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Schemberg M, Ender J, Bence J, van der Maaten J, Kunstd G, Mukherjee C, Meineri M. Intraoperative and Intraprocedural Use of 3-Dimensional Transesophageal Echocardiography: An International European Association of Cardiothoracic Anesthesia and Intensive Care Survey of Cardiac Surgical Centers. J Cardiothorac Vasc Anesth 2024; 38:1467-1476. [PMID: 38627172 DOI: 10.1053/j.jvca.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To assess the intraoperative use of 3-dimensional transesophageal echocardiography (3D TEE) in cardiac surgical centers, the authors created a survey aimed at evaluating the availability of equipment and the use of 3D TEE for specific surgical and interventional procedures and single-image modalities. The respondents were asked to identify the perceived impact on patient management and current limitations to its routine use. DESIGN A multiple choice 25-question online survey submitted to the members of the European Association of Cardiothoracic Anesthesia and Intensive Care (EACTAIC) on December 6, 2021, and closed on January 31, 2022. SETTING An online survey. PARTICIPANTS Registered EACTAIC members in 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 239 respondents from 44 different countries took part in the survey (27% of the total 903 EACTAIC members). Most respondents (59%) were TEE-certified by the National Board of Echocardiography, European Association of Cardiovascular Imaging (EACVI/EACTAIC), or had a national certificate. Of the respondents, 68% had no formal 3D TEE training. Eight percent of respondents had no 3D machines, whereas 40% had one for each operating room, and 33% had only one for the entire operating room block. 3D TEE was performed most frequently in more than 67% of cases for mitral valve surgery, and in more than 54% of cases for mitral and tricuspid clips, aortic valve, tricuspid valve, and aortic surgery. CONCLUSION Current guidelines suggest integrating 3D TEE into all comprehensive examinations. The authors' survey reported that intraoperative 3D TEE was used in the majority of mitral valve surgery and only one-half of the other valve surgeries and transcatheter procedures. Its use may be explained by the availability of 3D machines, trained personnel, and limited time to perform TEE in the operating room. Educational initiatives for training in 3D TEE may further increase its routine use.
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Affiliation(s)
- Mathias Schemberg
- Department of Anesthesiology and Intensive Care Medicine, Herzzentrum Leipzig, Leipzig, Germany
| | - Joerg Ender
- Department of Anesthesiology and Intensive Care Medicine, Herzzentrum Leipzig, Leipzig, Germany
| | - Johan Bence
- Department of Anaesthesiology and Intensive Care, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Joost van der Maaten
- Department of Anesthesiology, Cardiothoracic Anesthesia, University Medical Center Groningen, Groningen, the Netherlands
| | - Gudrun Kunstd
- Department of Anesthesiology, King's College, London, United Kingdom
| | - Chirojit Mukherjee
- Department of Anesthesiology and Intensive Care, Herzzentrum Karlsruhe, Karlsruhe, Germany
| | - Massimiliano Meineri
- Department of Anesthesiology and Intensive Care Medicine, Herzzentrum Leipzig, Leipzig, Germany.
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Mathews SJ, Little C, Zhang E, Beard P, Mastracci T, Rakhit R, Desjardins AE. Bend-insensitive fiber optic ultrasonic tracking probe for cardiovascular interventions. Med Phys 2023; 50:3490-3497. [PMID: 36842082 PMCID: PMC10615325 DOI: 10.1002/mp.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Transesophageal echocardiography (TEE) is widely used to guide medical device placement in minimally invasive cardiovascular procedures. However, visualization of the device tip with TEE can be challenging. Ultrasonic tracking, enabled by an integrated fiber optic ultrasound sensor (FOUS) that receives transmissions from the TEE probe, is very well suited to improving device localization in this context. The problem addressed in this study is that tight deflections of devices such as a steerable guide catheter can result in bending of the FOUS beyond its specifications and a corresponding loss of ultrasound sensitivity. PURPOSE A bend-insensitive FOUS was developed, and its utility with ultrasonic tracking of a steerable tip during TEE-based image guidance was demonstrated. METHODS Fiberoptic ultrasound sensors were fabricated using both standard and bend insensitive single mode fibers and subjected to static bending at the distal end. The interference transfer function and ultrasound sensitivities were compared for both types of FOUS. The bend-insensitive FOUS was integrated within a steerable guide catheter, which served as an exemplar device; the signal-to-noise ratio (SNR) of tracking signals from the catheter tip with a straight and a fully deflected distal end were measured in a cardiac ultrasound phantom for over 100 frames. RESULTS With tight bending at the distal end (bend radius < 10 mm), the standard FOUS experienced a complete loss of US sensitivity due to high attenuation in the fiber, whereas the bend-insensitive FOUS had largely unchanged performance, with a SNR of 47.7 for straight fiber and a SNR of 36.8 at a bend radius of 3.0 mm. When integrated into the steerable guide catheter, the mean SNRs of the ultrasonic tracking signals recorded with the catheter in a cardiac phantom were similar for straight and fully deflected distal ends: 195 and 163. CONCLUSION The FOUS fabricated from bend-insensitive fiber overcomes the bend restrictions associated with the FOUS fabricated from standard single mode fiber, thereby enabling its use in ultrasonic tracking in a wide range of cardiovascular devices.
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Affiliation(s)
- Sunish J. Mathews
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Callum Little
- Department of CardiologyImperial College Healthcare NHS Foundation TrustLondonUK
| | - Edward Zhang
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Paul Beard
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Tara Mastracci
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUK
| | - Roby Rakhit
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUK
| | - Adrien E. Desjardins
- Wellcome/EPSRC Centre for Interventional and Surgical SciencesUniversity College LondonLondonUK
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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Avesani M, Kang SL, Jalal Z, Thambo JB, Iriart X. Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging. Front Pediatr 2022; 10:894472. [PMID: 35664875 PMCID: PMC9160663 DOI: 10.3389/fped.2022.894472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Percutaneous interventions have completely refashioned the management of children with congenital heart diseases (CHD) and the use of non-invasive imaging has become the gold standard to plan and guide these procedures in the modern era. We are now facing a dual challenge to improve the standard of care in low-risk patients, and to shift our strategies from the classic open chest surgery to imaging-guided percutaneous interventions in high-risk patients. Such rapid evolution of ultrasound technologies over the last 20 years have permitted the integration of transthoracic, transesophageal and intracardiac echocardiography into the interventional workflow to improve image guidance and reduce radiation burden from fluoroscopy and angiography. Specifically, miniaturization of transesophageal probe and advances in three-dimensional (3D) imaging techniques have enabled real-time 3D image guidance during complex interventional procedure, In addition, multimodality and fusion imaging techniques harness the strengths of different modalities to enhance understanding of anatomical and spatial relationship between different structures, improving communication and coordination between interventionalists and imaging specialists. In this review, we aim to provide an overview of 3D imaging modalities and multimodal fusion in procedural planning and live guidance of percutaneous interventions. At the present times, 3D imaging can no longer be considered a luxury but a routine clinical tool to improve procedural success and patient outcomes.
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Affiliation(s)
- Martina Avesani
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Sok-Leng Kang
- Department of Pediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Zakaria Jalal
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Xavier Iriart
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
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Pillai MN, Suneel PR, Menon S, Unnikrishnan KP, Baruah SD, Mathew T, Lovhale SP, Dharan BS. Intraoperative Three-dimensional Imaging of Ventricular Septal Defects in Children Using Epicardial Echocardiography: A Novel Approach. J Cardiothorac Vasc Anesth 2021; 35:2892-2899. [DOI: 10.1053/j.jvca.2020.10.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 11/11/2022]
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5
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Kloesel B, Juhnke B, Irvine L, Donadio JV, Erdman A, Belani K. Computer-Generated Three-Dimensional Airway Models as a Decision-Support Tool for Preoperative Evaluation and Procedure-Planning in Pediatric Anesthesiology. J Med Syst 2021; 45:21. [PMID: 33426609 PMCID: PMC7797200 DOI: 10.1007/s10916-020-01698-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022]
Abstract
Technology improvements have rapidly advanced medicine over the last few decades. New approaches are constantly being developed and utilized. Anesthesiology strongly relies on technology for resuscitation, life-support, monitoring, safety, clinical care, and education. This manuscript describes a reverse engineering process to confirm the fit of a medical device in a pediatric patient. The method uses virtual reality and three-dimensional printing technologies to evaluate the feasibility of a complex procedure requiring one-lung isolation and one-lung ventilation. Based on the results of the device fit analysis, the anesthesiology team confidently proceeded with the operation. The approach used and described serves as an example of the advantages available when coupling new technologies to visualize patient anatomy during the procedural planning process.
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Affiliation(s)
- Benjamin Kloesel
- Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Minnesota, B515 Mayo Building, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Bethany Juhnke
- Earl E. Bakken Medical Devices Center, University of Minnesota, Minneapolis, MN, USA
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Laura Irvine
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - James V Donadio
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Arthur Erdman
- Earl E. Bakken Medical Devices Center, University of Minnesota, Minneapolis, MN, USA
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Kumar Belani
- Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Minnesota, B515 Mayo Building, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
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Fries RC, Clark-Price SC, Kadotani S, Stack JP, Schaeffer DJ, Lascola KM. Quantitative assessment of left ventricular volume and function by transthoracic and transesophageal echocardiography, ultrasound velocity dilution, and gated magnetic resonance imaging in healthy foals. Am J Vet Res 2020; 81:930-939. [PMID: 33251841 DOI: 10.2460/ajvr.81.12.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare measurements of left ventricular volume and function derived from 2-D transthoracic echocardiography (2DE), transesophageal echocardiography (TEE), and the ultrasound velocity dilution cardiac output method (UDCO) with those derived from cardiac MRI (cMRI) in healthy neonatal foals. ANIMALS 6 healthy 1-week-old Standardbred foals. PROCEDURES Foals were anesthetized and underwent 2DE, TEE, and cMRI; UDCO was performed simultaneously with 2DE. Images acquired by 2DE included the right parasternal 4-chamber (R4CH), left apical 4- and 2-chamber (biplane), and right parasternal short-axis M-mode (M-mode) views. The longitudinal 4-chamber view was obtained by TEE. Measurements assessed included left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), ejection fraction, stroke volume (LVSV), cardiac output (CO), and cardiac index (CI). Bland-Altman analyses were used to compare measurements derived from biplane, R4CH, and M-mode images and UDCO with cMRI-derived measurements. Repeatability of measurements calculated by 3 independent reviewers was assessed by the intraclass correlation coefficient. RESULTS Compared with cMRI, all 2DE and TEE modalities underestimated LVEDV and LVESV and overestimated ejection fraction, CO, and CI. The LVSV was underestimated by the biplane, R4CH, and TEE modalities and overestimated by UDCO and M-mode methods. However, the R4CH-derived LVSV, CO, and CI were clinically comparable to cMRI-derived measures. Repeatability was good to excellent for measures derived from the biplane, R4CH, M-mode, UDCO, and cMRI methods and poor for TEE-derived measures. CONCLUSIONS AND CLINICAL RELEVANCE All assessed modalities yielded clinically acceptable measurements of LVEDV, LVESV, and function, but those measurements should not be used interchangeably when monitoring patient progress.
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Davar J, Lazoura O, Caplin ME, Toumpanakis C. Features of carcinoid heart disease identified by cardiac computed tomography. J Cardiovasc Comput Tomogr 2020; 15:167-174. [PMID: 33004299 DOI: 10.1016/j.jcct.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Carcinoid heart disease (HD) is a rare form of valvular heart disease, the features of which have not been fully described by cardiac computed tomography (CT). METHODS All patients with carcinoid HD that underwent cardiac CT, either preoperatively or for assessment of coronary arteries, between Apr-2006 and Dec-2019 at the Royal Free Hospital, UK, were reviewed. RESULTS Of 32 patients with carcinoid HD, 29 (91%) had heart valve involvement. Abnormalities of the tricuspid and pulmonary valves were present in all patients, affecting all three leaflets in 23/26 (89%) unoperated patients for both valves. The aortic valve was affected in 4/29 (14%) patients and the mitral valve in 5/29 (17%). Left heart valves were affected in 6/29 (21%) patients. One patient (1/29; 3%) had all four valves affected. Severe changes with significant valvular regurgitation were seen in ≥75% of patients with tricuspid, pulmonary, and aortic valve abnormalities. Three patients had carcinoid myocardial metastases (3/32; 9%) and one patient had constrictive pericarditis (1/32; 3%). Ten patients had surgery of whom four (40%) had invasive coronary angiography preoperatively. Ten patients had a patent foramen ovale. Cardiac CT allowed an accurate assessment of damage to different leaflets/cusps, particularly of the pulmonary valve, where visualization with echocardiography was often (3/8; 38%) incomplete. CONCLUSION Cardiac CT is a powerful tool for assessment of cardiac valve abnormalities, coronary arteries and the spatial relationship of coronary arteries with myocardial metastasis in patients with carcinoid HD, and should form part of multimodal imaging of this complex pathology.
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Affiliation(s)
- Joseph Davar
- Carcinoid Heart Disease Clinic, Department of Cardiology, Royal Free Hospital, London, United Kingdom.
| | - Olga Lazoura
- Department of Radiology, Royal Free Hospital, London, United Kingdom.
| | - Martyn E Caplin
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom.
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom.
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Vandenheuvel M, Bouchez S, Wouters P, Mauermann E. Assessing Right Ventricular Function in the Perioperative Setting, Part II: What About Catheters? Anesthesiol Clin 2019; 37:697-712. [PMID: 31677686 DOI: 10.1016/j.anclin.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An-depth assessment of right ventricular function is important in a many perioperative settings. After exploring 2-dimensional echo-based evaluation, other proposed monitoring modalities are discussed. Pressure-based methods of right ventricular appraisal is discussed. Flow-based assessment is reviewed. An overview of the state of current right ventricular 3-dimensional echocardiography and its potential to construct clinical pressure-volume loops in conjunction with pressure measurements is provided. An overview of right ventricular assessment modalities that do not rely on 2-dimensional echocardiography is discussed. Tailored selection of monitoring modalities can be of great benefit for the perioperative physician. Integrating modalities offers optimal estimations of right ventricular function.
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Affiliation(s)
- Michael Vandenheuvel
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Stefaan Bouchez
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Patrick Wouters
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium
| | - Eckhard Mauermann
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, C. Heymanslaan 10, Ghent 9000, Belgium; Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, Basel University Hospital, Spitalstrasse 21, Basel 4031, Switzerland.
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Shojaei Fard M, Rezaeian N, Pourafkari L, Erami S, Nader ND. Level of agreement in three-dimensional planimetric measurement of mitral valve area between transthoracic and transesophageal echocardiography. Echocardiography 2019; 36:1501-1508. [PMID: 31287583 DOI: 10.1111/echo.14431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Echocardiographic measurement of mitral valve area (MVA) is critical prior to percutaneous transmitral commissurotomy (PTMC). This study aimed to compare the agreement between transthoracic (TTE) and transesophageal echocardiography (TEE) in three-dimensional (3D) planimetric measurement of the MVA among patients with severe mitral stenosis. METHODS MVA was measured with planimetry in 105 patients before undergoing PTMC. 3D reconstruction was applied to both TTE and TEE examinations. The MVA values from four different methods of 3D reconstruction were compared to the average values of 3D methods in TEE as the gold standard measurement method for the MVA in this study. The agreement levels between the two examinations were evaluated and analyzed for various reconstruction methods. RESULTS The mean age was 49 ± 12 years for 28 men and 77 women who were enrolled. The image quality was graded as "excellent" in 57% of 3D images obtained by TTE, while it was graded as "excellent" in 81% of 3D images obtained by TEE. The ventricular zooming method in TTE with a bias of -0.006 ± 0.065 cm2 (P < 0.0001) had the highest agreement with the 3D-MVA in TEE. While 2D-TTE and 3D-TEE measurements of the MVA (R = 0.91; P < 0.0001) were significantly correlated, 2D-TTE overestimated the MVA by 0.19 cm2 . CONCLUSION Although the quality of 3D images was significantly better in TEE than those in TTE, a good agreement existed between the measured 3D-TTE and 3D-TEE studies. We also demonstrated that 2D-TTE overestimated the MVA compare to 3D-TEE.
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Affiliation(s)
- Maryam Shojaei Fard
- Department of Cardiology, Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Rezaeian
- Department of Cardiology, Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leili Pourafkari
- Department of Cardiology, Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Sajad Erami
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nader D Nader
- Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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Kalçık M, Güner A, Yesin M, Bayam E, Kalkan S, Gündüz S, Gürsoy MO, Karakoyun S, Cerşit S, Özkan M. Identification of mechanical prosthetic heart valves based on distinctive cinefluoroscopic and echocardiographic markers. Int J Artif Organs 2019; 42:603-610. [PMID: 31269859 DOI: 10.1177/0391398819860845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The past 65 years have witnessed remarkable progress in the development of safe, hemodynamically favorable mechanical heart valves. Today, there are a large number and variety of prostheses in use and many prostheses have been used for a while and then discontinued. When patients lack reliable information about their heart valve prostheses, identification of valve model becomes difficult even for specialized physicians in this area. A combination of cinefluoroscopy and echocardiography makes it possible to provide accurate and detailed information regarding identification of prosthetic valve models. Fluoroscopic examination is a useful technique to evaluate patients following mechanical heart valve replacement. However, transthoracic echocardiography and transesophageal echocardiography have almost replaced cinefluoroscopy in the evaluation of prosthetic heart valves. Especially, real-time three-dimensional transesophageal echocardiography provides distinctive images of prosthetic heart valves, particularly for those in the mitral position. A large body of literature has been published to familiarize physicians with the radiological appearance of numerous mechanical prostheses. However, there is a lack of data regarding the identification of prosthetic valve models based on echocardiographic appearance. In this review, we aimed to describe distinctive echocardiographic and cinefluoroscopic markers for identifying the type and brand of several commonly used mechanical prosthetic heart valves.
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Affiliation(s)
- Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Ahmet Güner
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mahmut Yesin
- Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey
| | - Emrah Bayam
- Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Semih Kalkan
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Sabahattin Gündüz
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, Izmir Katip Çelebi University, Atatürk Training and Research Hospital, Izmir, Turkey
| | - Süleyman Karakoyun
- Department of Cardiology, Faculty of Medicine, Kars Kafkas University, Kars, Turkey
| | - Sinan Cerşit
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Özkan
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.,Division of Health Sciences, Ardahan University, Ardahan, Turkey
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Puchalski MD, Lui GK, Miller-Hance WC, Brook MM, Young LT, Bhat A, Roberson DA, Mercer-Rosa L, Miller OI, Parra DA, Burch T, Carron HD, Wong PC. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic. J Am Soc Echocardiogr 2019; 32:173-215. [DOI: 10.1016/j.echo.2018.08.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Bhatia M, Kumar P, Martinelli SM. Surgical Echocardiography of the MV: Focus on 3D. Semin Cardiothorac Vasc Anesth 2018; 23:26-36. [PMID: 30020031 DOI: 10.1177/1089253218789409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The mitral valve remains a complex structure where multiple forms of pathology can be seen. Mitral regurgitation continues to be one of the most common valvular diseases in the industrialized world. While intraoperative 2-dimensional transesophageal echocardiography has been commonplace for some time, 3-dimensional technology has emerged and has shown great benefit for diagnosis and guidance during mitral valve surgery. In the hands of a trained sonographer, high-quality real-time images can easily be obtained and correlate well with gross anatomical findings. The use of multiple angled views and color Doppler within 3-dimensional transesophageal echocardiography has become a valuable asset in the understanding and interpretation of the mitral valve for surgical interventions.
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Affiliation(s)
- Meena Bhatia
- 1 University of North Carolina, Chapel Hill, NC, USA
| | - Priya Kumar
- 1 University of North Carolina, Chapel Hill, NC, USA
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Wang S, Housden J, Zar A, Gandecha R, Singh D, Rhode K. Strategy for Monitoring Cardiac Interventions with an Intelligent Robotic Ultrasound Device. MICROMACHINES 2018; 9:E65. [PMID: 30393341 PMCID: PMC6187734 DOI: 10.3390/mi9020065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/17/2018] [Accepted: 01/31/2018] [Indexed: 11/16/2022]
Abstract
In recent years, 3D trans-oesophageal echocardiography (TOE) has become widely used for monitoring cardiac interventions. The control of the TOE probe during the procedure is a manual task which is tedious and harmful for the operator when exposed to radiation. To improve this technique, an add-on robotic system has been developed for holding and manipulating a commercial TOE probe. This paper focuses on the probe adjustment strategy in order to accurately monitor the moving intra-operative catheters. The positioning strategy is divided into an initialization step based on a pre-planning method, and a localized adjustment step based on the robotic differential kinematics. A series of experiments was performed to evaluate the initialization and the localized adjustment steps. The results indicate a mean error less than 10 mm from the phantom experiments for the initialization step, and a median error less than 1.5 mm from the computer-based simulation experiments for the localized adjustment step. Compared to the much bigger image volume, it is concluded that the proposed methods are feasible for this application. Future work will focus on evaluating the method in a more realistic TOE scanning scenario.
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Affiliation(s)
- Shuangyi Wang
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor North Wing, St Thomas' Hospital, London SE1 7EH, UK.
| | - James Housden
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor North Wing, St Thomas' Hospital, London SE1 7EH, UK.
| | - Areeb Zar
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor North Wing, St Thomas' Hospital, London SE1 7EH, UK.
| | - Ruchi Gandecha
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor North Wing, St Thomas' Hospital, London SE1 7EH, UK.
| | | | - Kawal Rhode
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor North Wing, St Thomas' Hospital, London SE1 7EH, UK.
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Tewari P, Dixit A, Soori R. Unknown left atrial appendage mass! real-time three-dimensional transesophageal echocardiography helps in identification. Ann Card Anaesth 2018; 21:97-98. [PMID: 29336407 PMCID: PMC5791505 DOI: 10.4103/aca.aca_124_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Left Atrial Appendage (LAA) is the most contractile part of Left atrium. It is also the most frequent place for thrombus formation that may lead to disastrous consequences. Complete trasoesophageal echocardiography examination always includes assessing LAA but sometimes unusually placed pectinate muscle, which is a normal structure may give baffling shadow that can only be interpreted correctly by Real time 3D echocardiography.
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Affiliation(s)
- Prabhat Tewari
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Aanchal Dixit
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Rashmi Soori
- Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India
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15
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Babu S, Koniparambil UP, Kumar M, Radhakrishnan BK, Aggarwal N, Nanda S. Distortion of aortic valve from mechanical traction imposed by the mitral valve prosthesis: The three-dimensional transesophageal echocardiographic perception. Ann Card Anaesth 2017; 20:472-474. [PMID: 28994691 PMCID: PMC5661325 DOI: 10.4103/aca.aca_176_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Iatrogenic injury to the aortic valve is a rare but frequently reported complication during mitral valve surgeries. Intraoperative 2-dimensional transesophageal echocardiography (2D TEE) has a major impact in diagnosing these injuries, so that timely intervention is possible. However, 2D TEE has lot of limitations during the perioperative period, which can be overcome by the three dimensional echocardiography (3D-TEE). We report a case where 3D TEE has undoubtedly delineated the cause for distortion of aortic sinus after mitral valve replacement and helped in the successful outcome.
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Affiliation(s)
- Saravana Babu
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Unnikrishnan P Koniparambil
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Muthu Kumar
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bineesh K Radhakrishnan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Neelam Aggarwal
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Saurabh Nanda
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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16
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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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17
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Huenges K, Pokorny S, Berndt R, Cremer J, Lutter G. Transesophageal Echocardiography in Swine: Establishment of a Baseline. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:974-980. [PMID: 28214035 DOI: 10.1016/j.ultrasmedbio.2016.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/21/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
The porcine model is a commonly used animal model in cardiovascular research. Along with new innovative operative techniques, choice of the optimal imaging technique is crucial. Transesophageal echocardiography (TEE) is a reliable imaging tool is highly important in a large number of experimental evaluations. But so far, TEE data for swine are limited, and few standard values have been established for the porcine model. The experience and baseline results for TEE in 45 swine are presented in this study. A full TEE examination was conducted in 45 German landrace or German large white swine, with an average body weight of 49 ± 3 kg, before experimental off-pump mitral valved stent implantation. Additionally hemodynamic measurements were evaluated. The valve implantation procedure was guided solely by real-time 3-D TEE. Baseline values of standard echocardiographic parameters are provided and, where appropriate, compared with human reference values. TEE proved to be an adequate imaging technique in this experimental porcine animal model. The baseline TEE and hemodynamic parameters established for the widely used porcine model can serve as a reference in future studies.
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Affiliation(s)
- Katharina Huenges
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Saskia Pokorny
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Rouven Berndt
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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18
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Vegas A. Three-dimensional transesophageal echocardiography: Principles and clinical applications. Ann Card Anaesth 2017; 19:S35-S43. [PMID: 27762247 PMCID: PMC5100241 DOI: 10.4103/0971-9784.192622] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A basic understanding of evolving 3D technology enables the echocardiographer to master the new skills necessary to acquire, manipulate, and interpret 3D datasets. Single button activation of specific 3D imaging modes for both TEE and transthoracic echocardiography (TTE) matrix array probes include (a) live, (b) zoom, (c) full volume (FV), and (d) color Doppler FV. Evaluation of regional LV wall motion by RT 3D TEE is based on a change in LV chamber subvolume over time from altered segmental myocardial contractility. Unlike standard 2D TEE, there is no direct measurement of myocardial thickening or displacement of individual segments.
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Affiliation(s)
- Annette Vegas
- Senior Consultant, Department of Anaesthesia, Toronto General Hospital, Toronto, Ontario, Canada
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19
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Bouchez S, Mauermann E, Philipsen T, Wouters P. 3D Echocardiographic Diagnosis of Right Ventricular Perforation With Polymethylmethacrylate Particles After Vertebroplasty. J Cardiothorac Vasc Anesth 2017; 31:2123-2126. [PMID: 28526207 DOI: 10.1053/j.jvca.2017.02.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Stefaan Bouchez
- Department of Anesthesia, Ghent University Hospital, Ghent, Belgium
| | - Eckhard Mauermann
- Department of Anesthesia, Ghent University Hospital, Ghent, Belgium.
| | - Tine Philipsen
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Patrick Wouters
- Department of Anesthesia, Ghent University Hospital, Ghent, Belgium
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20
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Currie ME, McLeod AJ, Moore JT, Chu MWA, Patel R, Kiaii B, Peters TM. Augmented Reality System for Ultrasound Guidance of Transcatheter Aortic Valve Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:31-9; discussion 39. [PMID: 26938173 DOI: 10.1097/imi.0000000000000235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Transcatheter aortic valve implantation (TAVI) relies on fluoroscopy and nephrotoxic contrast medium for valve deployment. We propose an alternative guidance system using augmented reality (AR) and transesophageal echocardiography (TEE) to guide TAVI deployment. The goals of this study were to determine how consistently the aortic valve annulus is defined from TEE using different aortic valve landmarks and to compare AR guidance with fluoroscopic guidance of TAVI deployment in an aortic root model. METHODS Magnetic tracking sensors were integrated into the TAVI catheter and TEE probe, allowing these tools to be displayed in an AR environment. Variability in identifying aortic valve commissures and cuspal nadirs was assessed using TEE aortic root images. To compare AR guidance of TAVI deployment with fluoroscopic guidance, a TAVI stent was deployed 10 times in the aortic root model using each of the two guidance systems. RESULTS Commissures and nadirs were both investigated as features for defining the valve annulus in the AR guidance system. The commissures were identified more consistently than the nadirs, with intraobserver variability of 2.2 and 3.8 mm, respectively, and interobserver variability of 3.3 and 4.7 mm, respectively. The precision of TAVI deployment using fluoroscopic guidance was 3.4 mm, whereas the precision of AR guidance was 2.9 mm, and its overall accuracy was 3.4 mm. This indicates that both have similar performance. CONCLUSIONS Aortic valve commissures can be identified more reliably than cuspal nadirs from TEE. The AR guidance system achieved similar deployment accuracy to that of fluoroscopy while eliminating the use and consequences of nephrotoxic contrast and radiation.
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Affiliation(s)
- Maria E Currie
- From the *Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada; †Canadian Surgical Technologies & Advanced Robotics, Lawson Health Research Institute, London, ON, Canada; ‡Medical Imaging Laboratory, Robarts Research Institute, Western University, London, ON, Canada; and §Department of Surgery, Schulich School of Medicine & Dentistry, and ∥Electrical and Computer Engineering, Western University, London, ON, Canada
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21
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Cardiac Imaging-3-Dimensional Echocardiography. Int Anesthesiol Clin 2016; 54:39-53. [PMID: 26655508 DOI: 10.1097/aia.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Abstract
Although anesthesia-associated mortality has been significantly reduced down to 0.00068-0.00082% over the last decades, recent studies have revealed a high perioperative mortality of 0.8- 4%. Apart from anesthesia and surgery-induced major complications, perioperative mortality is primarily negatively influenced by individual patient comorbidities. These risk factors predispose for acute critical incidents (e.g., myocardial infarction); however, the majority of fatal complications are a result of slowly progressing conditions, particularly infections or the sequelae of systemic inflammation. This implicates a broad window of opportunity for the detection and treatment of slow-onset complications to improve the perioperative outcome. The term "failure to rescue" (FTR), i.e., the proportion of patients who die from major complications compared to the number of all patients with complications, has been introduced as a valid indicator for the quality of perioperative care. Growing evidence has already shown that FTR is an underestimated factor in perioperative medicine accounting for or at least being involved in the development of postoperative mortality. While the incidence of severe postoperative complications amazingly does not show much variation between hospitals, FTR shows significant differences implying a major potential for improvement. With 14 million surgical procedures per year in Germany, a postoperative mortality of approximately 1% and an avoidable FTR rate of 40% mean that there are an estimated 60,000 preventable deaths per year. Hence, in the future it will be imperative to (1) identify patients at risk, (2) to prevent the development of postoperative complications with the use of adequate adjunctive therapeutic strategies, (3) to establish surveillance and monitoring systems for the early detection of postoperative complications and (4) to treat postoperative complications efficiently and in time when they arise.
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Affiliation(s)
- O Boehm
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - M K A Pfeiffer
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - G Baumgarten
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
| | - A Hoeft
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
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Mahmoud HM, Walley H, Hosny H, Yacoub M. Three-dimensional transesophageal echocardiography incremental value in a rare case of a bileaflet tricuspid valve. Echocardiography 2016; 33:1438-40. [PMID: 27493126 DOI: 10.1111/echo.13272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Detailed assessment of the tricuspid valve using two-dimensional echocardiography is always challenging, as only two of three leaflets can be seen at a time. Three-dimensional echocardiography can provide the enface view of the tricuspid valve that allows simultaneous visualization of all of the three leaflets. In a 42-year-old male patient scheduled for pulmonary endarterectomy, 3DTEE showed that the tricuspid valve is bileaflet, with one septal and another lateral leaflet. There were two commissures, one of them is anteriorly positioned and the other one is posterior. Our findings were confirmed intra-operatively by direct surgical visualization of the tricuspid valve.
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Affiliation(s)
- Hani M Mahmoud
- Adult Cardiology Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt.
| | - Hossam Walley
- Cardiac Anesthesia Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Hatem Hosny
- Cardiac Surgery Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Magdi Yacoub
- Cardiac Surgery Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt.,Imperial College London, London, United Kingdom
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24
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Le HT, Hangiandreou N, Timmerman R, Rice MJ, Smith WB, Deitte L, Janelle GM. Imaging Artifacts in Echocardiography. Anesth Analg 2016; 122:633-646. [DOI: 10.1213/ane.0000000000001085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Shan J, Zhang L, Holmes AA, Taub CC. The Impact of Race on the Prognosis of Preclinical Diastolic Dysfunction: A Large Multiracial Urban Population Study. Am J Med 2016; 129:222.e1-10. [PMID: 26475254 DOI: 10.1016/j.amjmed.2015.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/05/2015] [Accepted: 08/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study was performed to assess the impact of race on the incidence of heart failure and survival in patients with preclinical diastolic dysfunction. METHODS All adults during a 5-year period with grade 1 diastolic dysfunction on echocardiogram, left ventricular ejection fraction ≥ 50%, and no diagnosis of heart failure were included in this study. Clinical endpoints were new diagnosis of heart failure (International Classification of Diseases-Ninth Revision code 428.0) and all-cause mortality. A total of 7878 patients: 20.8% non-Hispanic White, 35.8% non-Hispanic Black, and 31.0% Hispanic individuals (mean age was 68 ± 12 years, 37% men) were included in the study. Non-Hispanic Whites were older, more frequently male, and had a higher mean socioeconomic status and more antecedent myocardial infarction. RESULTS Non-Hispanic Blacks and Hispanics had more hypertension, diabetes, renal disease, and cerebrovascular disease. After a median follow-up time of 6 years, 1356 patients developed heart failure and 2078 patients died. The 10-year cumulative probabilities of heart failure and all-cause mortality were 23.9% and 32.6%, respectively. Time to incident heart failure was similar among the 3 racial groups. However, non-Hispanic Blacks (hazard ratio 0.80, P = .002) and Hispanics (hazard ratio 0.67, P < .001) experienced lower mortality compared with non-Hispanic Whites, which was confirmed on a propensity-scored sensitivity analysis. CONCLUSIONS Time to heart failure was similar among the 3 racial groups, however, non-Hispanic Whites experienced worse survival compared with non-Hispanic Blacks and Hispanics, despite their higher burden of risk factors. The reasons for worse survival in the non-Hispanic white population need to be further explored.
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Affiliation(s)
- Jian Shan
- Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Lili Zhang
- Department of Medicine, Jacobi Medical Center, Bronx, NY
| | | | - Cynthia C Taub
- Division of Cardiology, Montefiore Medical Center, Bronx, NY.
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26
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Currie ME, McLeod AJ, Moore JT, Chu MWA, Patel R, Kiaii B, Peters TM. Augmented Reality System for Ultrasound Guidance of Transcatheter Aortic Valve Implantation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maria E. Currie
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
- Canadian Surgical Technologies & Advanced Robotics, Lawson Health Research Institute, London, ON, Canada
- Medical Imaging Laboratory, Robarts Research Institute, Western University, London, ON, Canada
| | - A. Jonathan McLeod
- Medical Imaging Laboratory, Robarts Research Institute, Western University, London, ON, Canada
| | - John T. Moore
- Medical Imaging Laboratory, Robarts Research Institute, Western University, London, ON, Canada
| | - Michael W. A. Chu
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
- Canadian Surgical Technologies & Advanced Robotics, Lawson Health Research Institute, London, ON, Canada
- Medical Imaging Laboratory, Robarts Research Institute, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Rajni Patel
- Canadian Surgical Technologies & Advanced Robotics, Lawson Health Research Institute, London, ON, Canada
- Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada
- Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
- Canadian Surgical Technologies & Advanced Robotics, Lawson Health Research Institute, London, ON, Canada
- Medical Imaging Laboratory, Robarts Research Institute, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Terry M. Peters
- Medical Imaging Laboratory, Robarts Research Institute, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine & Dentistry, London, ON, Canada
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27
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Kuroda M, Kumakura M, Sato T, Saito S. The Usefulness of Three-Dimensional Transesophageal Echocardiography for a Primum Atrial Septal Defect. Anesth Analg 2015; 121:1151-4. [DOI: 10.1213/ane.0000000000000958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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28
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Sung TY, Kwon WK, Park DH, Park CH, Kim TY. Intraoperative three-dimensional transesophageal echocardiography for evaluating an unusual structure in the left ventricular outflow tract: a case report. Korean J Anesthesiol 2015; 68:505-8. [PMID: 26495063 PMCID: PMC4610932 DOI: 10.4097/kjae.2015.68.5.505] [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: 09/15/2014] [Revised: 11/13/2014] [Accepted: 12/04/2014] [Indexed: 12/02/2022] Open
Abstract
Intraoperative three-dimensional (3D) transesophageal echocardiography (TEE) facilitates an understanding of the complex cardiac pathology that is not fully delineated in a two-dimensional (2D) echocardiographic evaluation, and it suggests earlier and more precise surgical planning and intraoperative decision making. In the present case, the intraoperative 2D-TEE midesophageal long-axis view indicated a significant narrowing of the left ventricular outflow tract (LVOT) area by a band-like structure that vertically traversed the middle of the LVOT and connected to the anterior mitral leaflet base and the interventricular septum. However, additional 3D-TEE images of the LVOT and their cropped and rendered 2D images showed that web-like tissue, which presumably had grown around the patch closure from a previous atrioventricular septal defect, was obstructing the LVOT partially.
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Affiliation(s)
- Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Won-Kyoung Kwon
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Dong-Ho Park
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Cheol-Hwan Park
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Tae-Yop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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29
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Magunia H, Rosenberger P. [Application fields of intraoperative transesophageal 3D echocardiography]. Anaesthesist 2015; 63:662-72, 674-7. [PMID: 24994014 DOI: 10.1007/s00101-014-2346-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intraoperative transesophageal echocardiography (TEE) is an established diagnostic tool and has to be regarded as the standard of care for intraoperative monitoring and cardiac surgical decision-making. Furthermore, intraoperative TEE is also used for monitoring and assessment of hemodynamic changes and the detection of previously unknown pathologies. In the past few years 3D-TEE has extended the spectrum of 2D-TEE by allowing pathomorphological features to be more easily and intuitively linked to the anatomy of the heart and the great vessels. Thus, a comprehensive 2D-TEE examination is favorably complemented by focused 3D-TEE. Especially during mitral valve surgery, 3D-TEE has proven its superiority in the diagnosis of the underlying pathology as demonstrated by a large number of studies in this field. This review presents the available data about the role of intraoperative 3D-TEE echocardiography and introduces practical fields of application.
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Affiliation(s)
- H Magunia
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Eberhard-Karls-Universität, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland,
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30
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Gurzun MM, Popescu AC, Ginghina C, Popescu BA. Management of organic mitral regurgitation: guideline recommendations and controversies. Korean Circ J 2015; 45:96-105. [PMID: 25810729 PMCID: PMC4372987 DOI: 10.4070/kcj.2015.45.2.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 11/25/2022] Open
Abstract
Mitral regurgitation (MR) represents the second most frequent valvular heart disease. The appropriate management of organic MR remains unclear in many aspects, especially in several specific clinical scenarios. This review aims to discuss the current guideline recommendations regarding the management of organic MR, while highlighting the controversial aspects encountered in daily clinical practice. The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair. The potential advantages of 3-dimensional echocardiography in assessing the MV are discussed. Other modern imaging techniques (tissue Doppler and speckle tracking) may provide additional useful information in borderline cases. Exercise echocardiography (evaluating MR severity, pulmonary pressure, or right ventricular function) may have an important role in the management of difficult cases. Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed. Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients.
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Affiliation(s)
- Maria-Magdalena Gurzun
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. ; Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Andreea C Popescu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. ; Cardiology Department, Emergency University Hospital Elias, Bucharest, Romania
| | - Carmen Ginghina
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. ; Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Bogdan A Popescu
- Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. ; Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
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32
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London MJ. Editorial comment: intraoperative transesophageal echocardiography to evaluate acute cessation of venous inflow during cardiopulmonary bypass. A & A CASE REPORTS 2014; 3:98-99. [PMID: 25611755 DOI: 10.1213/xaa.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Martin J London
- Department of Anesthesia and Perioperative Care, VA Medical Center and University of California, San Francisco, San Francisco, California,
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Keene AR. Change or be changed; anaesthetist accreditation in echocardiography: is it time? SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2010.10872709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tan CO, Harley I. Perioperative Transesophageal Echocardiographic Assessment of the Right Heart and Associated Structures: A Comprehensive Update and Technical Report. J Cardiothorac Vasc Anesth 2014; 28:1100-21. [DOI: 10.1053/j.jvca.2013.05.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Indexed: 11/11/2022]
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Meris A, Santambrogio L, Casso G, Mauri R, Engeler A, Cassina T. Intraoperative Three-Dimensional Versus Two-Dimensional Echocardiography for Left Ventricular Assessment. Anesth Analg 2014; 118:711-20. [DOI: 10.1213/ane.0000000000000093] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
There has been a recent explosion of education and training in echocardiography in the specialties of anesthesiology and critical care. These devices, by their impact on clinical management, are changing the way surgery is performed and critical care is delivered. A number of international bodies have made recommendations for training and developed examinations and accreditations.The challenge to medical educators in this area is to deliver the training needed to achieve competence into already over-stretched curricula.The authors found an apparent increase in the use of simulators, with proven efficacy in improving technical skills and knowledge. There is still an absence of evidence on how it should be included in training programs and in the accreditation of certain levels.There is a conviction that this form of simulation can enhance and accelerate the understanding and practice of echocardiography by the anesthesiologist and intensivists, particularly at the beginning of the learning curve.
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Grossgasteiger M, Hien MD, Graser B, Rauch H, Motsch J, Gondan M, Rosendal C. Image quality influences the assessment of left ventricular function: an intraoperative comparison of five 2-dimensional echocardiographic methods with real-time 3-dimensional echocardiography as a reference. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:297-306. [PMID: 24449733 DOI: 10.7863/ultra.33.2.297] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Transesophageal echocardiography has become a standard tool for evaluating left ventricular function during cardiac surgery. However, the image quality varies widely between patients and examinations. The aim of this study was to investigate the influence of the image quality on 5 commonly used 2-dimensional methods. METHODS Transesophageal real-time 3-dimensional echocardiography (3DE) served as a reference. Left ventricular function was evaluated in 63 patients with sufficient real-time 3DE image quality. The image quality was rated using the ratio of the visualized border divided by the total endocardial border. These ratings were used to generate groups of poor (0%-40%), fair (41%-70%), and good (71%-100%) image quality. The ejection fraction (EF), end-diastolic volume, and end-systolic volume were analyzed by the Simpson method of disks (biplane and monoplane), eyeball method, Teichholz method, and speckle-tracking method. Furthermore, the fractional area change was determined. Each correlation with real-time 3DE was evaluated. RESULTS Correlations of the EF and volumes, respectively, as determined by long-axis view methods increased with improving image quality: the Simpson biplane method was found to be the most accurate method, with good image quality for the EF (r = 0.946) and volumes (end-diastolic volume, r = 0.962; end-systolic volume, r = 0.989). Correlations of the EF and fractional area change by short-axis view methods decreased with improving image quality, with the Teichholz EF found to be most accurate with poor (r = 0.928) in contrast to good (r = 0.699) image quality. CONCLUSIONS With good image quality, the Simpson biplane method is the most accurate 2-dimensional method for assessing the left ventricular EF. Short-axis view methods, especially the Teichholz method yield better correlations with poor image quality. The eyeball method was unaffected by image quality.
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Affiliation(s)
- Manuel Grossgasteiger
- Cand.med, Department of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Automated Registration of 3D TEE Datasets of the Descending Aorta for Improved Examination and Quantification of Atheromas Burden. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-3-319-08554-8_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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The Contemporary Role of Intraoperative Echocardiography: Is it Underused or Overused? CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kim H, Bergman R, Matyal R, Khabbaz KR, Mahmood F. Three-dimensional echocardiography and en face views of the aortic valve: technical communication. J Cardiothorac Vasc Anesth 2013; 27:376-80. [PMID: 23507016 DOI: 10.1053/j.jvca.2012.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Indexed: 01/30/2023]
Abstract
With the resurgence in popularity of aortic valve (AV) repair, detailed anatomical information of the AV has become invaluable for surgical decision making as well as for evaluation of success postrepair. Perioperative 3-dimensional echocardiography is optimally suited to assist in repair planning. The volumetric nature of the 3-dimensional data allows accurate derivation of qualitative and quantitative measurements. A uniform approach to imaging and description of echocardiographic AV anatomy is essential to facilitate communication across specialties.
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Affiliation(s)
- Han Kim
- Department of Anesthesia & Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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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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Cowie B, Kluger R, Kalpokas M. Left ventricular volume and ejection fraction assessment with transoesophageal echocardiography: 2D vs 3D imaging. Br J Anaesth 2013; 110:201-6. [DOI: 10.1093/bja/aes350] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Skubas NJ, Shernan SK. Intraoperative 3-dimensional echocardiography for mitral valve surgery: just pretty pictures or ready for prime time? Anesth Analg 2013; 116:272-5. [PMID: 23340747 DOI: 10.1213/ane.0b013e318279b5e6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sohmer B, Hudson C, Atherstone J, Lambert AS, Labrosse M, Boodhwani M. Measuring aortic valve coaptation surface area using three-dimensional transesophageal echocardiography. Can J Anaesth 2012; 60:24-31. [DOI: 10.1007/s12630-012-9819-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 10/19/2012] [Indexed: 11/28/2022] Open
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[Real-time 3 dimensional full volume data set : benefits in problem focused intraoperative transesophageal echocardiography]. Anaesthesist 2012; 61:875-82. [PMID: 23080355 DOI: 10.1007/s00101-012-2088-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 08/31/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Comprehensive intraoperative transesophageal echcardiography (TEE) includes various measurements for quantification of cardiac chambers and valves based on multiple two dimensional (2D) standard views. Due to shortness of time during cardiac surgery most centres in Germany only carry out problem focussed intraoperative examinations which does not allow the complete repertoire of measurements to be exhausted. The aim of this study was to investigate which measurements for cardiac chamber and valve quantification can be performed with the acquisition of a real-time 3D full volume (RT-3D-FV) data set and to compare these measurements with those based on standard 2D views. MATERIALS AND METHODS In patients undergoing elective surgical mitral valve repair a comprehensive 2D TEE examination according to the guidelines of the American Society of Echocardiography (ASE) and the Society of Cardiovascular Anesthesiologists (SCA) was performed after induction of anesthesia. Additionally, a RT-3D-FV TEE data set based on the midesophageal four chamber view was recorded (iE 33, Philips, Netherlands). All measurements of the 2D TEE and the RT-3D-FV dataset (Qlab) were performed offline by two independent examiners. RESULTS After approval by the local ethic committee and obtaining written informed consent 50 patients (31 male and 19 female) with a mean age of 59.4 ± 11.5 years were enrolled in this study. All measurements recommended for chamber and valve quantification could be performed on the basis of the RT-3D-FV data set except for measurements of the sinus of Valsalva and the sinotubular junction. There was good correlation between the results of the two methods. CONCLUSIONS For intraoperative problem focussed TEE examinations the acquisition of an additional RT-3D-FV TEE data set allows accurate measurement of most of the recommended chamber and valve quantification parameters.
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Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13:1-46. [PMID: 22275509 DOI: 10.1093/ehjci/jer316] [Citation(s) in RCA: 365] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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A stenotic bioprosthetic valve in the tricuspid position: real-time 3-dimensional transesophageal echocardiography as a useful supplement to conventional assessment. Anesth Analg 2012; 115:253-6. [PMID: 22610847 DOI: 10.1213/ane.0b013e318258fb30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr 2012; 25:3-46. [PMID: 22183020 DOI: 10.1016/j.echo.2011.11.010] [Citation(s) in RCA: 473] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Kuroda M, Hiroki T, Suto T, Miyoshi S, Kadoi Y, Saito S. Two- and Three-Dimensional Transesophageal Echocardiography for Multiple Atrial Septal Defects. Anesth Analg 2012; 114:738-41. [DOI: 10.1213/ane.0b013e318246dfa4] [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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