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Access Statistics 2013 | January-June | Issue 1

 

REVIEW ARTICLE
Sundar Krishnan, Dallen Mill

Transesophageal Echocardiography in the Intensive Care Unit

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:4-15]


ABSTRACT

Management of shock in the intensive care unit involves advanced hemodynamic monitoring. Invasive monitoring with central venous lines and pulmonary artery catheters may be inadequate in guiding therapy and improving outcomes. Echocardiography is a reasonably-safe, minimally-invasive diagnostic technique that provides rapid bedside evaluation of ventricular filling and function. While transthoracic echocardiography is the method of choice initially, images can be suboptimal in up to a third of intensive care patients. Transesophageal echocardiography is then required to better evaluate the cause of hemodynamic instability. In addition, transesophageal echocardiography can be used to diagnose other causes of hemodynamic failure (for e.g., pericardial tamponade, pulmonary embolism and left ventricular outflow tract obstruction) and to diagnose intracardiac shunt. Echocardiography is also vital in diagnosing the cause and guiding management in patients with cardiac arrest. Specific training is required for physicians in order to achieve competence in probe insertion, completion of a comprehensive examination and interpretation of the images. In this article, we provide an overview of the indications and complications of the technique and training pathways for the intensivist, followed by transesophageal echocardiography-guided hemodynamic assessment and diagnosis of specific cardiac disorders commonly encountered in the intensive care unit.

Keywords:Transesophageal echocardiography, Hypotension, Intensive care unit, Preload, Contractility, Pericardial tamponade, Left ventricular outflow tract obstruction, Aortic dissection, Blunt chest trauma.

How to cite this article:Krishnan S, Mill D. Transesophageal Echocardiography in the Intensive Care Unit. J Perioper Echocardiogr 2013;1(1):4-15.

Source of Support: Nil

Conflict of Interest: None Declared

3066

ORIGINAL ARTICLE
Ashok Kumar Badamali, J Sethu Madhavan, BPS Ghuman, S Subash, Ravi Raj, Abhi Mishra, Ajay Mishra, VK Arya, Bhupesh Kumar, Aveek Jayant, KST Shyam, Sandeep Singh Rana, Harkant Singh, Anand Mishra, Sachin Kuthe, Sachin Mahajan, Shiva Prasad, Sarin Mathew, Inderjeet Arora, Goverdhan Dutt Puri

Routine Intraoperative Transesophageal Echocardiography: Impact on Intraoperative Surgical Decision Making, a Single Center Interim Analysis

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:16-20]


ABSTRACT

Transesophageal echocardiography (TEE) has become an important part of armamentarium for anesthesiologists in the management of patients undergoing cardiac surgery. Many studies have demonstrated the safety and utility of TEE in cardiac surgery. With advances in hardware and software, easy availability of resources for learning and optimal understanding of image generation and interpretation, many new findings crop up in the operating room (OR) which may have been missed in preoperative transthoracic echocardiography (TTE), leading to necessary changes in planned surgical procedure. In our retrospective analysis of 726 cases in which TEE was performed over the last 1 year, changes in decision was made in 65 (8.9%) of cases. This included 42 unanticipated findings prior to cardiopulmonary bypass and 23 new findings after CPB, requiring revision in 15 cases. With the increasing use and further impending advances of TEE, the number of cases in which surgical decision will be altered may increase in near future.

Keywords:Transesophageal echocardiography, Cardiac surgery, Intraoperative echocardiography.

How to cite this article:Badamali AK, Madhavan JS, Ghuman BPS, Subash S, Raj R, Mishra A, Mishra A, Arya VK, Kumar B, Jayant A, Shyam KST, Rana SS, Singh H, Mishra A, Kuthe S, Mahajan S, Prasad S, Mathew S, Arora I, Puri GD. Routine Intraoperative Transesophageal Echocardiography: Impact on Intraoperative Surgical Decision Making, a Single Center Interim Analysis. J Perioper Echocardiogr 2013;1(1):16-20.

Source of Support: Nil

Conflict of Interest: None

2838

EDITORIAL
Kathirvel Subramaniam, Balachundhar Subramaniam, Goverdhan Dutt Puri

Perioperative Transesophageal Echocardiography: Advances and Challenges

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:1-3]


ABSTRACT

The history of perioperative transesophageal echocardiography (PTE) dates back to the 1980s when intraoperative transesophageal echocardiography (TEE) was found to be a preferable modality for evaluation of repaired or reconstructed mitral valve.1,2 It was also found to be an extremely useful tool to monitor for ischemia in high-risk cardiac and noncardiac surgery.3 The potential for diagnostic use of TEE during routine cardiac surgery was recognized soon after. Cardiac anesthesiologists (some of them trained cardiologists who became anesthesiologists) at major cardiovascular surgical institutions in North America promoted the practice and education in diagnostic intraoperative TEE for anesthesiologists in the early 1990s. The American Society of Anesthesiologists (ASA) and the Society for Cardiovascular Anesthesiologists (SCA) jointly published PTE guidelines in 1996; the SCA and the American Society for Echocardiography (ASE) have published several updates to the guidelines since then.4,5 Over the years, cardiologists and cardiac anesthesiologists have worked together tirelessly to standardize the practice of intraoperative TEE; the results are evident in the improved outcomes of cardiac surgical patients.

How to cite this article: Subramaniam K, Subramaniam B, Puri GD. Perioperative Transesophageal Echocardiography: Advances and Challenges. J Perioper Echocardiogr 2013; 1(1):1-3.

Source of Support: Nil

Conflict of Interest: None Declared

2280

CASE REPORTS
Susie J Cho, Stephen O Bader, James W Heitz

Venous Air Embolism during Anterior Lumbar Surgery

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:30-32]


ABSTRACT

The use of transesophageal echocardiography (TEE) has improved the detection of venous air embolism (VAE), especially in the case of small VAE where clinical changes can be subtle and erroneously attributed to volume status or cardiac function. We present a case of VAE in a 62 years old female that occurred during anterior lumbar spine surgery that was diagnosed with the aid of TEE. As anterior lumbar spines surgery is traditionally not associated with VAE, we believe this is the first reported case of VAE in this type of procedure.

Keywords:TEE, Air embolism, Spine surgery, Intraoperative hypotension.

How to cite this article:Cho SJ, Bader SO, Heitz JW. Venous Air Embolism during Anterior Lumbar Surgery. J Perioper Echocardiogr 2013;1(1):30-32.

Source of Support: Nil

Conflict of Interest: None declared

2229

CASE REPORTS
J Sethumadhavan, H Singh, A Jayant

Tricuspid Valve Dilation in a Case of Ostium Secundum Atrial Septal Defect: Therapeutic Dilemmas in the Perioperative Period and a Call for Building the Evidence

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:24-26]


ABSTRACT

The adult literature on managing tricuspid regurgitation (TR) in left heart disease is in evolution. Tricuspid valve repair in pediatrics, on the other hand has more or less been restricted to disease subsets, such as children developing TR secondary to right ventricular disease or tricuspid valve anomalies. The pediatric literature on ‘acquired’ TR [as in congenital heart diseases, such as atrial septal defect (ASD)] is sparse. Some of the concerns that need to be addressed are thresholds for intervention, optimal annular reduction and methods of surgical reduction (DeVega vs ring annuloplasty). We present a case of a 5 years old female child who primarily presented for closure of her ostium secundum ASD. However, intraoperative transesophageal echocardiography (TEE) revealed TR and a tricuspid annular dimension beyond z +3 for her size. The surgeon chose to perform a DeVega annuloplasty and both the ASD closure and the annuloplasty were uneventful, postoperative TEE revealed no residual defect, no TR or stenosis. We seek to highlight this case in order to urge a more systematic study of such patients with a local focus since patients in our country present later than usual with asymptomatic heart disease and are more likely to undergo progressive right heart enlargement for a given shunt.

Keywords:TEE evaluation of tricuspid valve, TEE measurement of tricuspid annulus, TR in pediatric patients, DeVega in pediatric patients, TEE in congenital heart surgery.

How to cite this article:Sethumadhavan J, Singh H, Jayant A. Tricuspid Valve Dilation in a Case of Ostium Secundum Atrial Septal Defect: Therapeutic Dilemmas in the Perioperative Period and a Call for Building the Evidence. J Perioper Echocardiogr 2013;1(1):24-26.

Source of Support: Nil

Conflict of Interest: None declared

1975

CASE REPORTS
S Subash, BM Shivaprasad, A Jayant, Goverdhan Dutt Puri

Incidentally Detected Coronary Artery Fistula Detected on Routine Perioperative Transesophageal Echocardiography

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:27-29]


ABSTRACT

Coronary artery fistulae (CAF) are rare anomalies. Herein, we describe the use of intraoperative transesophageal echocardiography (TEE) in the diagnosis and management of CAF. A 3-year-old child diagnosed to have ostium secundum atrial septal defect (OS ASD) was posted for surgical closure under cardiopulmonary bypass (CPB). Post procedure TEE revealed a single continuous turbulent jet toward right atrium near the lateral wall of tricuspid region and was diagnosed as CAF communicating right coronary artery and right atrium. Surgical ligation of the CAF under CPB was done and the child was discharged postoperatively without complications. This case highlights the utility of intraoperative TEE in the diagnosis and management of CAF.

Keywords:Coronary artery fistula, Coronary cameral fistula, Coronary arterial fistula, Coronary anomaly, Transesophageal echocardiography.

How to cite this article:Subash S, Shivaprasad BM, Jayant A, Puri GD. Incidentally Detected Coronary Artery Fistula Detected on Routine Perioperative Transesophageal Echocardiography. J Perioper Echocardiogr 2013;1(1):27-29.

Source of Support: Nil

Conflict of Interest: None declared

1653

CASE REPORTS
Stephen M McHugh, Stephen O Bader

Intraoperative Transesophageal Echocardiography in the Management of a Right Coronary Artery to Coronary Sinus Fistula

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:21-23]


ABSTRACT

Coronary artery fistulas are rare but can have significant perioperative consequences. We describe the case of a 65- year-old man found to have a coronary artery fistula from the anterior right coronary artery to the coronary sinus. We discuss the unique advantages that transesophageal echocardiography offers in the monitoring and management of coronary artery fistulas.

Keywords:Transesophageal echocardiography, Coronary artery fistula, Monitoring, Bacterial endocarditis.

How to cite this article:McHugh SM, Bader SO. Intraoperative Transesophageal Echocardiography in the Management of a Right Coronary Artery to Coronary Sinus Fistula. J Perioper Echocardiogr 2013;1(1):21-23.

Source of Support: Nil

Conflict of Interest: None declared

1598

Selected Abstracts
Goverdhan Dutt Puri, Bala Subramaniam, Kathirvel Subramaniam

Selected Abstracts of the TEEPGI 2013 Workshop (1st to 3rd March 2013)

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:33-37]


ABSTRACT

Background: Paravalvular or paraprosthetic leak (PVL) is a complication associated with the surgical/transcatheter implantation of a prosthetic heart valve, more commonly a mechanical than a bioprosthetic valve. Transthoracic echocardiography (TTE) is the most important diagnostic modality for prosthetic valve function/dysfunction. However, TTE often cannot differentiate the PVL from prosthetic regurgitation. Transesophageal echocardiography (TEE) is the modality of choice which is also able to detect small, nonsignificant jets.

How to cite this article:Singh R, Tandon R, Kumbhkarni S, Aslam N, Mohan B, Gautam PL, Wander GS. A Case of Paraprosthetic Leak diagnosed with the Help of 3D TEE. J Perioper Echocardiogr 2013;1(1):33-37.

Source of Support: Nil

Conflict of Interest: None declared

1358



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