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Denault AY, Roberts M, Cios T, Malhotra A, Paquin SC, Tan S, Cavayas YA, Desjardins G, Klick J. Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach. Anesth Analg 2021; 133:630-647. [PMID: 34086617 DOI: 10.1213/ane.0000000000005537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of transesophageal echocardiography (TEE) in the operating room and intensive care unit can provide invaluable information on cardiac as well as abdominal organ structures and function. This approach may be particularly useful when the transabdominal ultrasound examination is not possible during intraoperative procedures or for anatomical reasons. This review explores the role of transgastric abdominal ultrasonography (TGAUS) in perioperative medicine. We describe several reported applications using 10 views that can be used in the diagnosis of relevant abdominal conditions associated with organ dysfunction and hemodynamic instability in the operating room and the intensive care unit.
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Affiliation(s)
- André Y Denault
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Michael Roberts
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Theodore Cios
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Anita Malhotra
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Sarto C Paquin
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM)
| | - Stéphanie Tan
- Department of Radiology, Montreal Heart Institute, Université de Montréal
| | - Yiorgos Alexandros Cavayas
- Department of Medicine and Intensive Care Unit, Montreal Sacré-Coeur Hospital and Department of Medicine and Intensive Care Unit, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - John Klick
- Department of Anesthesiology, University of Vermont Medical Center, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Singh NG, Nagaraja PS, Gopal D, Manjunath V, Nagesh KS, Manjunatha N, Patel GP, Mishra SK. Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study. Ann Card Anaesth 2017; 19:399-404. [PMID: 27397442 PMCID: PMC4971966 DOI: 10.4103/0971-9784.185518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF). Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE) during cardiac surgery under hypothermic cardiopulmonary bypass (CPB). Methodology: Thirty-five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP), cardiac output (CO), SMABF, superior mesenteric artery (SMA) diameter, superior mesentric artery blood flow over cardiac output (SMA/CO) ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure. Results: SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO decreased significantly (P < 0.0001) between T0 and T1, increased significantly (P ≤ 0.001) between T0 and T2. Lactates increased progressively from T0 to T2. Conclusion: Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period.
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Affiliation(s)
- Naveen G Singh
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - P S Nagaraja
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Divya Gopal
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - V Manjunath
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - K S Nagesh
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - N Manjunatha
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Guru Police Patel
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Satish Kumar Mishra
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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Mazzeffi M, Brown J, Bernstein W, Carter E, Lee IH, Strauss E. An Unusual Right Atrial Mass: A Misdiagnosis Identified by Intraoperative Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2015; 30:263-5. [PMID: 26442454 DOI: 10.1053/j.jvca.2015.06.031] [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: 06/02/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jamie Brown
- Prince George's Hospital Center, Cheverly, MD
| | | | | | - Ina H Lee
- University of Maryland, Baltimore, MD
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Kararmaz A, Kemal Arslantas M, Cinel I. Renal Resistive Index Measurement by Transesophageal Echocardiography: Comparison With Translumbar Ultrasonography and Relation to Acute Kidney Injury. J Cardiothorac Vasc Anesth 2015; 29:875-80. [DOI: 10.1053/j.jvca.2014.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Indexed: 12/29/2022]
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Sinning JM, Adenauer V, Scheer AC, Lema Cachiguango SJ, Ghanem A, Hammerstingl C, Sedaghat A, Müller C, Vasa-Nicotera M, Grube E, Nickenig G, Werner N. Doppler-based renal resistance index for the detection of acute kidney injury and the non-invasive evaluation of paravalvular aortic regurgitation after transcatheter aortic valve implantation. EUROINTERVENTION 2014; 9:1309-16. [PMID: 24168854 DOI: 10.4244/eijv9i11a221] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Acute kidney injury (AKI) is a strong but rather late predictor of mortality after transcatheter aortic valve implantation (TAVI). Early clinically useful markers for the detection of AKI and prediction of outcome are needed in order to control and improve management of periprocedural complications after TAVI. The aim of our study was to assess the predictive value of the Doppler-based renal resistance index (RRI), which correlates inversely with effective renal blood flow and creatinine clearance, for AKI in patients undergoing TAVI and to evaluate its association with paravalvular aortic regurgitation (PAR). METHODS AND RESULTS TAVI was performed with the Medtronic CoreValve prosthesis in 132 consecutive high-risk patients (mean logistic EuroSCORE: 30.3±18.2%). RRI, serum creatinine and cystatin C level were determined before, and 4 hrs, 24 hrs, 48 hrs, 72 hrs, and 7 days after TAVI. AKI occurred in 32/132 patients (24.2%). While serum creatinine and cystatin C levels decreased at first after TAVI (also in most patients developing AKI), the RRI increased significantly immediately after the procedure from 0.79±0.09 to 0.87±0.12 in patients developing AKI (p=0.003). A RRI >0.85 predicted post-interventional AKI with a sensitivity of 58% and specificity of 86%, and was superior to the serum creatinine level (p<0.001). In addition, an elevated RRI was significantly related to haemodynamic changes after TAVI and was associated with the occurrence of moderate/severe PAR (p<0.001). CONCLUSIONS Measurement of the Doppler-based RRI predicts risk for AKI and increased mortality rates at an early post-procedural time point and is related to the occurrence of more-than-mild paravalvular aortic regurgitation after TAVI.
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Affiliation(s)
- Jan-Malte Sinning
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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Ghadimi K, Vernick WJ, Horak J, Gutsche JT, Hanif H, Tagarakis GI, Whitlock RP, Augoustides JG. CASE 12--2014. Inferior vena cava compression by retroperitoneal hematoma during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2014; 28:1403-9. [PMID: 24461363 DOI: 10.1053/j.jvca.2013.10.020] [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: 10/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Kamrouz Ghadimi
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William J Vernick
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jiri Horak
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hasib Hanif
- Division of Cardiac Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Georgios I Tagarakis
- Division of Cardiothoracic Surgery, Department of Surgery, Aristotle University, Thessaloniki, Greece
| | - Richard P Whitlock
- Division of Cardiac Surgery, Department of Surgery Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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M’rabet Bensalah K, Uehlinger D, Kalicki R, Czerwinska J. Hemodynamic Modeling of the Intrarenal Circulation. Ann Biomed Eng 2013; 41:2630-44. [DOI: 10.1007/s10439-013-0865-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
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Unexpected co-arctation of aorta detected by transesophageal echocardiography during patent ductus arteriosus ligation. Front Med 2013; 7:270-3. [PMID: 23681889 DOI: 10.1007/s11684-013-0261-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 01/24/2013] [Indexed: 02/05/2023]
Abstract
In the presence of a large patent ductus arteriosus (PDA), aortic co-arctation (CoA) cannot be diagnosed clinically because PDA masks the clinical features. This condition impedes the identification of CoA by transthoracic echcocardiography. However, the closure of PDA can result in a severe clinical condition that causes a patient with undiagnosed CoA to suffer from shock and multi-organ failure. In this article, a case of PDA was presented, in which transesophageal echocardiography provided full information that could be used as reference to identify and define CoA during PDA ligation surgery.
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A Transesophageal Echocardiography Technique to Locate the Kidney and Monitor Renal Perfusion. Anesth Analg 2013; 116:549-54. [DOI: 10.1213/ane.0b013e31827ab3b1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zabala L, Ullah S, Pierce CD, Gautam NK, Schmitz ML, Sachdeva R, Craychee JA, Harrison D, Killebrew P, Bornemeier RA, Prodhan P. Transesophageal Doppler Measurement of Renal Arterial Blood Flow Velocities and Indices in Children. Anesth Analg 2012; 114:1277-84. [DOI: 10.1213/ane.0b013e31824cb727] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zhu D, Yu H, Zhou Y, Li Q, Zhao L, Peng LQ, Liu B. Feasibility of Measuring Renal Blood Flow Using Transesophageal Echocardiography in Pediatric Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2012; 26:39-45. [DOI: 10.1053/j.jvca.2011.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Indexed: 11/11/2022]
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Jackson AH, Salerno P, Shaw M, Dhital K. Absent renal blood flow diagnosed by transesophageal echocardiography during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2011; 26:1080-2. [PMID: 21993401 DOI: 10.1053/j.jvca.2011.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew H Jackson
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia.
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Goldstein S. Pro: The General Anesthesiologist Should Be Trained and Certified in Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2010; 24:183-8. [DOI: 10.1053/j.jvca.2009.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Indexed: 11/11/2022]
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The Feasibility of Measuring Renal Blood Flow Using Transesophageal Echocardiography in Patients Undergoing Cardiac Surgery: Erratum. Anesth Analg 2009. [DOI: 10.1213/ane.0b013e3181b575e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Garwood S. Measuring Renal Blood Flow with the Intraoperative Transesophageal Echocardiography Probe. Anesth Analg 2009; 108:1371-6. [DOI: 10.1213/ane.0b013e31819ed3f6] [Citation(s) in RCA: 7] [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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