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Waldmann V, Milleron O, Iung B, Messika-Zeitoun D, Lepage L, Ghodbane W, Brochet E, Vahanian A, Nataf P, Jondeau G. Is Transesophageal Echocardiography Needed before Hospital Discharge in Patients after Bentall Surgery? J Am Soc Echocardiogr 2016; 30:52-58. [PMID: 27843101 DOI: 10.1016/j.echo.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Indexed: 01/16/2023]
Abstract
BACKGOUND Whether transesophageal echocardiography (TEE) should be routinely performed before hospital discharge after Bentall surgery remains unclear. The investigators took advantage of this practice at their institution to evaluate its benefit. METHODS All patients who had undergone the Bentall procedure at Bichat Hospital from January 2010 to March 2014 were included. For each patient, transthoracic echocardiographic and transesophageal echocardiographic data and clinical events were retrospectively collected from the various reports. RESULTS One hundred ninety-eight patients underwent the Bentall procedure during the study period. Postoperative TEE was performed in 117 patients (59.1%), including nine with abnormalities observed on transthoracic echocardiography (a vibrating element on the new prosthetic valve, suspicion of peritubular complications in two patients, and aortic regurgitation in six patients). In 108 patients, routine TEE was performed (i.e., without clinical indication beyond baseline postoperative imaging). Patients with and those without routine TEE were identical, except for more frequent endocarditis as an indication for surgery in patients with routine TEE. Routine TEE did not reveal any new findings that prior transthoracic echocardiography had not shown. The most frequent finding on transthoracic echocardiography or TEE was periaortic hematoma, which sometimes led to the performance of computed tomography. This imaging did not change the care of the patients in this population. CONCLUSIONS This study does not support the performance of TEE after Bentall surgery during the in-hospital course in the absence of a specific indication. Baseline postoperative imaging using TEE or computed tomography should preferably be recommended beyond the early postoperative period after periaortic hematoma has resolved.
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Affiliation(s)
| | | | - Bernard Iung
- Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France
| | - David Messika-Zeitoun
- Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France
| | - Laurent Lepage
- Department of Cardiac Surgery, Bichat Hospital, Paris, France
| | - Walid Ghodbane
- Department of Cardiac Surgery, Bichat Hospital, Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat Hospital, Paris, France
| | - Alec Vahanian
- Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France
| | - Patrick Nataf
- Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; Department of Cardiac Surgery, Bichat Hospital, Paris, France; University Paris 7, Paris, France
| | - Guillaume Jondeau
- Department of Cardiology, Bichat Hospital, Paris, France; Laboratory for Vascular Translational Science, INSERM U1148, Bichat Hospital, Paris, France; University Paris 7, Paris, France.
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Rakow N, Barka N, Gerhart R, Grassl E, Green M, Rothstein P, Schu C, Kopcak M, Shecterle LM, St Cyr JA. Chronic aortic root pressure-loading assessment model. Ther Adv Cardiovasc Dis 2015; 9:40-4. [PMID: 25561010 DOI: 10.1177/1753944714566425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Percutaneous placement of transcatheter prosthetic aortic valves without cardiopulmonary bypass (CPB) continues to gain clinical acceptance. However, information on pressure-loading characteristics of the aortic root/annular areas is limited. For this reason, we designed a preclinical model, implanting an aortic root load transducer with a power source/telemetry system for chronic, conscious, loading data acquisition. This research study was conducted to determine whether an animal model could accurately measure in vivo loading. METHODS Preoperatively, echocardiography and magnetic resonance imaging were used to determine both aortic annular and sinotubular junction dimensions, as well as ascending aortic length. Six adult sheep were placed on CPB, aortic root and ascending aorta were skeletonized and the origins of both coronary ostia were identified. Cardiac arrest with myocardial protection with cold coronary blood cardioplegia was instituted. A properly sized aortic root load-sensing device, consisting of a transcatheter aortic valve with a ring load transducer was implanted via a left apical ventriculotomy. Verification of position was determined before closure of the ventriculotomy. Each animal was weaned from CPB, and closed in routine fashion with the power source of the device placed in a subcutaneous pocket. RESULTS There were no operative deaths or significant postoperative complications. Serial pressure-load sensing assessments in a conscious state produced reproducible proprietary data. CONCLUSIONS This animal model allowed successful serial pressure-load sensing assessment of the aortic root/annular areas, providing a better physiological understanding of these anatomical inter-relationships. This added information could aid in future device designs with potential improved clinical outcomes.
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Affiliation(s)
- Nancy Rakow
- Physiological Research Laboratories, Medtronic, Inc., Minneapolis, MN, USA
| | - Noah Barka
- Physiological Research Laboratories, Medtronic, Inc., Minneapolis, MN, USA
| | - Renee Gerhart
- Physiological Research Laboratories, Medtronic, Inc., Minneapolis, MN, USA
| | - Erin Grassl
- Physiological Research Laboratories, Medtronic, Inc., Minneapolis, MN, USA
| | - Michael Green
- Physiological Research Laboratories, Medtronic, Inc., Minneapolis, MN, USA
| | - Paul Rothstein
- Physiological Research Laboratories, Medtronic, Inc., Minneapolis, MN, USA
| | - Carl Schu
- Physiological Research Laboratories, Medtronic, Inc., Minneapolis, MN, USA
| | - Michael Kopcak
- Physiological Research Laboratories, Medtronic, Inc., Minneapolis, MN, USA
| | - Linda M Shecterle
- Physiological Research Laboratories, Medtronic, Inc., Minneapolis, MN, USA
| | - John A St Cyr
- Physiological Research Laboratories, Medtronic, Inc., 11520 Yellow Pine Street NW, Minneapolis, MN 55448, USA
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Dutt M, Ngai J. Anesthetic management of total tetralogy of Fallot repair in an adult patient after diagnosis by transesophageal echocardiography. J Cardiothorac Vasc Anesth 2014; 29:425-30. [PMID: 24589072 DOI: 10.1053/j.jvca.2013.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Dutt
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY
| | - Jennie Ngai
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY.
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Prcovic B. Significance of transesophageal echocardiography in the evaluation of aortic valve stenosis. VOJNOSANIT PREGL 2010; 67:7-12. [DOI: 10.2298/vsp1001007p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Transesophageal echocardiography (TEE) is a relatively new diagnostic method offering better resolution of cardiac anatomy than the conventional transthoracal two-dimensional echocardiography (TTE). Clinical indications for TEE have been expanding, thus the technique as a diagnostic procedure is used in numerous cardiac diseases such as endocarditis, congenital heart defect, aortic dissection, prosthetic valves dysfunction, as well as in calculation of aortic valve surface in aortic stenosis. The aim of the study was to prove TEE as a more precise method in determination of the level of seriousness of aortic valve stenosis. Methods. All the patients went through TTE and TEE. Evaluating of the aortic valve surface was performed by the use of Gorlin's formula in TTE while it was planimetric in TEE examination. Results. Comparative analysis of all parameters obtained by TTE and TEE showed a difference between them. All the parameters values except that for surface area of the aortic valve orifice confluence were higher in TEE than in TTE examination, but no difference was statistically significant (p > 0.05; t-test for a dependant specimens). By the use of the TTE method, the size of aortic orifice stenosis was 1.22 ? 0.54 cm2, and by the TEE method it was 1.08 ? 0.54 cm2. Conclusion. Multiplain TEE is reliable in quantification of an aortic valve area in patients with aortic stenosis. It offers useful clinical information, particularly in patients with non-adequate evaluation with TTE, as well as in seriously ill patients or those with a confirmed valvular defect.
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Affiliation(s)
- Biljana Prcovic
- Vojnomedicinska akademija, Dijagnostičko-poliklinički centar, Beograd%SR71-02
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Quintavalla C, Pradelli D, Domenech O, Bussadori C. TRANSESOPHAGEAL ECHOCARDIOGRAPHY OF THE LEFT VENTRICULAR OUTFLOW TRACT, AORTIC VALVE AND ASCENDING AORTA IN BOXER DOGS WITH HEART MURMURS. Vet Radiol Ultrasound 2006; 47:307-12. [PMID: 16700184 DOI: 10.1111/j.1740-8261.2006.00145.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The study was aimed at evaluating the anatomy of the left ventricular outflow tract, aortic valve, and ascending aorta by means of multiplane transesophageal echocardiography in Boxer dogs with left basilar heart murmurs and at comparing two-dimensional (2D) transthoracic to transesophageal echocardiography for the diagnosis of subaortic stenosis in this breed. Twenty-eight Boxers were included in the study and allocated to four groups according to physical and routine transthoracic 2D and Doppler echocardiography findings: group A--dogs with low grade (I-II/VI) heart murmurs without overt evidence of aortic stenosis (14 dogs); group B--dogs with type 1 subaortic stenosis (seven dogs); group C--dogs with type 2 subaortic stenosis (five dogs); group D--dogs with type 3 subaortic stenosis (two dogs). Anatomic lesions were not discovered by transesophageal echocardiography in dogs belonging to group A. Transesophageal imaging confirmed the type of subaortic stenosis, as graded by transthoracic echocardiography, in diseased animals (groups BCD). Morphologic information obtained by transesophageal echocardiography in Boxer dogs was similar to that obtained by transthoracic echocardiography.
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Gologorsky E, Gologorsky A. Aortic valve fibroelastomas as an incidental intraoperative transesophageal echocardiographic finding. Anesth Analg 2002; 95:1198-9, table of contents. [PMID: 12401593 DOI: 10.1097/00000539-200211000-00015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
IMPLICATIONS We report incidental findings of aortic valve fibroelastomas during routine intraoperative transesophageal echocardiography examination in cardiac surgery. Preoperative echocardiography failed to identify this potentially devastating pathology. The echocardiographic features of this lesion are reviewed, and the importance of diligence and complete examination are emphasized.
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Affiliation(s)
- Edward Gologorsky
- Department of Anesthesiology, Memorial Regional Hospital, 3501 Johhson Street, Hollywood, FL 33021, USA.
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