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Access Statistics 2013 | July-December | Issue 2

 

REVIEW ARTICLE
Kathirvel Subramaniam, Stephen A Esper

Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:48-56]


ABSTRACT

Lung transplantation is the only option for patients with end-stage lung disease. Chronic obstructive lung disease, idiopathic pulmonary fibrosis, cystic fibrosis and primary pulmonary hypertension are few common indications for lung transplantation. Patients with end-stage lung disease may have pre-existing cardiovascular compromise related to pulmonary hypertension and other cardiovascular lesions, such as coronary artery disease or valvular heart disease. Preoperative evaluation and optimization of hemodynamics is expected to improve outcomes from lung transplantation. Intraoperative hemodynamic instability is common during lung transplantation and requires highest level of cardiovascular monitoring. After transplantation, vascular anastomosis should be evaluated for flow patterns to rule out obstruction from stenosis or thrombosis. Postoperative complications are common and include bleeding, cardiac failure and hypoxemia from right to left shunt. Primary graft dysfunction may necessitate mechanical cardiorespiratory support. Transesophageal echocardiography plays a central role in preoperative evaluation, intraoperative hemodynamic management, evaluation of pulmonary vascular anastomosis, diagnosis of postoperative complications and also in the critical care management of mechanical cardiorespiratory support.

Keywords: Lung transplantation, Transesophageal echocardiography, Perioperative management.

How to cite this article:Subramaniam K, Esper SA. Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery. J Perioper Echocardiogr 2013;1(2):48-56.

Source of support: Nil

Conflict of interest: None declared

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CASE REPORT
Amit Bardia, Balachundhar Subramaniam

Systolic Anterior Motion: An Illustrative Case and Discussion of Management Strategy

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:62-65]


ABSTRACT

Systolic anterior motion (SAM) of the mitral leaflets can lead to hemodynamic instability following mitral valve repair. Perioperative echocardiography plays a crucial role in the management of SAM. Perioperative echocardiography helps to (a) identify patients at high risk for SAM before repair, (b) assess SAM and diagnose severity and (c) follow-up management efficacy. An illustrative case is shown in this report to take the reader through the current management strategy of SAM following mitral valve repair.

Keywords: SAM, Mitral repair, Myxomatous.

How to cite this article:Bardia A, Subramaniam B. Systolic Anterior Motion: An Illustrative Case and Discussion of Management Strategy. J Perioper Echocardiogr 2013;1(2): 62-65.

Source of support: Nil

Conflict of interest: None declared

3136

CASE SERIES
Usha Kiran, Arindam Choudhury, Neeti Makhija, Kulbhushan Saini, Randhir Singh Rajput, Balram Airan

Infective Endocarditis: The Anesthesiologist’s Perspective

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:57-61]


ABSTRACT

Infective endocarditis (IE) usually involves one or more heart valves resulting in vegetation, perforation, abscess, fistula and/or pseudoaneurysm formation. In IE, the mainstay of treatment remains antimicrobial agent for 4 to 6 weeks. However, 40 to 60% requires surgical intervention because of some complications. Surgery could be risky in the active stage of the disease, but it becomes essential to avoid preoperative heart failure, irreversible structural damage and also to prevent systemic embolization. Perioperative transesophageal echocardiography (TEE) examination is an important diagnostic modality for guiding therapeutic decisions. We recently managed four patients of IE. Two of them presented with mitral valve vegetations resulting in severe mitral regurgitation and one with aortic root abscess. We monitored TEE in all the four cases throughout the surgery.

Keywords:Infective endocarditis, Vegetation, Aortic root abscess, Transesophageal echocardiography.

How to cite this article:Kiran U, Choudhury A, Makhija N, Saini K, Rajput RS, Airan B. Infective Endocarditis: The Anesthesiologist's Perspective. J Perioper Echocardiogr 2013; 1(2):57-61.

Source of support: Nil

Conflict of interest: None declared

2741

CASE REPORT
Kelly T Peretich, Jeffrey C Liu, Samir Saba, Heather Byrd, Kathirvel Subramaniam

A Case of Delayed Cardiac Tamponade: Highlighting the Importance of Transthoracic Echocardiography Training for Anesthesiologists

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:69-71]


ABSTRACT

This echo report describes a patient who developed cardiac temponade in the post-anesthesia care unit after laser lead extraction at electrophysiology laboratory. Diagnosis was readily established by transthoracic echocardiography and this lead to good outcome. Transthoracic ultrasound helps in preoperative evaluation of non-cardiac surgical patients and also postoperative care of hemodynamically unstable patients. This describes the importance of training and competence in transthoracic ultrasound for anesthesiologists.

Keywords: Transthoracic ultrasound, Cardiac tamponade, Laser lead extraction.

How to cite this article:Peretich KT, Liu JC, Saba S, Byrd H, Subramaniam K. A Case of Delayed Cardiac Tamponade: Highlighting the Importance of Transthoracic Echocardiography Training for Anesthesiologists. J Perioper Echocardiogr 2013; 1(2):69-71.

Source of support: Nil

Conflict of interest: None declared

2346

ORIGINAL ARTICLE
Shrinivas Gadhinglajkar, Rupa Sreedhar, Sabarinath Menon, S Omprakash

Pulmonary Venous Doppler Flow Profile before and after Surgical Closure of Atrial Septal Defect in Children

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:42-47]


ABSTRACT

Objectives: A secundum atrial septal defect is associated with a characteristic pattern of continuous antegrade wave on a pulmonary venous Doppler flow profile. It is replaced with a regular S and D wave after the closure of defect. Although, a few published reports have described these features in adults, there are not enough studies in pediatric patients under anesthesia.

Setting: A tertiary referral center.

Participants: A total of 12 children with uncomplicated secundum atrial septal defect participated in the evaluation process.

Interventions: After anesthesia induction, three of them were excluded from detailed pulmonary venous study as they did not satisfy selection criteria. In remaining nine children, the intraoperative pulmonary venous Doppler changes were assessed before and after the defect closure, manually tracing the pulmonary venous waveforms.

Measurements and main results: The antegrade wave was observed in 9/9 patients before surgery that characteristically lacked distinct systolic and diastolic waves, although in seven patients, a larger systolic peak and a smaller diastolic peak were identified.
Normal S and D waves were seen after termination of cardiopulmonary bypass with S/D ratio > in all cases. The maximum velocity of atrial retrograde wave increased and heart rate decreased significantly after surgery.

Conclusion: The continuous antegrade wave is a consistent pulmonary venous Doppler feature of an uncomplicated secundum ASD in anesthetized children. The Doppler pattern is normalized immediately after termination of cardiopulmonary bypass.

Keywords:Transesophageal echocardiography, Atrial septal defect, Doppler.

How to cite this article:Gadhinglajkar S, Sreedhar R, Menon S, Omprakash S. Pulmonary Venous Doppler Flow Profile before and after Surgical Closure of Atrial Septal Defect in Children. J Perioper Echocardiogr 2013;1(2):42-47.

Source of support: Nil

Conflict of interest: None declared

2029

EDITORIAL
Kathirvel Subramaniam, Vinay Badhwar

Systolic Anterior Motion after Mitral Valve Repair: Hemodynamic Optimization or Provocation for Surgical Correction in the Operating Room?

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:40-41]


ABSTRACT

How to cite this article: Subramaniam K, Badhwar V. Systolic Anterior Motion after Mitral Valve Repair: Hemodynamic Optimization or Provocation for Surgical Correction in the Operating Room? J Perioper Echocardiogr 2013;1(2):40-41.

Source of support: Nil

Conflict of interest: None declared

1637

CASE REPORT
Bhupesh Kumar, Vikas Goswami, SS Rana, GD Puri

Utility of Transesophageal Echocardiography in Confirmation of Spread of Local Anesthetic in the Epidural Space

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:72-74]


ABSTRACT

A 30-years-old female with diagnosis of carcinoid tumor of right bronchus was planned to undergo right pneumonectomy under combined epidural and general anesthesia. A pediatric transesophageal echocardiography (TEE) probe was inserted for intraoperative monitoring of the right ventricular function. It also showed spinal canal structures (dura matter, epidural and subarachnoid space and spinal cord) and helped in visualization of local anesthetic spread in the epidural space.

Keywords: Epidural, Local anesthetic spread, Transesophageal echocardiography.

How to cite this article: Kumar B, Goswami V, Rana SS, Puri GD. Utility of Transesophageal Echocardiography in Confirmation of Spread of Local Anesthetic in the Epidural Space. J Perioper Echocardiogr 2013;1(2):72-74.

Source of support: Nil

Conflict of interest: None declared

1430

CASE REPORT
Sambhunath Das, Randhir Singh Rajput

Coexistence of Chronic Constrictive Pericarditis can make the Echocardiographic Diagnosis of Atrial Septal Defect Challenging

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:66-68]


ABSTRACT

Missing the diagnosis of atrial septal defect (ASD) increases morbidities to patient and may require second surgery or intervention. Chronic constrictive pericarditis produces thickening and calcification of pericardium. The detection of any intracardiac lesion may be difficult by echocardiography due to the masking or shadowing effect of calcified pericardium. We report a case of 30-year-old male presented with congestive heart failure, dyspnea and abdominal swelling. Transthoracic echocardiography diagnosed constrictive pericarditis with no evidence of ASD. The contrast enhanced computed tomography (CECT) showed extensive diffuse pericardial calcification with a large ASD. In the operating room initial transesophageal echocardiography (TEE) examination was not able to detect any ASD. Agitated saline injected through the central venous line into right atrium showed bubbles in the left atrium under TEE monitoring. Subsequent movement of TEE probe in deeper position detected the ASD. It is recommended that all the views and methods of echocardiography examination may be practiced in difficult moments to avoid missing the presence of ASD.

Keywords: Transesophageal echocardiography, Chronic constrictive pericarditis, Atrial septal defect.

How to cite this article: Das S, Rajput RS. Coexistence of Chronic Constrictive Pericarditis can make the Echocardiographic Diagnosis of Atrial Septal Defect Challenging. J Perioper Echocardiogr 2013;1(2):66-68.

Source of support: Nil

Conflict of interest: None declared

1136

EDITORIAL
R Krishna Kumar

Physiological Insights from Doppler Flow Patterns

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:39]


ABSTRACT

How to cite this article:Kumar RK. Physiological Insights from Doppler Flow Patterns. J Perioper Echocardiogr 2013;1(2):39.

Source of support: Nil

Conflict of interest: None declared

947



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