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Chen T, Hayward G, Apruzzese P, Maslow A. Transesophageal echocardiographic imaging of the coronary sinus: a retrospective analysis of mid-esophageal views and a novel transgastric view. BMC Anesthesiol 2022; 22:326. [PMID: 36280815 PMCID: PMC9590129 DOI: 10.1186/s12871-022-01873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Transesophageal echocardiographic imaging plays an important role in assessing coronary sinus anatomy prior to placement of a retrograde cardioplegia cannula. The coronary sinus can be imaged in the long axis by advancing the TEE probe from the mid-esophageal 4-chamber view or using a modified mid-esophageal bicaval view, while a short axis view can be obtained in the mid-esophageal 2-chamber view. While use of a transgastric view is only briefly mentioned in the literature as an alternative to mid-esophageal views, the authors commonly include it in our comprehensive transesophageal echocardiographic exam of the coronary sinus. This study examines the various imaging strategies. We hypothesize that the transgastric view offers comparable coronary sinus imaging to the mid-esophageal views. Methods After approval by our institutional review board, the intraoperative transesophageal echocardiographic exams for 50 consecutive elective cardiac surgical patients with a comprehensive echocardiographic assessment of the coronary sinus were retrospectively reviewed and analyzed to evaluate imaging of the coronary sinus in the various views. For each view, we noted and recorded if the coronary sinus and coronary sinus cannula were visualized. Statistical analysis required pairwise comparisons between each of the 4 views. P values were calculated using McNemar’s Exact test. Results Both the coronary sinus and coronary sinus cannula were visualized a majority of the time for each view. There was no statistically significant difference between each view in its ability to visualize the coronary sinus, nor was there a statistically significant difference between each view in its ability to visualize the coronary sinus cannula. Conclusions Use of a transgastric window provides the echocardiographer with an effective alternate modality for imaging the coronary sinus when mid-esophageal views are limited.
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Affiliation(s)
- Tzonghuei Chen
- grid.40263.330000 0004 1936 9094Department of Anesthesiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital / Lifespan, 593 Eddy Street, Providence, RI 02903 USA ,East Greenwich, USA
| | - Geoffrey Hayward
- grid.40263.330000 0004 1936 9094Department of Anesthesiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital / Lifespan, 593 Eddy Street, Providence, RI 02903 USA
| | - Patricia Apruzzese
- grid.40263.330000 0004 1936 9094Department of Anesthesiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital / Lifespan, 593 Eddy Street, Providence, RI 02903 USA
| | - Andrew Maslow
- grid.40263.330000 0004 1936 9094Department of Anesthesiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital / Lifespan, 593 Eddy Street, Providence, RI 02903 USA
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VAN DER MERWE J, CASSELMAN F. Minimally invasive surgical and transcatheter interventions for aortic valve incompetence: current concepts and future perspectives. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:3-11. [DOI: 10.23736/s0021-9509.20.11516-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nicoara A, Skubas N, Ad N, Finley A, Hahn RT, Mahmood F, Mankad S, Nyman CB, Pagani F, Porter TR, Rehfeldt K, Stone M, Taylor B, Vegas A, Zimmerman KG, Zoghbi WA, Swaminathan M. Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach: From the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. J Am Soc Echocardiogr 2020; 33:692-734. [PMID: 32503709 DOI: 10.1016/j.echo.2020.03.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intraoperative transesophageal echocardiography is a standard diagnostic and monitoring tool employed in the management of patients undergoing an entire spectrum of cardiac surgical procedures, ranging from "routine" surgical coronary revascularization to complex valve repair, combined procedures, and organ transplantation. Utilizing a protocol as a starting point for imaging in all procedures and all patients enables standardization of image acquisition, reduction in variability in quality of imaging and reporting, and ultimately better patient care. Clear communication of the echocardiographic findings to the surgical team, as well as understanding the impact of new findings on the surgical plan, are paramount. Equally important is the need for complete understanding of the technical steps of the surgical procedures being performed and the complications that may occur, in order to direct the postprocedure evaluation toward aspects directly related to the surgical procedure and to provide pertinent echocardiographic information. The rationale for this document is to outline a systematic approach describing how to apply the existing guidelines to questions on cardiac structure and function specific to the intraoperative environment in open, minimally invasive, or hybrid cardiac surgery procedures.
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Affiliation(s)
| | | | - Niv Ad
- White Oak Medical Center and University of Maryland, Silver Spring, Maryland
| | - Alan Finley
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Bradley Taylor
- University of Maryland Medical Center, Baltimore, Maryland
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The Prevalence of the Double-Barrel View with Prominent Eustachian Valve in Patients with Atrial Septal Defect. J Am Soc Echocardiogr 2019; 32:1618-1619. [DOI: 10.1016/j.echo.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/17/2022]
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Malvindi PG, Carbone C, Labriola C, Paparella D. Surgical retrieval of a degenerated Sapien 3 valve after 29 months. Interact Cardiovasc Thorac Surg 2017; 25:155-156. [PMID: 28379465 DOI: 10.1093/icvts/ivx057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/01/2017] [Indexed: 11/14/2022] Open
Abstract
A 70-year-old man developed heart failure due to severe mixed disease of a degenerated transcatheter aortic valve prosthesis. The patient underwent retrieval of the transcatheter aortic valve and implantation of a 25-mm bioprosthesis through a redo sternotomy.
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Affiliation(s)
- Pietro Giorgio Malvindi
- Department of Cardiovascular Surgery, GVM Care and Research, Santa Maria Hospital, Bari, Italy
| | - Carmine Carbone
- Department of Cardiovascular Surgery, GVM Care and Research, Santa Maria Hospital, Bari, Italy
| | - Cataldo Labriola
- Department of Cardiovascular Surgery, GVM Care and Research, Santa Maria Hospital, Bari, Italy
| | - Domenico Paparella
- Department of Cardiovascular Surgery, GVM Care and Research, Santa Maria Hospital, Bari, Italy.,Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
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Labriola C, Paparella D, Labriola G, Dambruoso P, Cassese M, Speziale G. Reliability of Percutaneous Pulmonary Vent and Coronary Sinus Cardioplegia in the Setting of Minimally Invasive Aortic Valve Replacement: A Single-Center Experience. J Cardiothorac Vasc Anesth 2017; 31:1203-1209. [PMID: 28082031 DOI: 10.1053/j.jvca.2016.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Evaluating the efficacy of 2 new percutaneous devices specifically designed to be placed through the right internal jugular vein, therefore named "necklines," for achieving retrograde cardioplegia and pulmonary venting in the setting of minimally invasive aortic valve replacement (MIAVR). DESIGN Case series. SETTING University-affiliated private hospital. PARTICIPANTS Patients undergoing MIAVR. INTERVENTIONS Necklines were placed by the anesthesiologist using transesophageal electrocardiography, with pressure guidance before the surgical procedure was initiated. MEASUREMENTS AND MAIN RESULTS The records of 51 consecutive patients who underwent MIAVR with necklines placement were reviewed retrospectively. The access for MIAVR was through either a J-hemisternotomy or a right anterior thoracotomy. The efficacy of the 2 catheters, successful placement rate, time needed to deploy catheters, and perioperative complications were recorded. Necklines were placed successfully in all patients in 23±13 minutes. A total of 110 doses of retrograde cardioplegia were delivered at a mean flow rate of 173±35 mL/min and a mean pressure of 41±6 mmHg. The pulmonary catheter ensured venting of the heart that was graded by surgeons as "excellent" in 33 patients, "sufficient" in 12 patients, and "not adequate" in 2 patients. There were no major adverse events or deaths. CONCLUSIONS Necklines ensure effective retrograde cardioplegia and venting of the heart, provide optimal surgical vision and access during MIAVR, and allow surgeons to operate in an unobstructed surgical field. Nevertheless, additional studies are required to determine whether the use of necklines is associated with better outcomes than those with conventional methods.
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Affiliation(s)
- Cataldo Labriola
- Department of Cardiac Anesthesia, Santa Maria Hospital-GVM Care & Research, Bari, Italy.
| | | | - Giuseppe Labriola
- Department of Cardiac Surgery, Santa Maria Hospital-GVM Care & Research, Bari, Italy
| | - Pierpaolo Dambruoso
- Department of Cardiac Anesthesia, Santa Maria Hospital-GVM Care & Research, Bari, Italy
| | - Mauro Cassese
- Department of Cardiac Surgery, Santa Maria Hospital-GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Santa Maria Hospital-GVM Care & Research, Bari, Italy
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Martinelli GL, Cotroneo A, Caimmi PP, Musica G, Barillà D, Stelian E, Romano A, Novelli E, Renzi L, Diena M. Safe Reentry for False Aneurysm Operations in High-Risk Patients. Ann Thorac Surg 2016; 103:1907-1913. [PMID: 27916243 DOI: 10.1016/j.athoracsur.2016.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the absence of a standardized safe surgical reentry strategy for high-risk patients with large or anterior postoperative aortic false aneurysm (PAFA), we aimed to describe an effective and safe approach for such patients. METHODS We prospectively analyzed patients treated for PAFA between 2006 and 2015. According to the preoperative computed tomography scan examination, patients were divided into two groups according to the anatomy and extension of PAFA: in group A, high-risk PAFA (diameter ≥3 cm) developed in the anterior mediastinum; in group B, low-risk PAFA (diameter <3 cm) was situated posteriorly. For group A, a safe surgical strategy, including continuous cerebral, visceral, and coronary perfusion was adopted before resternotomy; group B patients underwent conventional surgery. RESULTS We treated 27 patients (safe reentry, n = 13; standard approach, n = 14). Mean age was 60 years (range, 29 to 80); 17 patients were male. Mean interval between the first operation and the last procedure was 4.3 years. Overall 30-day mortality rate was 7.4% (1 patient in each group). No aorta-related mortality was observed at 1 and 5 years in either group. The Kaplan-Meier overall survival estimates at 1 and 5 years were, respectively, 92.3% ± 7.4% and 73.4% ± 13.4% in group A, and 92.9% ± 6.9% and 72.2% ± 13.9% in group B (log rank test, p = 0.830). Freedom from reoperation for recurrent aortic disease was 100% at 1 year and 88% at 5 years. CONCLUSIONS The safe reentry technique with continuous cerebral, visceral, and coronary perfusion for high-risk patients resulted in early and midterm outcomes similar to those observed for low-risk patients undergoing conventional surgery.
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Affiliation(s)
- Gian Luca Martinelli
- Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy.
| | - Attilio Cotroneo
- Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
| | - Philippe Primo Caimmi
- Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
| | - Gabriele Musica
- Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
| | - David Barillà
- Vascular Surgery Department, Ospedali Riuniti Bianchi Melacrino Morelli, Reggio Calabria
| | - Edmond Stelian
- Department of Cardiac Anesthesiology, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
| | - Angelo Romano
- Department of Cardiac Anesthesiology, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
| | - Eugenio Novelli
- Department of Biostatistics and Clinical Research, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
| | - Luca Renzi
- Unit of Cardiopulmonary Circulatory Support, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
| | - Marco Diena
- Department of Cardiac Surgery, Clinica San Gaudenzio-Gruppo Policlinico di Monza, Novara, Italy
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Hanada S, Sakamoto H, Swerczek M, Ueda K. Initial experience with percutaneous coronary sinus catheter placement in minimally invasive cardiac surgery in an academic center. BMC Anesthesiol 2016; 16:33. [PMID: 27401491 PMCID: PMC4940684 DOI: 10.1186/s12871-016-0203-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/30/2016] [Indexed: 12/18/2022] Open
Abstract
Background Placement of a percutaneous coronary sinus catheter (CSC) by an anesthesiologist for retrograde cardioplegia in minimally invasive cardiac surgery is relatively safe in experienced hands. However, the popularity of its placement remains limited to a small number of centers due to its perceived complexity and potential complications. Methods We retrospectively reviewed all cardiac cases performed by one surgeon between December 2009 and April 2012. The reviewed cases were divided into two groups: cardiac cases with percutaneous CSC placement (CSC group) and cardiac cases without placement (control group). Anesthesia preparation time (APT) was then compared between the CSC group and control group. In the CSC group, cases were further divided into two groups. One group contained cases with an APT of less than 90 min (success group) and the other contained cases with an APT greater than or equal to 90 min or cases with CSC placement failure (delay/failure group). Patients’ characteristics, type of surgery, and transesophageal echocardiography (TEE) findings were compared between the two groups (success group vs. delay/failure group) to identify variables associated with prolongation of the APT or CSC placement failure. Results Percutaneous CSC placement was required in 83 cases (CSC group). The catheter was successfully placed in 74 of those cases. We experienced one complication, coronary sinus injury after multiple attempts at placing the catheter. The mean APT was 102 ± 31 min in the CSC group (n = 81) and 42 ± 15 min in the control group (n = 285). We could not identify any variables associated with prolongation of the APT or catheter placement failure. Conclusions The success rate of the placement was 89.1 % in our academic center. On average, placing the CSC added approximately one additional hour to the APT. This time is not an accurate representation of true catheter placement time, as it included time for preparation of the CSC, TEE, and fluoroscopy. We experienced one documented complication (coronary sinus injury), which was immediately diagnosed by TEE and fluoroscopy in the operating room. No variables associated with prolongation of APT or CSC placement failure were identified. Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0203-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Satoshi Hanada
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 6JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Hajime Sakamoto
- Department of Anesthesia, Akashi Medical Center, 743-33 Okubocho Yagi, Akashi, Hyogo Prefecture, 674-0063, Japan
| | - Michael Swerczek
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 6JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Kenichi Ueda
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 6JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Mehra L, Raheja S, Agarwal S, Rani Y, Kaur K, Tuli A. Anatomical considerations of percutaneous transvenous mitral annuloplasty: a novel procedure for treatment of functional mitral regurgitation. Anat Cell Biol 2016; 49:68-72. [PMID: 27051569 PMCID: PMC4819079 DOI: 10.5115/acb.2016.49.1.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/29/2016] [Accepted: 03/03/2016] [Indexed: 12/27/2022] Open
Abstract
Percutaneous transvenous mitral annuloplasty (PTMA) has evolved as a latest procedure for the treatment of functional mitral regurgitation. It reduces mitral valve annulus (MVA) size and increases valve leaflet coaptation via compression of coronary sinus (CS). Anatomical considerations for this procedure were elucidated in the present study. In 40 formalin fixed adult cadaveric human hearts, relation of the venous channel formed by CS and great cardiac vein (GCV) to MVA and the adjacent arteries was described, at 6 points by making longitudinal sections perpendicular to the plane of MVA, numbered 1-6 starting from CS ostium. CS/GCV formed a semicircular venous channel on the atrial side of MVA. Based on the distance of CS/GCV from MVA, two patterns were identified. In 37 hearts, the venous channel at point 2 was widely separated from the MVA compared to the two ends and in three hearts a nonconsistent pattern was observed. GCV crossed circumflex artery superficially. GCV or CS crossed the left marginal artery and ventricular branches of circumflex artery superficially in 17 and 23 hearts, respectively. As the venous channel was related more to the left atrial wall, PTMA devices probably exert an indirect traction on MVA. The arteries crossing deep to the venous channel may be compressed by PTMA device leading to myocardial ischemia. Knowledge of the spatial relations of MVA and a preoperative and postoperative angiogram may help to reduce such complications during PTMA.
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Affiliation(s)
- Lalit Mehra
- Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Shashi Raheja
- Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Sneh Agarwal
- Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Yashoda Rani
- Department of Forensic Medicine and Toxicology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Kulwinder Kaur
- Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Anita Tuli
- Department of Anatomy, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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