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Hattori K, Komasawa N, Kuzukawa Y, Fujisawa T, Minami T. Right radial artery pulse loss after transesophageal echocardiography probe insertion in an infant with an aberrant right subclavian artery. J Clin Anesth 2015; 28:84. [PMID: 26235108 DOI: 10.1016/j.jclinane.2015.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Kazuo Hattori
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan
| | - Nobuyasu Komasawa
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan.
| | - Yosuke Kuzukawa
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan
| | - Takanobu Fujisawa
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan
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Ajib K. Perioperative Echocardiography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479313493668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Echocardiography has been utilized perioperatively since the 1970s and many studies have been conducted to prove its efficacy. Epicardiac echocardiography (EE) is the modality of choice when transesophageal echocardiography (TEE) is contraindicated or when aortic atherosclerosis is suspected. Perioperative TEE has shown to be an excellent tool in the operating room for assessment, diagnosis, surgical guidance, and outcome evaluation. Pediatric surgery has also shown better surgical outcomes for congenital disease states with the guidance of TEE. The cardiac Sonographer’s role in the operating room is a very important one because it involves operating the ultrasound machine and communicating image interpretations to surgeons in a timely and efficient manner. Cardiac Sonographers eager to progress in their careers can take advantage of this opportunity to enhance their clinical and educational qualifications. Technology is advancing quickly with the breakthrough of 3D and 4D TEE, where images are captured in real time, providing improved diagnoses and prognosis. This article discusses the evolution of echocardiography in the operating room and its future impact on perioperative evaluation, with attention paid to the role of cardiac Sonographers and the future clinical progression in their scope of practice.
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Affiliation(s)
- Kholoud Ajib
- Florida Hospital College of Health Sciences, Orlando, FL, USA
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Kim SJ, Park SA, Song J, Shim WS, Choi EY, Lee SY. The role of transesophageal echocardiography during surgery for patients with tetralogy of Fallot. Pediatr Cardiol 2013; 34:240-4. [PMID: 22790360 DOI: 10.1007/s00246-012-0423-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 06/22/2012] [Indexed: 11/30/2022]
Abstract
Routine use of intraoperative transesophageal echocardiography (TEE) is a safe monitoring and diagnostic method during pediatric congenital cardiac surgery. However, the question of whether intraoperative TEE is accurate and cost effective for patients with tetralogy of Fallot (TOF) has not been raised. This study aimed to analyze the cost-benefit of routine TEE during the repair of TOF. The medical records, including TEE results, for patients who underwent correction of TOF between January 1997 and June 2007 were reviewed and retrospectively analyzed. Intraoperative TEE was performed for 340 patients (85 %). Residual problems were detected in 17.9 % (61/340), and a return to bypass was needed for 10 % (34/340) of the patients. The degree of agreement between the intraoperative TEE and early postoperative transthoracic echocardiography (TTE) was relatively high. Surgeons with less surgical experience more frequently used intraoperative TEE (p = 0.007) and performed repeat bypass surgery at a higher rate (p = 0.00). Even relatively unskilled surgeons might be able to achieve surgical outcomes similar to those of experienced surgeons using intraoperative TEE. By avoiding late surgical revision, the possible cost savings were estimated to be 1,726,000 Korean won (US$1,489) per TEE examination. Intraoperative TEE can be used as a tool for surgeons in making decisions in the operating room. In addition, intraoperative TEE decreased the frequency of reoperations and postoperative interventions. The results of this study demonstrate that routine intraoperative TEE during repair of TOF was both clinically beneficial and cost effective.
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Affiliation(s)
- Soo-Jin Kim
- Department of Pediatric Cardiology, School of Medicine, Konkuk University, 4-12 Hwayng-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea.
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Ferns S, Komarlu R, Van Bergen A, Multani K, Cui VW, Roberson DA. Transesophageal echocardiography in critically ill acute postoperative infants: comparison of AcuNav intracardiac echocardiographic and microTEE miniaturized transducers. J Am Soc Echocardiogr 2012; 25:874-81. [PMID: 22749435 DOI: 10.1016/j.echo.2012.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple barriers to transthoracic echocardiography are present in critically ill infants immediately after surgery. Transesophageal echocardiography (TEE) is sometimes needed to obtain specific important information that transthoracic echocardiography fails to demonstrate. Formerly, the investigators used the AcuNav intracardiac echocardiographic (ICE) intravascular ultrasound transducer (8 Fr, 2.5 mm, 64-element crystal array, multifrequency [5.5-10 MHz], single longitudinal plane, linear phased array [Siemens Medical Solutions USA, Inc., Mountain View, CA]). Recently, the investigators have also used the microTEE transducer (8-mm transducer tip, 5.2-mm shaft, multifrequency [3-8 MHz], multiplane phased array, 32-element probe [Philips Medical Systems, Andover, MA]). Both transducers have two-dimensional, M-mode, color Doppler, and pulsed-wave and continuous-wave Doppler capabilities. The aim of this study was to compare the efficacy, safety, ease of insertion, capabilities, utilization, and cost of the AcuNav ICE transducer versus those of the microTEE transducer. METHODS A retrospective review of all 50 postoperative critically ill infants who underwent TEE using the AcuNav and microTEE in the past 5 years was conducted. TEE was performed as ordered by the attending physician to answer a specific question not answered by transthoracic echocardiography. RESULTS In all cases, the clinical information sought was obtained. The AcuNav ICE transducer was safe, easy to insert through the transnasal route, and did not require paralysis; however, it had a limited number of echocardiographic views and had greater sterilization cost. The microTEE transducer had greater echocardiographic capabilities and lower sterilization cost; however, it was slightly more difficult to insert, had a few manageable complications, and required more sedation and paralysis. CONCLUSIONS TEE in this setting has increased because of demonstrated efficacy and safety. Both the AcuNav ICE and microTEE transducers are useful and effective in this critical clinical scenario.
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Affiliation(s)
- Sunita Ferns
- Heart Institute for Children, Hope Children's Hospital, Chicago Medical School, Oak Lawn, Illinois 60453, USA
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Abstract
AIM To assess the quality of imaging modalities of a new micro multiplane transoesophageal echocardiogram probe. METHOD This is a prospective study of micro transoesophageal echocardiogram S8-3t probe used at a single institution between 15 December, 2009 and 15 March, 2010. The images were compared with standard paediatric or adult probes where possible. Assessors prospectively rated imaging quality - two dimensional, colour flow imaging, pulse wave, and continuous wave Doppler - with a subjective 4-point scale (1 = poor to 4 = excellent). RESULTS A total of 24 studies were performed on 23 patients, with a median weight = 11.7 kilograms (2.6-72 kilograms) and a median age of 3 years (0.16-60 years). Of the 23 patients, one neonate (2.8 kilograms) had transient bradycardia on probe insertion. Imaging in patients less than 10 kilograms was of full diagnostic value and new information was obtained in eight out of ten patients. Pulse wave and continuous wave Doppler was consistently good across all weight groups. There were high frame rates and good imaging quality to a depth of 4-6 centimetres in all studies. A comparison with a larger alternative probe was available for 12 studies (weight 11.9-72 kilograms). The median micro transoesophageal two-dimensional image quality score was 3 (2-4) and 4 (3-4) with the comparative probe. For the 10- to 30-kilogram group, image quality with the micro transoesophageal echocardiogram probe was judged as inferior to larger standard probes. Adult sized patients had good imaging of near the field, allowing guidance for percutaneous device closure of the atrial septum. CONCLUSION The micro multiplane transoesophageal echocardiogram probe provides imaging of diagnostic quality in neonates. In larger patients, it offers good imaging of near field structures. In the intermediate-sized child (10-30 kilograms), standard paediatric probes provide better imaging.
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Abstract
Transesophageal echocardiography (TEE) plays an important role in the anatomical, functional, and hemodynamic assessment of patients with congenital heart disease (CHD). This imaging approach has been applied to both children and adults with a wide range of cardiovascular malformations. Extensive clinical experience documents significant contributions, particularly in the perioperative setting. In fact, in the current medical era, many consider this technology to be an essential adjunct to surgical and anesthetic management in CHD. This review focuses on the applications of TEE in patients with tetralogy of Fallot (TOF), the most common form of cyanotic heart disease. Emphasis is given to the perioperative use of this imaging modality and benefits derived during the prebypass and postbypass periods. Limitations and pitfalls relevant to the TEE assessment in patients with this anomaly are also addressed.
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The impact of additional epicardial imaging to transesophageal echocardiography on intraoperative detection of residual lesions in congenital heart surgery. J Thorac Cardiovasc Surg 2012; 143:361-7. [DOI: 10.1016/j.jtcvs.2011.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 05/09/2011] [Accepted: 06/07/2011] [Indexed: 11/23/2022]
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The added value of real-time three-dimensional echocardiography in the diagnosis of supravalvar mitral ring: case report and review of the literature. J Echocardiogr 2011; 9:127-9. [PMID: 27277288 DOI: 10.1007/s12574-011-0090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 03/21/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
Abstract
Supravalvular mitral stenosis is a rare condition characterized by an abnormal ridge, with one or two orifices, covering and obstructing the mitral valve. Preoperative identification of the supravalvular ring is the target for obtaining good surgical results. Two-dimensional echocardiogram and transesophageal echocardiography both failed in reaching this objective. In this case, we showed that three-dimensional echocardiogram is a new technique that provides additional and more accurate echocardiographic characterization of congenital supravalvular mitral stenosis.
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Park SY, Kim DH, Joe HB, Park SK, Hwang JH, Hong YW. Occlusion of the right subclavian artery after insertion of a transesophageal echocardiography probe in an adult with a vascular ring -A case report-. Korean J Anesthesiol 2010; 59:283-5. [PMID: 21057621 PMCID: PMC2966712 DOI: 10.4097/kjae.2010.59.4.283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 01/02/2010] [Accepted: 02/03/2010] [Indexed: 11/10/2022] Open
Abstract
Intraoperative transesophageal echocardiography (TEE) has become an important monitoring device for patients undergoing cardiac or noncardiac surgery. Complications associated with TEE are unusual, but the potential for TEE probe compression of the posterior vascular structures has been reported in pediatric patients. We present here a case of occlusion of the right subclavian artery in an adult patient with a vascular ring after insertion of a TEE probe.
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Affiliation(s)
- Sung Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University of College of Medicine, Suwon, Korea
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Scohy TV, Matte G, van Neer PLMJ, van der Steen AFW, McGhie J, Bogers A, de Jong N. A new transesophageal probe for newborns. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1686-1689. [PMID: 19647919 DOI: 10.1016/j.ultrasmedbio.2009.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 04/21/2009] [Accepted: 05/18/2009] [Indexed: 05/28/2023]
Abstract
Current transesophageal probes are designed for adults and are used both in the operating theatre for monitoring as well as in the outpatient clinic for patients with specific indications, like obesity, artificial valves, etc. For newborns (<5 kg), transesophageal echocardiography (TEE) is not possible because the current probes are too big for introducing them into the esophagus. There is a clear need for a small probe in newborns that are scheduled for complicated cardiac surgery and catheterization. We present the design and realization of a small TEE phased array probe with a tube diameter of 5.2mm and head size of only 8.2-7 mm. The number of elements is 48 and the center frequency of the probe is 7.5 MHz. A separate clinical evaluation study was carried out in 42 patients (Scohy et al. 2007).
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Affiliation(s)
- Thierry V Scohy
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Klein AA, Snell A, Nashef SAM, Hall RMO, Kneeshaw JD, Arrowsmith JE. The impact of intra-operative transoesophageal echocardiography on cardiac surgical practice. Anaesthesia 2009; 64:947-52. [DOI: 10.1111/j.1365-2044.2009.05991.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yoon SJ, Ko JS, Kim CS. Ventilatory compromise in an infant with Tetralagy of fallot and right aortic arch after insertion of transesophageal echocardiography probe: A case report. Korean J Anesthesiol 2009; 57:104-107. [PMID: 30625839 DOI: 10.4097/kjae.2009.57.1.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Right aortic arch, a congenital malformation of the great vessels, can cause compression of trachea and/or esophagus. We experienced a case of ventilatory compromise in an infant with tetralogy of Fallot and right aortic arch immediately after insertion of transesophageal echocardiography probe during cardiac surgery. Although intraoperative transesophageal echocardiography can be safely performed in infants with congenital heart disease, it should be done with caution in patient with similar vascular malformation.
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Affiliation(s)
- Se Jeong Yoon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Chung Su Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Image quality using a micromultiplane transesophageal echocardiographic probe in older children during cardiac surgery. Eur J Anaesthesiol 2009; 26:445-7. [DOI: 10.1097/eja.0b013e32831bd8d4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Optimal head position during transesophageal echocardiographic probe insertion for pediatric patients weighing up to 10 kg. Pediatr Cardiol 2009; 30:441-6. [PMID: 19219486 DOI: 10.1007/s00246-008-9373-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 11/26/2008] [Accepted: 12/24/2008] [Indexed: 10/21/2022]
Abstract
No data exists for the optimal head position during transesophageal echocardiography (TEE) probe insertion in children. Turning the head to the side closes the ipsilateral pyriform sinus and dilates the contralateral pyriform sinus, theoretically making probe insertion safer and easier. In this study, 94 children (weight, <or=10 kg) undergoing TEE during heart surgery between March 2000 and August 2001 were studied. The head position was either midline or left. A scale was devised to grade the resistance during probe insertion: grade 1 (none), grade 2 (mild), grade 3 (moderate), grade 4 (severe), and grade 5 (inability to insert probe). Probe insertion was midline in 38 and left in 56 of the children. Mild or no resistance was encountered in 86% of the head left versus 63% of the head midline children (p = 0.002). Probe insertion was easier with the head left in three subgroups: I (weight, >5 kg), II (weight, 4-5 kg), and III (weight, <4 kg). The difference was statistically significant only for subgroup III (p = 0.0001). Insertion failed in four children with the head in the midline position but was successful when the head was turned leftward. Children undergoing TEE who weigh less than 10 kg should have the head positioned to the side rather than in the midline position during probe insertion. If insertion is unsuccessful or difficult with the head in the midline position, the authors recommend turning the head to the side and reattempting probe insertion.
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Impact of Intraoperative Transesophageal Echocardiography on Surgical Decisions in 12,566 Patients Undergoing Cardiac Surgery. Ann Thorac Surg 2008; 85:845-52. [DOI: 10.1016/j.athoracsur.2007.11.015] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Revised: 11/01/2007] [Accepted: 11/05/2007] [Indexed: 11/20/2022]
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Park SY, Park SKA, Hong YS, Hong YW. Compromised Ventilation Caused by Transesophageal Echocardiography Probe in Pediatric Patients Undergoing Congenital Heart Surgery - A case report -. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.6.682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sung Yong Park
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Sun Kyung A Park
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
| | - You Sun Hong
- Department of Thoracic and Cardiovascular Surgery, Ajou University College of Medicine, Suwon, Korea
| | - Yong Woo Hong
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
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Ecocardiografía transesofágica intraoperatoria: recomendaciones para la formación del anestesiólogo. Rev Esp Cardiol 2000. [DOI: 10.1016/s0300-8932(00)75244-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Andropoulos DB, Stayer SA, Bent ST, Campos CJ, Bezold LI, Alvarez M, Fraser CD. A Controlled Study of Transesophageal Echocardiography to Guide Central Venous Catheter Placement in Congenital Heart Surgery Patients. Anesth Analg 1999. [DOI: 10.1213/00000539-199907000-00012] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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