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Notarianni AP, Montealegre-Gallegos M, Pospishil L. Looking With New Eyes: The Updated Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging. J Cardiothorac Vasc Anesth 2024; 38:1611-1614. [PMID: 38862289 DOI: 10.1053/j.jvca.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 06/13/2024]
Affiliation(s)
- Andrew P Notarianni
- Division of Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar St., TMP 3, PO Box 208051, New Haven, CT 06520
| | - Mario Montealegre-Gallegos
- Division of Cardiac Anesthesiology and Critical Care, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar St., TMP 3, PO Box 208051, New Haven, CT 06520
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, 550 First Avenue TH 530, New York, NY 10016
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Sharkey A, Mahmood F, Hai T, Khamooshian A, Gao Z, Amador Y, Khabbaz K. Regional geometric differences between regurgitant and non-regurgitant mitral valves in patients with coronary artery disease. Echocardiography 2023; 40:750-759. [PMID: 37002823 DOI: 10.1111/echo.15549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Demonstrate that regional geometric differences exist between regurgitant and non-regurgitant mitral valves (MV's) in patients with coronary artery disease and due to the heterogenous and regional nature of ischemic remodeling in patients with coronary artery disease (CAD), that the available anatomical reserve and likelihood of developing mitral regurgitation (MR) is variable in non-regurgitant MV's in patients with CAD. METHODS In this retrospective, observational study intraoperative three-dimensional transesophageal echocardiographic data was analyzed in patients undergoing coronary revascularization with MR (IMR group) and without MR (NMR group). Regional geometric differences between both groups were assessed and MV reserve which was defined as the increase in antero-posterior (AP) annular diameter from baseline that would lead to coaptation failure was calculated in three zones of the MV from antero-lateral (zone 1), middle (zone 2), and posteromedial (zone 3). MEASUREMENTS AND MAIN RESULTS There were 31 patients in the IMR group and 93 patients in the NMR group. Multiple regional geometric differences existed between both groups. Most significantly patients in the NMR group had significantly larger coaptation length and MV reserve than the IMR group in zones 1 (p-value = .005, .049) and 2 (p-value = .00, .00), comparable between the two groups in zone 3 (p-value = .436, .513). Depletion of the MV reserve was associated with posterior displacement of the coaptation point in zones 2 and 3. CONCLUSIONS There are significant regional geometric differences between regurgitant and non-regurgitant MV's in patients with coronary artery disease. Due to regional variations in available anatomical reserve and the risk of coaptation failure in patients with CAD, absence of MR is not synonymous with normal MV function.
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Affiliation(s)
- Aidan Sharkey
- Department of Anesthesia Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Feroze Mahmood
- Department of Anesthesia Critical Care and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ting Hai
- Department of Anesthesiology, Peking University Peoples Hospital, Beijing, China
| | - Arash Khamooshian
- Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Zhifeng Gao
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yannis Amador
- Department of Anesthesiology and Perioperative Medicine, Queens University, Kingston, Ontario, Canada
| | - Kamal Khabbaz
- Division of Cardiac Surgery, Roberta L Hines Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Hassan AY, Kandil HI, Salem MA, Mohamed AS, Kassem HH. Diagnostic accuracy of cardiac computed tomographic angiography and transesophageal echocardiography in evaluation of patients with prosthetic paravalvular leakage. Echocardiography 2022; 39:1122-1130. [DOI: 10.1111/echo.15428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/11/2022] [Accepted: 07/11/2022] [Indexed: 10/16/2022] Open
Affiliation(s)
- Amr Youssef Hassan
- Department of Cardiovascular medicine Cairo University Hospital Cairo Egypt
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Katsiampoura A, Mufarrih SH, Sharkey A, Bose R, Mahboobi SK, Matyal R, Mahmood F. A Sequential Approach for Echocardiographic Guidance of Trans-Septal Puncture – The PITLOC Protocol. J Cardiothorac Vasc Anesth 2021; 36:3257-3264. [DOI: 10.1053/j.jvca.2021.12.025] [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: 10/18/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 11/11/2022]
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Qureshi NQ, Sharkey A, Mufarrih SH, Baribeau V, Quraishi I, Bose R, Matyal R, Khabbaz KR, Mahmood F. Dynamic Geometric Tricuspid Valve Assessment: Extending from Bench to Bedside. J Cardiothorac Vasc Anesth 2021; 36:3244-3249. [PMID: 34969563 DOI: 10.1053/j.jvca.2021.11.035] [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: 10/07/2021] [Accepted: 11/22/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Nada Qaisar Qureshi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Syed Hamza Mufarrih
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vincent Baribeau
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ibrahim Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ruma Bose
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Mahmood F, Sharkey A, Maslow A, Mufarrih SH, Qureshi NQ, Matyal R, Khabbaz KR. Echocardiographic Assessment of the Mitral Valve for Suitability of Repair: An Intraoperative Approach From a Mitral Center. J Cardiothorac Vasc Anesth 2021; 36:2164-2176. [PMID: 34334319 DOI: 10.1053/j.jvca.2021.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 11/11/2022]
Abstract
Intraoperative echocardiography of the mitral valve in the precardiopulmonary bypass period is an integral part of the surgical decision-making process for assessment of suitability for repair. Although there are comprehensive reviews in the literature regarding echocardiographic examination of the mitral valve, the authors present a practical stepwise algorithmic workflow to make objective recommendations. Advances in echocardiography allow for quantitative geometric analyses of the mitral valve, along with precise assessment of the valvular apparatus with three-dimensional echocardiography. In the precardiopulmonary bypass period, echocardiographers are required to diagnose and quantify valvular dysfunction, assess suitability for repair, assist in annuloplasty ring sizing, and determine the success or failure of the surgical procedure. In this manuscript the authors outline an algorithmic approach to intraoperative echocardiography examination using two-dimensional and three-dimensional modalities to objectively analyze mitral valve function and assist in surgical decision-making.
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Affiliation(s)
- Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Syed Hamza Mufarrih
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Nada Qaisar Qureshi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kamal R Khabbaz
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Hassan AY, Kassem HH, Kandil HI, Meshaal MS, Salem MA, Mohamed AS. Impact of Cardiac Computed Tomographic Angiography on Diagnostic and Therapeutic Decisions in Patients with Suspected Prosthetic Heart Valve Dysfunction. J Saudi Heart Assoc 2021; 33:85-94. [PMID: 33936942 PMCID: PMC8084306 DOI: 10.37616/2212-5043.1231] [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: 09/27/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Computed Tomography (CT) scan is a helpful tool to assess the coronary arteries and the great vessels. However, its routine use in the assessment of patients with suspected prosthetic valve dysfunction (PVD) has not been studied thoroughly. Objective To determine the impact of routine cardiac computed tomography angiography (CCTA) on diagnostic and therapeutic decisions in patients with suspected PVD. Methods and results This was a prospective cohort study that was conducted on 50 consecutive patients with suspected PVD who underwent both 64-slice ECG-gated CT and transesophageal echocardiography (TEE). The gold standard was the intraoperative findings. Surgery was performed in forty-six patients. ECG-gated CT showed findings that were not detected by TEE in sixteen patients (32%) namely aortic root abscess, aortic pseudoaneurysm, paravalvular leakage (PVL), sclero-calcific disruption of sutures as cause of PVL, mechanical prosthesis occluder malfunction, an underlying thrombus as cause of malfunction and finally presence of aortic dissection. Furthermore, CTA findings dictated treatment changes in fourteen patients (28%). Conclusion This study demonstrates that ECG-gated CTA has a complementary role to TEE in patients with suspected PVD. CCTA is more accurate in diagnosis of periannular complications (Aortic root abscess and Pseudo-aneurysm) and in delineating their anatomical relation to surrounding cardiac structures. Therefore CCTA can have important role in deciding and planning the method of correction whether surgical or percutaneous and has to be considered after TEE in patients with a high suspicion on PVD.
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Sizing of mitral annuloplasty rings using real-time three-dimensional transesophageal echocardiography and the difference between patients with and without recurrent mitral regurgitation: retrospective cohort study. J Echocardiogr 2020; 18:169-174. [PMID: 32144581 DOI: 10.1007/s12574-020-00465-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/08/2020] [Accepted: 02/25/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Previous studies showed that the mitral inter-commissural (IC) distance differed by a few millimeters between the systolic and diastolic cardiac cycles. However, sizing of the mitral annuloplasty ring with a ring sizer, which should be performed in the systole, is performed in diastole during hyperkalemic cardioplegic arrest. The aim of this study was to investigate whether three-dimensional transesophageal echocardiography (3D-TEE) measurements of the mitral valve in end-systole are effective to determine the size of the annuloplasty ring. METHODS This study retrospectively reviewed 92 patients who underwent mitral annuloplasty for degenerative. The IC distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systole. The annuloplasty ring size was measured by the surgeons using specific ring sizers. We compared the IC distance measured by 3D-TEE with the implanted annuloplasty size. We also investigated differences in IC distance, A2 height, and ratio of A2 height to IC distance in patients with and without recurrent mild to moderate MR for 36 months. RESULTS There was a significant correlation between the IC distance by 3D-TEE and the implanted ring size (R2 = 0.7023, p < 0.001). Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059). CONCLUSIONS Our results demonstrated a larger ratio of A2 height to IC distance in patients with recurrent MR. 3D-TEE could be useful for the ring sizing.
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Baribeau Y, Sharkey A, Mahmood E, Feng R, Chaudhary O, Baribeau V, Mahmood F, Matyal R, Khabbaz K. Three-Dimensional Printing and Transesophageal Echocardiographic Imaging of Patient-Specific Mitral Valve Models in a Pulsatile Phantom Model. J Cardiothorac Vasc Anesth 2019; 33:3469-3475. [DOI: 10.1053/j.jvca.2019.07.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/11/2022]
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Holmes M, Sheu R. The Use of Intraoperative Three-Dimensional Echocardiography to Evaluate Origin of Bioprosthetic Aortic Valve Regurgitant Jets. J Cardiothorac Vasc Anesth 2019; 33:3504-3508. [PMID: 31375407 DOI: 10.1053/j.jvca.2019.05.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/22/2019] [Accepted: 05/29/2019] [Indexed: 01/18/2023]
Abstract
Degradation of bioprosthetic aortic valves can eventually lead to both paravalvular and intravalvular regurgitation. However, differentiating between the two may be difficult in the case of multiple lesions in close proximity or highly eccentric jets. Whereas such exact distinction may be of little procedural significance in open cardiac surgery, it is of crucial importance when approaching such lesions in the catheterization laboratory or hybrid operating room. Interventions on one lesion often have a significant effect on the other. For example, guidewires may damage new bioprosthetic valve leaflets and dislodge vascular plugs. Even more concerning is the possibility of undergoing a lengthy and risky procedure on a lesion that does not truly exist. Fortunately, the use of three-dimensional Doppler echocardiography can expand our vision beyond the single imaging plane of a standard two-dimensional examination, allowing extensive manipulation of cutting planes and a wider field of view. Regurgitant jets can thus be tracked in a way that may be otherwise impossible, better quantifying their true origins. Here the authors present a unique case of misdiagnosis after surgical aortic valve degradation, where the use of intraoperative three-dimensional echocardiography significantly altered the preoperative plan and reduced operative time.
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Affiliation(s)
- Michael Holmes
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Richard Sheu
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA.
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Miyoshi F, Seino Y, Nomura M, Ozaki M. Intraoperative real-time three-dimensional transesophageal echocardiography as a precise navigator for a successful complicated postoperative left ventricular pseudoaneurysm repair: a case report. JA Clin Rep 2019; 5:41. [PMID: 32026078 PMCID: PMC6967255 DOI: 10.1186/s40981-019-0261-y] [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: 04/24/2019] [Accepted: 06/14/2019] [Indexed: 11/15/2022] Open
Abstract
Background Left ventricular pseudoaneurysm (LV-PAN) formation is a rare complication after cardiac surgery and mainly occurs after mitral valve surgery. Echocardiography plays a critical role in the assessment of rupture location, orifice geometry, and anatomical relationship with surrounding structures. Case presentation A 56-year-old man presented with LV-PAN formation 1 year after aortic root replacement combined with aortic replacement despite the lack of direct manipulation of the rupture site in the procedure and postoperative myocardial infarction. Intraoperative real-time three-dimensional transesophageal echocardiography (RT 3-D TEE) during surgical repair of the LV-PAN facilitated understanding of the shape of the LV-PAN orifice and the exact anatomical relationship between the rupture site and the posteromedial papillary muscle. Information sharing with surgeons contributed to avoiding direct papillary muscle injury and thus mitral valve deformation. Conclusion LV-PAN formation after cardiac surgery can present without direct manipulation of the rupture site and major coronary lesion. Intraoperative RT 3-D TEE can facilitate better understanding of the anatomical relationship between the rupture site and the posteromedial papillary muscle and allow for information sharing to avoid complications during surgical repair.
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Affiliation(s)
- Futaba Miyoshi
- Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yusuke Seino
- Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
| | - Minoru Nomura
- Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Makoto Ozaki
- Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
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Chacon MM, Neuburger PJ. Intraoperative Measurement of the Tricuspid Annulus: To 3D or not to 3D? J Cardiothorac Vasc Anesth 2019; 33:146-148. [DOI: 10.1053/j.jvca.2018.07.009] [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: 07/03/2018] [Indexed: 01/16/2023]
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Aortic annulus sizing in stenotic bicommissural non-raphe-type bicuspid aortic valves: reconstructing a three-dimensional structure using only two hinge points. Clin Res Cardiol 2018; 108:6-15. [DOI: 10.1007/s00392-018-1295-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/05/2018] [Indexed: 02/06/2023]
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Role of Echocardiography in Transcatheter Mitral Valve Replacement in Native Mitral Valves and Mitral Rings. J Am Soc Echocardiogr 2018; 31:475-490. [DOI: 10.1016/j.echo.2018.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Indexed: 02/06/2023]
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Capdeville M, Ural KG, Patel PA, Broussard DM, Goldhammer JE, Linganna RE, Feinman JW, Gordon EK, Augoustides JG. The Educational Evolution of Fellowship Training in Cardiothoracic Anesthesiology – Perspectives From Program Directors Around the United States. J Cardiothorac Vasc Anesth 2018; 32:607-620. [DOI: 10.1053/j.jvca.2017.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Indexed: 12/28/2022]
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Nyman CB, Mackensen GB, Jelacic S, Little SH, Smith TW, Mahmood F. Transcatheter Mitral Valve Repair Using the Edge-to-Edge Clip. J Am Soc Echocardiogr 2018; 31:434-453. [PMID: 29482977 DOI: 10.1016/j.echo.2018.01.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 12/20/2022]
Abstract
Percutaneous intervention for mitral valve (MV) disease has been established as an alternative to open surgical MV repair in patients with prohibitive surgical risk. Multiple percutaneous approaches have been described and are in various stages of development. Edge-to-edge leaflet plication with the MitraClip (Abbott, Menlo Park, CA) is currently the only Food and Drug Administration-approved device specifically for primary or degenerative lesions. Use of the edge-to-edge clip for secondary mitral regurgitation is currently under investigation and may result in expanded indications. Echocardiography has significantly increased our understanding of the anatomy of the MV and provided us with the ability to classify and quantify the associated mitral regurgitation. For percutaneous interventions of the MV, transesophageal echocardiography imaging is used for patient screening, intraprocedural guidance, and confirmation of the result. Optimal outcomes require the echocardiographer and the proceduralist to have a thorough understanding of intra-atrial septal and MV anatomy, as well as an appreciation for the key points and potential pitfalls of each of the procedural steps. With increasing experience, more complex valvular pathology can be successfully percutaneously treated. In addition to two-dimensional echocardiography, advances in three-dimensional echocardiography and fusion imaging will continue to support the refinement of current technologies, the expansion of clinical applications, and the development of novel devices.
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Affiliation(s)
- Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Stephen H Little
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Thomas W Smith
- Department of Internal Medicine, Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Feroze Mahmood
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Salgado-Filho MF, Morhy SS, Vasconcelos HDD, Lineburger EB, Papa FDV, Botelho ESL, Fernandes MR, Daher M, Bihan DL, Gatto CST, Fischer CH, Silva AAD, Galhardo Júnior C, Neves CB, Fernandes A, Vieira MLC. [Consensus on Perioperative Transesophageal Echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2018; 68:1-32. [PMID: 28867150 PMCID: PMC9391779 DOI: 10.1016/j.bjan.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/03/2017] [Accepted: 07/17/2017] [Indexed: 01/22/2023]
Abstract
Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.
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Affiliation(s)
- Marcello Fonseca Salgado-Filho
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil.
| | - Samira Saady Morhy
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Henrique Doria de Vasconcelos
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Universidade Federal do Vale da São Francisco (Univasf), Petrolina, PE, Brasil; Jonhs Hopkins University, Baltimore, EUA
| | - Eric Benedet Lineburger
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Hospital São José, Criciúma, SC, Brasil
| | - Fabio de Vasconcelos Papa
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Takaoka Anestesia, São Paulo, SP, Brasil
| | - Eduardo Souza Leal Botelho
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brasil; Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
| | - Marcelo Ramalho Fernandes
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil; Hospital Copa Star, Rio de Janeiro, RJ, Brasil
| | - Maurício Daher
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brasil
| | - David Le Bihan
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil; Hospital do Rim e Hipertensão, São Paulo, SP, Brasil; Grupo Dasa, São Paulo, SP, Brasil
| | - Chiara Scaglioni Tessmer Gatto
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto do Coração (Incor), São Paulo, SP, Brasil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
| | - Cláudio Henrique Fischer
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Alexander Alves da Silva
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; São Paulo Serviços Médicos de Anestesia (SMA), São Paulo, SP, Brasil
| | - Carlos Galhardo Júnior
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brasil
| | - Carolina Baeta Neves
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil; Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Alexandre Fernandes
- Núcleo Vida - Ecocardiografia Transesofágica Intraoperatória da Sociedade Brasileira de Anestesiologia (ETTI/SBA), Rio de Janeiro, RJ, Brasil; Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ, Brasil; Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil
| | - Marcelo Luiz Campos Vieira
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), São Paulo, SP, Brasil; Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; Instituto do Coração (Incor), São Paulo, SP, Brasil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil
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Salgado-Filho MF, Morhy SS, Vasconcelos HDD, Lineburger EB, Papa FDV, Botelho ESL, Fernandes MR, Daher M, Bihan DL, Gatto CST, Fischer CH, Silva AAD, Galhardo Júnior C, Neves CB, Fernandes A, Vieira MLC. Consensus on Perioperative Transesophageal Echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 28867150 PMCID: PMC9391779 DOI: 10.1016/j.bjane.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), created a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.
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Intraoperative Echocardiography. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_40] [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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Turton EW, Ender J. Role of 3D Echocardiography in Cardiac Surgery: Strengths and Limitations. CURRENT ANESTHESIOLOGY REPORTS 2017; 7:291-298. [PMID: 28890667 PMCID: PMC5565647 DOI: 10.1007/s40140-017-0226-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW This review aims to highlight the general and specific strengths and limitations of intraoperative 3D echocardiography. This article explains the value of real-time three-dimensional transesophageal echocardiography (RT 3D TEE) during cardiac surgery and cardiac interventions. RECENT FINDINGS Recently published recommendations and guidelines include the use of RT 3D TEE. RT 3 D TEE provides additional value particularly for guidance during cardiac interventions (i.e., transcatheter mitral valve repair, left atrial appendix and atrial septal defect closures), assessment of the mitral valve in surgical repair, measurement of left ventricular outflow tract area for transcatheter valvular replacements, and estimating right and left ventricular volumes and function. The exact localization of paravalvular leakage is another strength of RT 3D TEE. The major limitation is the reduced temporal resolution compared to 2D TEE. SUMMARY Three-dimensional echocardiography is a powerful tool that improves communication and accurate measurements of cardiac structures.
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Affiliation(s)
- Edwin Wilberforce Turton
- Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Struempellstr 39, 04289 Leipzig, Germany
| | - Jörg Ender
- Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Struempellstr 39, 04289 Leipzig, Germany
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Hai T, Amador Y, Mahmood F, Jeganathan J, Khamooshian A, Knio ZO, Matyal R, Nicoara A, Liu DC, Senthilnathan V, Khabbaz KR. Changes in Tricuspid Annular Geometry in Patients with Functional Tricuspid Regurgitation. J Cardiothorac Vasc Anesth 2017; 31:2106-2114. [PMID: 29100836 DOI: 10.1053/j.jvca.2017.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine whether the indices of tricuspid annular dynamics that signify irreversible tricuspid valvular remodeling can improve surgical decision making by helping to better identify patients with functional tricuspid regurgitation who could benefit from annuloplasty. DESIGN Retrospective analysis study. SETTING Tertiary hospital. PARTICIPANTS A total number of 55 patients were selected, 18 with functional tricuspid valve (TV) regurgitation and 37 normal nonregurgitant TVs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS When comparing the basal, mid, and longitudinal diameters of the right ventricle between the nonregurgitant valve (NTR) group and the functional tricuspid regurgitation (FTR) group, tricuspid annulus was more dilated (p < 0.001, p = 0.001, and p = 0.006, respectively) and less nonplanar (p < 0.001) in the FTR group. At end-systole (ES), the posterolateral-anteroseptal axis was significantly greater in the FTR group than in the NTR group (mean difference = 7.15 mm; p < 0.001). The right ventricle in the FTR group was also significantly dilated with greater leaflet restriction (p = 0.015). CONCLUSIONS As compared to NTR TVs, FTR is associated with identifiable indices of tricuspid annular structural changes that are indicative of irreversible remodeling.
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Affiliation(s)
- Ting Hai
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yannis Amador
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Anesthesia, Hospital México, University of Costa Rica, San José, Costa Rica
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Jelliffe Jeganathan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Arash Khamooshian
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ziyad O Knio
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alina Nicoara
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - David C Liu
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Venkatachalam Senthilnathan
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kamal R Khabbaz
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Mahmood F, Knio ZO, Yeh L, Amir R, Matyal R, Mashari A, Gorman RC, Gorman JH, Khabbaz KR. Regional Heterogeneity in the Mitral Valve Apparatus in Patients With Ischemic Mitral Regurgitation. Ann Thorac Surg 2017; 103:1171-1177. [PMID: 28274519 DOI: 10.1016/j.athoracsur.2016.11.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/17/2016] [Accepted: 11/28/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Apical displacement of the coaptation point of the mitral valve (MV) in response to ischemic mitral regurgitation (IMR) represents remodeling of the MV apparatus. Whereas it implies chronicity, it lacks specificity in discriminating normal from a significantly remodeled MV apparatus. Regional aspects of MV remodeling have shown superior value over global remodeling in predicting recurrence after MV repair for IMR. Quite possibly, presence of specific regional changes in MV geometry that are unique to chronic IMR patients could also be used to diagnose the presence and track progression of remodeling. Knowledge of these changes in MV apparatus in patients with IMR can possibly be used to identify patients for surgical intervention before irreversible remodeling occurs. METHODS Three-dimensional transesophageal echocardiographic data were collected from patients who underwent MV surgery for IMR (IMR group, n = 66), and from patients with normal valvular and biventricular function (control group, n = 10). The acquired data of the MV were geometrically analyzed to make regional comparisons between the IMR and the control group to identify measurements that reliably differentiate normal from remodeled MVs. RESULTS Lengthening of the middle potion of the anterior annulus (A2 regional perimeter: 11.149 mm versus 9.798 mm, p = 0.0041), larger nonplanarity angle (147.985 versus 140.720 degrees, p = 0.0459), and increased tenting angle of the posteromedial scallop of the posterior leaflet (P3 tenting angle: 44.354 versus 40.461 degrees, p = 0.0435) were sufficient in differentiating between IMR and the control group. CONCLUSIONS Specific three-dimensional changes in MV geometry can be used to reliably identify a significantly remodeled valve apparatus.
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Affiliation(s)
- Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ziyad O Knio
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lu Yeh
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Anesthesia and Pain Medicine, University of Groningen, University Medical Center, Groningen, Netherlands
| | - Rabia Amir
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Azad Mashari
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph H Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kamal R Khabbaz
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Khamooshian A, Amador Y, Jeganathan J, Maslow A, Mahmood F. Three-Dimensional Examination of the Mitral Valve in Patients With Arrhythmias and Motion Artifacts. J Cardiothorac Vasc Anesth 2017; 31:174-177. [DOI: 10.1053/j.jvca.2016.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Indexed: 11/11/2022]
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Mashari A, Montealegre-Gallegos M, Knio Z, Yeh L, Jeganathan J, Matyal R, Khabbaz KR, Mahmood F. Making three-dimensional echocardiography more tangible: a workflow for three-dimensional printing with echocardiographic data. Echo Res Pract 2016; 3:R57-R64. [PMID: 27974356 PMCID: PMC5302065 DOI: 10.1530/erp-16-0036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/14/2016] [Indexed: 11/08/2022] Open
Abstract
Three-dimensional (3D) printing is a rapidly evolving technology with several potential applications in the diagnosis and management of cardiac disease. Recently, 3D printing (i.e. rapid prototyping) derived from 3D transesophageal echocardiography (TEE) has become possible. Due to the multiple steps involved and the specific equipment required for each step, it might be difficult to start implementing echocardiography-derived 3D printing in a clinical setting. In this review, we provide an overview of this process, including its logistics and organization of tools and materials, 3D TEE image acquisition strategies, data export, format conversion, segmentation, and printing. Generation of patient-specific models of cardiac anatomy from echocardiographic data is a feasible, practical application of 3D printing technology.
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Affiliation(s)
- Azad Mashari
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada.,Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mario Montealegre-Gallegos
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ziyad Knio
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lu Yeh
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jelliffe Jeganathan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Schisler T, Subramaniam K. Diagnosis of a Fenestrated Secundum Atrial Septal Defect Detected by Real-Time Three-Dimensional Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2016; 31:980-982. [PMID: 27595529 DOI: 10.1053/j.jvca.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Travis Schisler
- Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Kathirvel Subramaniam
- Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA
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