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Patel AR, Caffarelli A, Pandian NG. Aortic Disorders. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hansen KL, Møller-Sørensen H, Pedersen MM, Hansen PM, Kjaergaard J, Lund JT, Nilsson JC, Jensen JA, Nielsen MB. First report on intraoperative vector flow imaging of the heart among patients with healthy and diseased aortic valves. ULTRASONICS 2015; 56:243-250. [PMID: 25128079 DOI: 10.1016/j.ultras.2014.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 06/03/2023]
Abstract
The vector velocity method Transverse Oscillation (TO) implemented on a conventional ultrasound (US) scanner (ProFocus, BK Medical, Herlev, Denmark) can provide real-time, angle-independent estimates of the cardiac blood flow. During cardiac surgery, epicardial US examination using TO was performed on (A) 3 patients with healthy aortic valve and (B) 3 patients with aortic valve stenosis. In group B, the systolic flow of the ascending aorta had higher velocities, was more aliased and chaotic. The jet narrowed to 44% of the lumen compared to 75% in group A and with a vector concentration, a measure of flow complexity, of 0.41 compared to 0.87 in group A. The two groups had similar secondary flow of the ascending aorta with an average rotation frequency of 4.8 Hz. Simultaneous measurements were obtained with spectral Doppler (SD) and a thermodilution technique (TD). The mean difference in peak systolic velocity compared to SD in group A was 22% and 45% in B, while the mean difference in volume flow compared to TD in group A was 30% and 32% in B. TO can potentially reveal new information of cardiac blood flow, and may become a valuable diagnostic tool in the evaluation of patients with cardiovascular diseases.
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Affiliation(s)
| | - Hasse Møller-Sørensen
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Mads Møller Pedersen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Peter Møller Hansen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jens Teglgaard Lund
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jens Christian Nilsson
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, DTU Elektro, Technical University of Denmark, Denmark
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Mookadam F, Kendall CB, Wong RK, Kalya A, Warsame T, Arabia FA, Lusk J, Moustafa S, Steidley E, Quader N, Chandrasekaran K. Left ventricular assist devices: physiologic assessment using echocardiography for management and optimization. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:335-345. [PMID: 22230137 DOI: 10.1016/j.ultrasmedbio.2011.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/12/2011] [Accepted: 11/15/2011] [Indexed: 05/31/2023]
Abstract
Left ventricular assist devices (LVAD) are being deployed increasingly in patients with severe left ventricular dysfunction and medically refractory congestive heart failure of any etiology. The United States Food and Drug Administration (FDA) recently approved the use of the Thoratec Heartmate II (Thoratec Corporation, Pleasanton, CA, USA) for outpatient use. Echocardiography is fundamental during each stage of patient management, pre-LVAD placement, during LVAD placement, for postoperative LVAD optimization and long-term follow-up. We present a pragmatic and systematic echocardiographic approach that serves as a guide for the management of left ventricular assist devices.
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Affiliation(s)
- Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA.
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Robinson AR, Robinson MS, Martin TD, Muehlschlegel JD, Peng YG. Intraoperative Transesophageal Echocardiography Alters the Surgical Course for Patients Undergoing Ascending Aortic Aneurysm Repair. J Cardiothorac Vasc Anesth 2009; 23:71-4. [DOI: 10.1053/j.jvca.2007.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Indexed: 11/11/2022]
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Aortic Disorders. Echocardiography 2009. [DOI: 10.1007/978-1-84882-293-1_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Chumnanvej S, Wood MJ, MacGillivray TE, Melo MFV. Perioperative echocardiographic examination for ventricular assist device implantation. Anesth Analg 2007; 105:583-601. [PMID: 17717209 DOI: 10.1213/01.ane.0000278088.22952.82] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ventricular assist devices (VADs) are systems for mechanical circulatory support of the patient with severe heart failure. Perioperative transesophageal echocardiography is a major component of patient management, and important for surgical and anesthetic decision making. In this review we present the rationale and available data for a comprehensive echocardiographic assessment of patients receiving a VAD. In addition to the standard examination, device-specific pre-, intra-, and postoperative considerations are essential to the echocardiographic evaluation. These include: (a) the pre-VAD insertion examination of the heart and large vessels to exclude significant aortic regurgitation, tricuspid regurgitation, mitral stenosis, patent foramen ovale, or other cardiac abnormality that could lead to right-to-left shunt after left VAD placement, intracardiac thrombi, ventricular scars, pulmonic regurgitation, pulmonary hypertension, pulmonary embolism, and atherosclerotic disease in the ascending aorta; and to assess right ventricular function; and (b) the post-VAD insertion examination of the device and reassessment of the heart and large vessels. The examination of the device aims to confirm completeness of device and heart deairing, cannulas alignment and patency, and competency of device valves using two-dimensional, and color, continuous and pulsed wave Doppler modalities. The goal for the heart examination after implantation should be to exclude aortic regurgitation, or an uncovered right-to-left shunt; and to assess right ventricular function, left ventricular unloading, and the effect of device settings on global heart function. The variety of VAD models with different basic and operation principles requires specific echocardiographic assessment targeted to the characteristics of the implanted device.
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Affiliation(s)
- Siriluk Chumnanvej
- Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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Abstract
Advances in ultrasound technology continue to enhance its diagnostic applications in daily medical practice. Bedside echocardiographic examination has become useful to properly trained cardiologists, anesthesiologists, intensivists, surgeons, and emergency room physicians. Cardiac ultrasound can permit rapid, accurate, and noninvasive diagnosis of a broad range of acute cardiovascular pathologies. Although transesophageal echocardiography was once the principal diagnostic approach using ultrasound to evaluate intensive care unit patients, advances in ultrasound imaging, including harmonic imaging, digital acquisition, and contrast for endocardial enhancement, has improved the diagnostic yield of transthoracic echocardiography. Ultrasound devices continue to become more portable, and hand-carried devices are now readily available for bedside applications. This article discusses the application of bedside echocardiography in the intensive care unit. The emphasis is on echocardiography and cardiovascular diagnostics, specifically on goal-directed bedside cardiac ultrasonography.
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Affiliation(s)
- Yanick Beaulieu
- Hôpital Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada.
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Inatsugi M, Tanaka K, Kitahata H, Nozaki J, Kawahito S, Oshita S. Minute distance obtained from pulmonary venous flow velocity using transesophageal pulsed Doppler echocardiography is related to cardiac output during cardiovascular surgery. THE JOURNAL OF MEDICAL INVESTIGATION 2005; 52:178-85. [PMID: 16167536 DOI: 10.2152/jmi.52.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE We studied the relationship between minute distance calculated from pulmonary venous flow (PVF) velocity tracing and cardiac output (CO) measured with thermodilution method in patients undergoing cardiovascular surgery. METHODS In 32 patients undergoing cardiovascular surgery, simultaneous measurements of hemodynamics including CO and transesophageal pulsed Doppler signals of PVF velocity were performed before and after surgical repair. Minute distance was calculated as the product of the heart rate and the sum of time-velocity integrals of PVF. RESULTS The minute distance after surgical intervention increased from 1121 +/- 347 cm x sec(-1) to 1764 +/- 538 cm x sec(-1) (p < 0.001; mean +/- SD), while CO increased after surgical intervention from 3.5 +/- 0.9 L x min(-1) to 5.3 +/- 1.1 L x min(-1). Simple linear regression analysis showed that minute distance was related with CO before and after surgical intervention (r = 0.81 and r = 0.76, respectively). The changes in minute distance were also related with those in CO (r = 0.80). CONCLUSION The present study demonstrated that minute distance obtained from the pulsed Doppler tracings of PVF velocity was related with CO during cardiovascular surgery in adults. These results suggest that the changes in CO could be estimated from minute distance in pulmonary vein.
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Affiliation(s)
- Mikiko Inatsugi
- Department of Anesthesiology, Institute of Health Biosciences, The University of Tokushima Graduate School, Kuramoto-cho, Tokushima 770-8503, Japan
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Abstract
Ultrasonography has become an invaluable tool in the management of critically ill patients. Its safety and portability allow for use at the bedside to provide rapid, detailed information regarding the cardiovascular system and the function and anatomy of certain internal organs. Echocardiography can noninvasively elucidate cardiac function and structure. This information is vital in the management hemodynamically unstable patients in the ICU. In addition, ultrasonography has particular value for the assessment and safe drainage of pleural and intra-abdominal fluid and the placement of central venous catheters. A new generation of portable, battery-powered, inexpensive, hand-carried ultrasound devices have recently become available; these devices can provide immediate diagnostic information not assessable by physical examination alone and allow for ultrasound-guided thoracocentesis, paracentesis, and central venous cannulation. This two-part article reviews the application of bedside ultrasonography in the ICU.
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Affiliation(s)
- Yanick Beaulieu
- Division of Cardiology and Critical Care Medicine, Hôpital Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin O., Montreal, Québec, Canada, H4J 1C5.
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Abstract
This is the second of a two-part review on the application of bedside ultrasonography in the ICU. In this part, the following procedures will be covered: (1) echocardiography and cardiovascular diagnostics (second part); (2) the use of bedside ultrasound to facilitate central-line placement and to aid in the care of patients with pleural effusions and intra-abdominal fluid collections; (3) the role of hand-carried ultrasound in the ICU; and (4) the performance of bedside ultrasound by the intensivist. The safety and utility of bedside ultrasonography performed by adequately trained intensivists has now been well demonstrated. This technology, as a powerful adjunct to the physical examination, will become an indispensable tool in the management of critically ill patients.
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Affiliation(s)
- Yanick Beaulieu
- Division of Cardiology and Critical Care Medicine, Hôpital Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin O., Montreal, Quebec, Canada, H4J 1C5.
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Affiliation(s)
- A Thomas Pezzella
- Cardiothoracic Surgery, Good Samaritan Hospital, Mt. Vernon, IL, USA
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Ionescu AA, West RR, Proudman C, Butchart EG, Fraser AG. Prospective study of routine perioperative transesophageal echocardiography for elective valve replacement: clinical impact and cost-saving implications. J Am Soc Echocardiogr 2001; 14:659-67. [PMID: 11447410 DOI: 10.1067/mje.2001.112101] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Transesophageal echocardiography (TEE) is widely used during heart valve replacement operations, but its clinical impact and cost-saving profile have not been studied prospectively for this indication. We investigated the clinical benefits and cost-savings of routine TEE for elective valve replacement at a regional tertiary center. We prospectively studied 300 patients (140 men; mean age [+/-SD], 66 +/- 9 years) undergoing aortic valve, mitral valve, or double-valve replacements. Transesophageal echocardiography with a biplane (in 161 patients) or a multiplane probe was performed before and after surgery. We assessed whether the TEE findings changed the operation or the postoperative treatment and the cost of TEE either as an extension of a preexisting service or as a new development. In 2 patients undergoing aortic valve replacement, significant mitral regurgitation on TEE led to additional mitral valve replacement, and in 1 patient undergoing mitral valve replacement, aortic regurgitation also required aortic valve replacement. Immediate reoperation (dehisced mitral valve prosthesis) and delayed extubation (suspected obstruction of an aortic valve prosthesis) were prompted by postoperative TEE. Extending an existing TEE service to routine intraoperative use saved up to $109 (US) per patient per year. Routine intraoperative TEE can provide major clinical benefit to a small proportion of patients undergoing elective valve replacement, and this can lead to cost savings, but only if the service can be provided without major capital investment.
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Affiliation(s)
- A A Ionescu
- Department of Cardiology, University of Wales College of Medicine, Cardiff, UK.
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Michel-Cherqui M, Ceddaha A, Liu N, Schlumberger S, Szekely B, Brusset A, Bonnet V, Bachet J, Goudot B, Dreyfus G, Guilmet D, Fischler M. Assessment of systematic use of intraoperative transesophageal echocardiography during cardiac surgery in adults: a prospective study of 203 patients. J Cardiothorac Vasc Anesth 2000; 14:45-50. [PMID: 10698392 DOI: 10.1016/s1053-0770(00)90055-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the usefulness of systematic intraoperative transesophageal echocardiography in a cardiac surgical unit. DESIGN Open prospective observational survey. SETTING University Hospital. PARTICIPANTS Consecutive adult patients (n = 203) undergoing elective or urgent cardiac operations. MEASUREMENTS AND MAIN RESULTS Pre-cardiopulmonary bypass imaging yielded unsuspected findings in 26 patients (12.8%) and changed the planned surgery in 22 patients (10.8%). Transesophageal echocardiography modified the diagnosis in eight patients (17%) operated on for mitral valvulopathy, in seven patients (15.5%) with aortic valvular disease, in four patients (4.6%) with coronary artery disease, in five patients operated on for thoracic aorta diseases regardless of their localization (18.5%), and in two miscellaneous cases. On the basis of the data obtained from the transesophageal echocardiography carried out at the end of cardiopulmonary bypass, an immediate reintervention was required in five cases (2.5%). CONCLUSIONS It is concluded that systematic intraoperative transesophageal echocardiography significantly affected decision making in this cardiac surgical unit. Its routine use in all cardiac surgical patients is recommended.
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Affiliation(s)
- M Michel-Cherqui
- Département d'Anesthésie and the Service de Chirurgie Cardio-Vasculaire, Hôpital Foch, Suresnes, France
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Mishra M, Chauhan R, Sharma KK, Dhar A, Bhise M, Dhole S, Omar A, Kasliwal RR, Trehan N. Real-time intraoperative transesophageal echocardiography--how useful? Experience of 5,016 cases. J Cardiothorac Vasc Anesth 1998; 12:625-32. [PMID: 9854658 DOI: 10.1016/s1053-0770(98)90232-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate transesophageal echocardiography (TEE) as an intraoperative monitoring modality and to assess its safety, reliability, and overall utility in real-time use during cardiac surgery. DESIGN Prospective, observational cohort study performed from January 1993 to June 1997. SETTING Operating room of a tertiary care hospital for cardiology and cardiovascular surgery. PARTICIPANTS Five thousand and sixteen adult patients with acquired heart disease, who underwent 1,356 valve procedures and 3,660 coronary artery bypass graftings (CABGs). INTERVENTIONS All patients were monitored with radial artery and pulmonary artery catheters, along with continuous TEE monitoring with a multiplane transducer. MEASUREMENTS AND MAIN RESULTS Prebypass imaging yielded unsuspected findings that either helped or modified the surgical plan in 158 of 1,356 valve procedures (11.65%) and in 993 of 3,660 CABGs (27.13%). There were 3,217 TEE-guided hemodynamic interventions in 944 patients (25.79%) in the CABG group and 629 in 142 patients (10.47%) in the valve group. TEE was the sole guiding factor in initiating therapy in 23.53% of events, whereas it was supportive to other monitoring modalities in 76.46% of events. Postbypass TEE identified the need for graft revision in 29 patients (0.8%), intra-aortic balloon pump (IABP) requirement in 29 patients (0.8%), and inadequate valve repair in 28 patients (2.08%). For the entire series, 38.78% of patients benefited from prebypass and 39.16% from postbypass use of TEE. There were no complications attributable to the use of TEE in the entire series. There was 87% concordance between online interpretation by a trained anesthesiologist and offline analysis by a cardiologist. CONCLUSION Intraoperative TEE is useful in formulating the surgical plan, guiding various hemodynamic interventions, and assessing the immediate results of surgery. It is safe and the results are reliable in the hands of trained anesthesiologists.
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Affiliation(s)
- M Mishra
- Escorts Heart Institute and Research Centre, New Delhi, India
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Bashar Izzat M, Yim AP. Importance of transesophageal echocardiography in directing the surgical approach to atrial myxomas. Surg Endosc 1997; 11:1136-7. [PMID: 9348396 DOI: 10.1007/s004649900552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Amuchastegui LM, Marani LP, Caeiro A. Right Ventricular Outflow Tract Tumor Mimicking a Thrombus in the Main Pulmonary Artery. Echocardiography 1997; 14:611-614. [PMID: 11175000 DOI: 10.1111/j.1540-8175.1997.tb00770.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Primary sarcomas of the pulmonary artery and right ventricle are rare, and their presentation is unusual in clinical practice; therefore, their diagnosis is often missed or delayed. The progression of the obstruction from the outflow tract of the right ventricle to the pulmonary artery resembles massive pulmonary embolism. We present a case of one of these tumors which mimicked transesophageal echocardiography (TEE), a massive pulmonary embolism. We conclude that TEE represents a noninvasive method of diagnosis and evaluation when the suspicion is massive pulmonary thromboembolism or a heart tumor.
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Affiliation(s)
- Luis M. Amuchastegui
- Servicio de Cardiologia-Hospital Privado, Naciones Unidas 346-Cordoba 5016, Argentina
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Bryden KE, Hall RI. Con: transesophageal echocardiography is not a cost-effective monitor during cardiac surgery. J Cardiothorac Vasc Anesth 1997; 11:250-2. [PMID: 9106002 DOI: 10.1016/s1053-0770(97)90223-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- K E Bryden
- Department of Anaesthesia, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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