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Wang L, Zhang J, Zheng SP, He L, Wang J, Wang XF, Xie MX. Research and application of transnasal transesophageal echocardiography probe. Curr Med Sci 2017; 37:782-786. [PMID: 29058296 DOI: 10.1007/s11596-017-1805-x] [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: 02/20/2017] [Revised: 06/16/2017] [Indexed: 11/26/2022]
Abstract
The intubation of conventional transesophageal echocardiography (TEE) probes into patients causes serious esophagus irritation, and thus the use of TEE probes in pediatric practice is limited. In this study, we aimed at the development of a special probe which could be inserted through the nasopharyngeal cavity into the esophagus to obtain the same high-quality echocardiography images as those obtained by conventional TEE and improve patients' experience. During the examination, the patients felt relaxed for a longer time and cooperated with the sonographers in the process of cardiac catheterization conducted in the surgery room or the intensive care unit (ICU), resulting in improved accuracy of the diagnosis and timely administration of appropriate treatment. Two years ago, Prof. Xin-fang WANG put theories into practice by inserting the probe through the nasal cavity and pharynx into the esophagus of volunteers to successfully detect the heart and great vessels at the retrocardiac space. Later, Prof. Ming-xing XIE performed the transnasal TEE examination in 12 atrial septal defect (ASD) patients and proved the safety and reliability of this method, which could become a new way for clinical diagnosis and treatment.
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Affiliation(s)
- Lei Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shao-Ping Zheng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lin He
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xin-Fang Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ming-Xing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Fletcher N, Geisen M, Meeran H, Spray D, Cecconi M. Initial clinical experience with a miniaturized transesophageal echocardiography probe in a cardiac intensive care unit. J Cardiothorac Vasc Anesth 2015; 29:582-7. [PMID: 25575411 DOI: 10.1053/j.jvca.2014.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the safety of a novel, miniaturized, monoplane transesophageal echocardiography probe (mTEE) and its potential as a hemodynamic monitoring tool. DESIGN This was a retrospective analysis of the clinical evaluation of a disposable mTEE in ventilated patients with severe cardiogenic shock requiring hemodynamic support. mTEE assessment was performed by operators with mixed levels of TEE training. Information on hemodynamic interventions based on mTEE findings was recorded. SETTING A tertiary university cardiac critical care unit. PARTICIPANTS Male and female critical care patients admitted to the unit with severe hemodynamic instability. INTERVENTIONS Insertion of miniaturized disposable TEE probe and hemodynamic and other critical care interventions based on this and conventional monitoring. MEASUREMENTS AND MAIN RESULTS In 41 patients (51.2% female, 73.2% after cardiac surgery), hemodynamic support probe insertion was accomplished without major complications. A total of 195 mTEE studies were performed, resulting in changes in therapy in 37 (90.2%) patients based on mTEE findings, leading to an improvement in hemodynamic parameters in 33 (80.5%) patients. Right ventricular (RV) failure was diagnosed in 25 patients (67.6%) and mTEE had a direct therapeutic impact on management of RV failure in 17 patients (68 %). CONCLUSIONS Insertion and operation of a novel, miniaturized transoesophageal echocardiography probe can be performed for up to 72 hours without major complications. Repeated assessment using this device provides complementary information to invasive monitoring in the majority of patients and has an impact on hemodynamic management.
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Affiliation(s)
- Nick Fletcher
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom.
| | - Martin Geisen
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom
| | - Hanif Meeran
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom
| | - Dominic Spray
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom
| | - Maurizio Cecconi
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom
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Left ventricular diastolic dysfunction in the intensive care unit: trends and perspectives. Crit Care Res Pract 2012; 2012:964158. [PMID: 22666570 PMCID: PMC3359774 DOI: 10.1155/2012/964158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 03/06/2012] [Accepted: 03/06/2012] [Indexed: 01/02/2023] Open
Abstract
Heart failure with a normal or nearly normal left ventricular (LV) ejection fraction (HFNEF) may represent more than 50% of heart failure cases. Although HFNEF is being increasingly recognized, there is a relative lack of information regarding its incidence and prognostic implications in intensive care unit (ICU) patients. In the ICU, many factors related to patient's history, or applied therapies, may induce or aggravate LV diastolic dysfunction. This may impact on patients' morbidity and mortality. This paper discusses methods for assessing LV diastolic function and the feasibility of their implementation for diagnosing HFNEF in the ICU.
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Taniguchi M, Akagi T. Real-time imaging for transcatheter closure of atrial septal defects. Interv Cardiol 2011. [DOI: 10.2217/ica.11.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD. EAE/ASE Recommendations for the Use of Echocardiography in New Transcatheter Interventions for Valvular Heart Disease. J Am Soc Echocardiogr 2011; 24:937-65. [DOI: 10.1016/j.echo.2011.07.003] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. Eur Heart J 2011; 32:2189-214. [PMID: 21885465 DOI: 10.1093/eurheartj/ehr259] [Citation(s) in RCA: 245] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zamorano JL, Badano LP, Bruce C, Chan KL, Goncalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD, Vahanian A, Di Bello V, Buck T. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:557-84. [DOI: 10.1093/ejechocard/jer086] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE OF REVIEW Trauma patients require evaluation of the anatomic structure as well as the hemodynamic profile of the heart to improve effectiveness of resuscitation. They are prone to hemodynamic instability and must be monitored with various modalities to detect deterioration early. Newer, less invasive ultrasound technologies are replacing familiar 'gold standard' modalities of the past. This article reviews the indications, roles, imaging approaches, and limitations of modern echocardiography. A brief review of other ICU monitoring modalities is also presented. RECENT FINDINGS Echocardiography has emerged as a first-line diagnostic tool for assessment of trauma patients, especially those with hemodynamic compromise. It yields crucial information about structural damage as well as the hemodynamic profile and can be performed through either the transesophageal or transthoracic route. Quick and systematic use of echocardiography for diagnosis and management of critically injured patients may lead to improved outcomes. SUMMARY Echocardiography plays an important role in the trauma bay for diagnosis of thoracic injury and at the bedside in the ICU for evaluation of the hemodynamic profile.
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Fukuda S, Shimada K, Kawasaki T, Taguchi H, Maeda K, Fujimoto H, Inanami H, Yoshida K, Jissho S, Yoshiyama M, Yoshikawa J. Transnasal transesophageal echocardiography in the detection of left atrial thrombus. J Cardiol 2009; 54:425-31. [PMID: 19944318 DOI: 10.1016/j.jjcc.2009.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/16/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The widespread use of transesophageal echocardiography (TEE) is limited by disadvantages, including patient intolerance and increased medical costs. We aimed to investigate the feasibility and safety of transnasal TEE in the detection of possible embolic sources in patients with atrial fibrillation (AF) and/or stroke, using an ultrathin TEE probe. METHODS Sixty-two patients with AF and/or stroke underwent transnasal TEE without conscious sedation. The presence or the absence of the following parameters was evaluated: left atrial (LA) thrombus; LA spontaneous echocardiographic contrast; intraatrial shunts; and aortic plaque. RESULTS The insertion of a TEE probe was successful in 52 (84%) patients. TEE found LA thrombus in 10 (19%) patients and other embolic sources in 4 (8%) patients. Two (4%) patients had mild epistaxis. CONCLUSIONS This study demonstrated that the use of transnasal TEE was feasible and safe in the detection of LA thrombus in patients with AF and/or stroke.
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Affiliation(s)
- Shota Fukuda
- Department of Medicine, Cardiovascular Division, Osaka Ekisaikai Hospital, 2-1-10 Honden, Nishi-ku, Osaka 550-0022, Japan.
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Côté G, Denault A. Transesophageal echocardiography-related complications. Can J Anaesth 2008; 55:622-47. [DOI: 10.1007/bf03021437] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Aronson LA. Transnasal Placement of Biplane Transesophageal Echocardiography Probe Intraoperatively in an Adolescent with Congenital Heart Disease. Anesth Analg 2003; 97:1617-1619. [PMID: 14633530 DOI: 10.1213/01.ane.0000086729.89284.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Intraoperative transesophageal echocardiography (TEE) is frequently used in children with congenital heart disease (CHD). Although transnasal TEE is being used in various settings in the adult population, there are no descriptions of its use intraoperatively in patients with CHD. This report describes the successful use of transnasal TEE after multiple unsuccessful transoral attempts in an adolescent male undergoing subaortic stenosis repair. IMPLICATIONS Transnasal transesophageal echocardiography (TEE) is being used in various settings in the adult population. The author describes its use intraoperatively in an adolescent undergoing surgery for congenital heart disease after unsuccessful transoral attempts.
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Affiliation(s)
- Lori A Aronson
- From the Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Zimmermann P, Greim C, Trautner H, Sagmeister U, Kraemer K, Roewer N. Echocardiographic monitoring during induction of general anesthesia with a miniaturized esophageal probe. Anesth Analg 2003; 96:21-7, table of contents. [PMID: 12505917 DOI: 10.1097/00000539-200301000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Standard transesophageal echocardiography (TEE) does not allow cardiac monitoring during the induction of anesthesia because standard probes would limit the oropharyngeal space and impair mask ventilation and tracheal intubation. We hypothesized that a prototype, miniaturized TEE probe could be safely introduced transnasally in awake patients and that mask ventilation and orotracheal intubation could be performed while continuously monitoring left ventricular (LV) function during the induction of anesthesia. Forty-five patients were studied prospectively. The transnasal TEE probe was introduced through one of the nares and advanced until a transverse plane image of the LV at the level of the papillary muscles was seen. Anesthesia was induced, and the patients were ventilated with a mask that had previously been threaded over the TEE probe via a central perforation. Probe insertion was successful in 12 patients under local anesthesia alone and in an additional 31 patients with a combination of local anesthesia and mild sedation. In two cases, probe placement was unsuccessful. Overall, hemodynamic variables did not change significantly during insertion. No case of significant mucosal bleeding was seen. In one patient, regurgitation of gastric contents occurred without affecting the perioperative outcome. The two-dimensional echocardiogram image quality of the LV during the induction of anesthesia was good or acceptable in 95% of patients. We conclude that transnasal TEE can effectively be used for cardiac monitoring during the induction of general anesthesia. IMPLICATIONS This study demonstrates that it is feasible and generally safe to introduce a miniaturized transesophageal echocardiography probe transnasally in awake cardiac risk patients to monitor cardiac performance during the induction of general anesthesia.
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Affiliation(s)
- Peter Zimmermann
- Department of Anesthesiology, University of Würzburg Medical Center, Germany.
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Echocardiographic Monitoring During Induction of General Anesthesia with a Miniaturized Esophageal Probe. Anesth Analg 2003. [DOI: 10.1213/00000539-200301000-00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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