(11)70040-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 12/13/2010] [Indexed: 11/30/2022] Open
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133
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Vergnat M, Jassar AS, Jackson BM, Ryan LP, Eperjesi TJ, Pouch AM, Weiss SJ, Cheung AT, Acker MA, Gorman JH, Gorman RC. Ischemic mitral regurgitation: a quantitative three-dimensional echocardiographic analysis. Ann Thorac Surg 2011; 91:157-64. [PMID: 21172506 DOI: 10.1016/j.athoracsur.2010.09.078] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 09/27/2010] [Accepted: 09/30/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND A comprehensive three-dimensional echocardiography based approach is applied to preoperative mitral valve (MV) analysis in patients with ischemic mitral regurgitation (IMR). This method is used to characterize the heterogeneous nature of the pathologic anatomy associated with IMR. METHODS Intraoperative real-time three-dimensional transesophageal echocardiograms of 18 patients with IMR (10 with anterior, 8 with inferior infarcts) and 17 patients with normal MV were analyzed. A customized image analysis protocol was used to assess global and regional determinants of annular size and shape, leaflet tethering and curvature, relative papillary muscle anatomy, and anatomic regurgitant orifice area. RESULTS Both mitral annular area and MV tenting volume were increased in the IMR group as compared with patients with normal MV (mitral annular area=1,065±59 mm2 versus 779±44 mm2, p=0.001; and MV tenting volume=3,413±403 mm3 versus 1,696±200 mm3, p=0.001, respectively). Within the IMR group, patients with anterior infarct had larger annuli (1,168±99 mm2) and greater tenting volumes (4,260±779 mm3 versus 2,735±245 mm3, p=0.06) than the inferior infarct subgroup. Papillary-annular distance was increased in the IMR group relative to normal; these distances were largest in patients with anterior infarcts. Whereas patients with normal MV had very consistent anatomic determinants, annular shape and leaflet tenting distribution in the IMR group were exceedingly variable. Mean anatomic regurgitant orifice area was 25.8±3.0 mm2, and the number of discrete regurgitant orifices varied from 1 to 4. CONCLUSIONS Application of custom analysis techniques to three-dimensional echocardiography images allows a quantitative and systematic analysis of the MV, and demonstrates the extreme variability in pathologic anatomy that occurs in patients with severe IMR.
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Affiliation(s)
- Mathieu Vergnat
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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134
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Jassar AS, Brinster CJ, Vergnat M, Robb JD, Eperjesi TJ, Pouch AM, Cheung AT, Weiss SJ, Acker MA, Gorman JH, Gorman RC, Jackson BM. Quantitative mitral valve modeling using real-time three-dimensional echocardiography: technique and repeatability. Ann Thorac Surg 2011; 91:165-71. [PMID: 21172507 DOI: 10.1016/j.athoracsur.2010.10.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 10/13/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Real-time three-dimensional (3D) echocardiography has the ability to construct quantitative models of the mitral valve (MV). Imaging and modeling algorithms rely on operator interpretation of raw images and may be subject to observer-dependent variability. We describe a comprehensive analysis technique to generate high-resolution 3D MV models and examine interoperator and intraoperator repeatability in humans. METHODS Patients with normal MVs were imaged using intraoperative transesophageal real-time 3D echocardiography. The annulus and leaflets were manually segmented using a TomTec Echo-View workstation. The resultant annular and leaflet point cloud was used to generate fully quantitative 3D MV models using custom Matlab algorithms. Eight images were subjected to analysis by two independent observers. Two sequential images were acquired for 6 patients and analyzed by the same observer. Each pair of annular tracings was compared with respect to conventional variables and by calculating the mean absolute distance between paired renderings. To compare leaflets, MV models were aligned so as to minimize their sum of squares difference, and their mean absolute difference was measured. RESULTS Mean absolute annular and leaflet distance was 2.4±0.8 and 0.6±0.2 mm for the interobserver and 1.5±0.6 and 0.5±0.2 mm for the intraobserver comparisons, respectively. There was less than 10% variation in annular variables between comparisons. CONCLUSIONS These techniques generate high-resolution, quantitative 3D models of the MV and can be used consistently to image the human MV with very small interoperator and intraoperator variability. These data lay the framework for reliable and comprehensive noninvasive modeling of the normal and diseased MV.
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Affiliation(s)
- Arminder Singh Jassar
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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135
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Mestres CA, Fita G, Azqueta M, Miró JM. Role of echocardiogram in decision making for surgery in endocarditis. Curr Infect Dis Rep 2011; 12:321-8. [PMID: 21308513 DOI: 10.1007/s11908-010-0124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Infective endocarditis is a serious disease that carries significant morbidity and mortality. Adequate treatment is based on a high degree of clinical suspicion, accurate microbiologic diagnosis, and high-quality imaging. Echocardiography has been shown to be a fundamental tool for diagnosis and management. Currently accepted Duke criteria include blood cultures and echocardiography. Transthoracic and transesophageal echocardiography play a critical role in the decision-making process, especially when surgical treatment is contemplated. Because infective endocarditis is considered a medical and surgical disease, and considering that the current rate of surgery is about 50%, echocardiography has definite value in preoperative diagnosis and surgical planning, intraoperative confirmation of lesions and quality of repair or replacement before and after cardiopulmonary bypass, and postoperative assessment.
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Affiliation(s)
- Carlos-A Mestres
- Department of Cardiovascular Surgery, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain,
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136
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Smyth K, Hebballi R, Peterson MK. Use of transoesophageal echocardiography during the peri-operative period for trauma patients. J ROY ARMY MED CORPS 2011; 156:373-9. [PMID: 21302659 DOI: 10.1136/jramc-156-04s-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The medical facility at Camp Bastion continues to evolve as a consequence of the increased throughput of battlefield trauma patients. There is a requirement for rapid and accurate diagnosis of haemodynamic instability and continued haemodynamic monitoring throughout the peri-operative period. Transoesophageal echocardiography (TOE) has been used for this purpose in the arena of cardiac anaesthesia since the mid 1980s. It is being introduced to other peri-operative settings where severe haemodynamic instability is expected. The old proverb: 'There are none so blind as those who cannot see' (Jeremiah 5:21) is applicable to this topic, in that TOE is proven to be a rapid, portable, safe and effective tool in the assessment of the haemodynamically unstable patient. This paper explores the application of TOE for the assessment of the major causes of haemodynamic instability in the trauma population.
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Affiliation(s)
- K Smyth
- Royal Air Force, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester
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137
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Michaux I, Filipovic M, Skarvan K, Bolliger D, Schumann R, Bernet F, Seeberger MD. A randomized comparison of right ventricular function after on-pump versus off-pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2011; 141:361-7. [DOI: 10.1016/j.jtcvs.2010.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 01/22/2010] [Accepted: 02/05/2010] [Indexed: 10/19/2022]
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138
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Metaxa V, Tsagourias M, Matamis D. The role of echocardiography in the early diagnosis of the complications of endovascular repair of blunt aortic injury. J Crit Care 2011; 26:434.e7-12. [PMID: 21255968 DOI: 10.1016/j.jcrc.2010.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 11/16/2010] [Accepted: 11/21/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Endovascular repair of traumatic aortic injury has been associated with severe procedural complications, including endoleaks, coverage of the left subclavian artery, stent collapse, access complications, and questionable durability. Echocardiography has proven to be a valuable tool in the intraoperative detection of these complications. In the current study, we report on the use of echocardiography as an early postoperative diagnostic technique for the evaluation of endovascular stent graft positioning in the intensive care setting. METHODS From January 2005 to January 2009, 14 patients who underwent endovascular repair of a blunt aortic injury were admitted in our intensive care unit. Transesophageal and/or transthoracic echocardiography were used as first-line diagnostic tools in the assessment of the endovascular graft position. RESULTS Twenty-eight percent of patients (4 of 14) developed a pressure gradient between upper and lower limbs (greater than 50 mm Hg), which presented with persistent hypertension, requiring antihypertensive therapy in high doses and difficult weaning. In all 4 patients, stent graft malposition was identified using echocardiography. The diagnosis was verified by computed tomography and aortography. CONCLUSION Noninvasive echocardiographic monitoring proved to be a valuable tool in the early diagnosis of postoperative stent graft malalignment. To our knowledge, this is the first time that echocardiography is described in the relevant literature as an early diagnostic technique in this setting.
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Affiliation(s)
- Victoria Metaxa
- Intensive Care Unit, Papageorgiou General Hospital, Thessaloniki, Greece.
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139
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Harvey NJ, Swanevelder JLC. Transoesophageal echocardiography assessment of the aortic valve. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2011. [DOI: 10.1080/22201173.2011.10872728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- NJ Harvey
- Glenfield Hospital, University Hospitals of Leicester, UK
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140
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Mahmood F, Gorman JH, Subramaniam B, Gorman RC, Panzica PJ, Hagberg RC, Lerner AB, Hess PE, Maslow A, Khabbaz KR. Changes in mitral valve annular geometry after repair: saddle-shaped versus flat annuloplasty rings. Ann Thorac Surg 2010; 90:1212-20. [PMID: 20868816 DOI: 10.1016/j.athoracsur.2010.03.119] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 03/17/2010] [Accepted: 03/22/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Saddle-shaped annuloplasty rings are being increasingly used during mitral valve (MV) repair to conform the mitral annulus to a more nonplanar shape and possibly reduce leaflet stress. In this study utilizing three-dimensional transesophageal echocardiography we compared the effects of rigid flat rings with those of the saddle rings on the mitral annular geometry. Specifically we measured the changes in nonplanarity angle (NPA) before and after MV repair. METHODS Geometric analysis on 38 patients undergoing MV repair for myxomatous and ischemic mitral regurgitation with full flat rings (n = 18) and saddle rings (n = 18) were performed. The acquired three-dimensional volumetric data were analyzed utilizing the "Image Arena" software (TomTec GmBH, Munich, Germany). Specifically, the degree of change in the NPA was calculated and compared before and after repair for both types of rings. RESULTS Both types of annuloplasty rings resulted in significant changes in the geometric structure of the MV after repair. However, saddle rings lead to a decrease in the NPA (7% for ischemic and 8% for myxomatous MV repairs) (ie, made the annulus more nonplanar), whereas flat rings increased the NPA (7.9% for ischemic and 11.8% for myxomatous MV repairs) (ie, made the annulus less nonplanar); p value 0.001 or less. CONCLUSIONS Implantation of saddle-shaped rings during MV repair surgery is associated with augmentation of the nonplanar shape of the mitral annulus (ie, decreases NPA). This favorable change in the mitral annular geometry could possibly confer a structural advantage to MV repairs with the saddle rings.
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Affiliation(s)
- Feroze Mahmood
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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141
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Matyal R, Mahmood F, Hess P, Zhao X, Mitchell J, Maslow A, Gangadharan S, Decamp M. Right ventricular echocardiographic predictors of postoperative supraventricular arrhythmias after thoracic surgery: a pilot study. Ann Thorac Surg 2010; 90:1080-6. [PMID: 20868791 DOI: 10.1016/j.athoracsur.2010.05.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 05/03/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND We used echocardiographically derived myocardial performance index (MPI) to assess changes in global right ventricular function with lung isolation. We hypothesized that changes in MPI with lung isolation may be related to the incidence of postoperative supraventricular tachycardia (SVT). METHODS Transesophageal echocardiographic examinations were performed after induction of general anesthesia in patients undergoing elective lung resections. Doppler tissue imaging was used to calculate MPI at baseline and 10 minutes after institution of one-lung ventilation (OLV). Arrhythmias occurring within the first 5 postoperative days were recorded. RESULTS Fifty-nine patients completed the study. Nineteen of 59 patients with a normal baseline MPI (<0.40) had a higher incidence of SVT as compared with patients with an abnormal baseline MPI (42% versus 10%; p = 0.012). The MPI worsened during OLV in 46 patients; a worsening of MPI with lung isolation that was normal at baseline was associated with higher incidence of SVT (57% versus 0%; p = 0.045) compared with a worsening of MPI in patients with an abnormal baseline MPI (13% versus 6%; p = 0.62). A normal baseline MPI value that worsened after OLV, left atrial dilation, and advanced age were identified as predictors of postoperative SVT. CONCLUSIONS Lung isolation is associated with acute changes in global right ventricular function. A normal baseline MPI that worsens after lung isolation is a better predictor of postoperative SVT as compared with baseline abnormal MPI that does not worsen after lung isolation. Myocardial performance index has a potential to be used as a right ventricular stress test to tolerate OLV before thoracic surgery.
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Affiliation(s)
- Robina Matyal
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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142
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Kahn RA. Electronic Storage of Echocardiographic Images: From Clips to Bits. J Cardiothorac Vasc Anesth 2010; 24:859-66. [DOI: 10.1053/j.jvca.2009.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Indexed: 11/11/2022]
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143
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Petrini J, Yousry M, Rickenlund A, Liska J, Hamsten A, Eriksson P, Franco-Cereceda A, Caidahl K, Eriksson MJ. The Feasibility of Velocity Vector Imaging by Transesophageal Echocardiography for Assessment of Elastic Properties of the Descending Aorta in Aortic Valve Disease. J Am Soc Echocardiogr 2010; 23:985-92. [DOI: 10.1016/j.echo.2010.06.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Indexed: 10/19/2022]
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144
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Bainbridge D. The Use of Ultrasound to Guide Interventions: From Bench to Bedside and Back Again. Semin Cardiothorac Vasc Anesth 2010; 14:183-185. [DOI: 10.1177/1089253210376597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The ultrasound machine was originally devised as a diagnostic tool to help evaluate heart structure and function. With recent advances in ultrasound, including live 3D ultrasound, its potential to guide interventions within the heart has increasingly been recognized. Cardiologists have adapted this technology and have now published guidelines on the use of ultrasound to guide interventional procedures. Anesthesiologists have also used ultrasound with much success in cardiac operating rooms (ORs) to guide cannula placement and, to a limited extent, interventions. The focus of this article is a review of the author’s work on ultrasound and virtual reality—guided cardiac interventions, both in the research laboratory and in the OR.
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Affiliation(s)
- Daniel Bainbridge
- London Health Sciences Centre, University of Western Ontario, London, ON, Canada,
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145
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Fassl J, Augoustides JG. Transcatheter Aortic Valve Implantation—Part 2: Anesthesia Management. J Cardiothorac Vasc Anesth 2010; 24:691-9. [DOI: 10.1053/j.jvca.2010.02.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Indexed: 11/11/2022]
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146
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Pitkin AD, Blas ML, Klodell CT, Oware A, Augoustides JG. Case 4—2010Successful Use of Transesophageal Echocardiography After Esophagogastrectomy. J Cardiothorac Vasc Anesth 2010; 24:700-5. [DOI: 10.1053/j.jvca.2010.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Indexed: 12/28/2022]
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147
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van Zaane B, Nierich A, Brandon Bravo Bruinsma G, Rosseel P, Ramjankhan F, de Waal E, Buhre W, Moons K. Diagnostic accuracy of modified transoesophageal echocardiography for pre-incision assessment of aortic atherosclerosis in cardiac surgery patients. Br J Anaesth 2010; 105:131-8. [DOI: 10.1093/bja/aeq122] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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148
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Buckberg GD. Controlled reperfusion after ischemia may be the unifying recovery denominator. J Thorac Cardiovasc Surg 2010; 140:12-8, 18.e1-2. [DOI: 10.1016/j.jtcvs.2010.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 02/08/2010] [Indexed: 11/27/2022]
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149
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Three-Dimensional Transesophageal Echocardiography Is a Major Advance for Intraoperative Clinical Management of Patients Undergoing Cardiac Surgery. Anesth Analg 2010; 110:1548-73. [DOI: 10.1213/ane.0b013e3181d41be7] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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150
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Ender J, Selbach M, Borger MA, Krohmer E, Falk V, Kaisers UX, Mohr FW, Mukherjee C. Echocardiographic Identification of Iatrogenic Injury of the Circumflex Artery During Minimally Invasive Mitral Valve Repair. Ann Thorac Surg 2010; 89:1866-72. [DOI: 10.1016/j.athoracsur.2010.02.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 02/15/2010] [Accepted: 02/17/2010] [Indexed: 10/19/2022]
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