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Access Statistics 2014 | January-June | Issue 1

 

REVIEW ARTICLE
Manchula Navaratham, Rajesh Punn, Theresa A Tacy

Imaging Congenital Heart Disease in the Perioperative Period using Transesophageal Echocardiography

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:10-28]


ABSTRACT

Intraoperative transesophageal echocardiography (TEE) for pediatric congenital heart disease has become a standard of care in most institutions in the USA and across Europe. Advances in technology have facilitated the safe use of this tool in patients as small as 2.5 kg and have proved invaluable in guiding surgical repair of congenital cardiac lesions as well as guiding anesthesia management for cardiac and noncardiac procedures. This article describes a systematic approach to image acquisition in children with congenital heart disease (CHD). Specific congenital heart lesions are also described with an emphasis on intraoperative TEE data acquisition and analysis.

Keywords: Transesophageal, Echocardiography, Congenital heart disease.

How to cite the article: Navaratham M, Punn R, Tacy TA. Imaging Congenital Heart Disease in the Perioperative Period using Transesophageal Echocardiography. J Perioper Echocardiogr 2014;2(1):10-28.

Source of support: Nil

Conflict of interest: None

2985

ORIGINAL ARTICLE
Abhi Mishra, J Sethu Madhavan, BPS Ghuman, Ravi Raj, Ajay Kumar, Vikas Dutta, Sunder Negi, Yamini Tandon, Amit Kumar, VK Arya, Bhupesh Kumar, Aveek Jayant, Goverdhan Dutt Puri

Impact and Cost Effectiveness of Routine Intraoperative Transthoracic and Transesophageal Echocardiography on Surgical Decision Making in Pediatric Cardiac Surgery

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:3-9]


ABSTRACT

Introduction: Congenital heart diseases (CHD) present with wide spectrum of lesions leading to diagnostic dilemmas and it is quite possible to miss correct diagnosis during preoperative transthoracic echocardiography (TTE) in an inadequately sedated child, especially in a busy outpatient setting. It is a routine practice in our center to do baseline TTE after induction of anesthesia followed by pre and postcardiopulmonary bypass (CPB) transesophageal echocardiography (TEE) in all CHD patients thus helping us review our surgical plan.

Materials and methods: All pediatric patients <18 years undergoing cardiac surgery from January 2013 to December 2013 at our tertiary care center in whom perioperative echocardiograhy was done were included. Appropriate sized TTE and TEE probes were used with the Philips iE33 echocardiography platform (Philips, Andover, MA) .

Results: Out of total 352 pediatric cardiac surgical patients, perioperative echocardiography was done in 347(98.5%) patients. Baseline TTE showed new findings leading to change in surgical plan in 11 (3.1%) patients while additional new findings in baseline TEE were seen in 9 (2.6%). Post bypass TEE showed residual lesions requiring a CPB rerun in 19 (5.5%) patients. Intraoperative echocardiography was found to be cost effective with an estimated savings per patient of ` 3950 to 5373($61 - 83).

Conclusion: Intraoperative echocardiography is an important tool in armamentarium of perioperative physician which can be used to review diagnosis and help to formulate an informed surgical plan. Post-bypass transesophageal echocardiography is also useful as it identifies the residual lesions and establishes anatomical correction, which ultimately translates to lesser redo surgeries and a better postoperative outcome.

Keywords: Intraoperative echocardiography, Pediatric cardiac surgery, Congenital heart diseases, Transesophageal echocardiography.

How to cite the article: Mishra A, Madhavan JS, Ghuman BPS, Raj R, Kumar A, Dutta V, Negi S, Tandon Y, Kumar A, Arya VK, Kumar B, Jayant A, Puri GD. Impact and Cost Effectiveness of Routine Intraoperative Transthoracic and Transesophageal Echocardiography on Surgical Decision Making in Pediatric Cardiac Surgery. J Perioper Echocardiogr 2014;2(1):3-9.

Source of support: Nil

Conflict of interest: None

2260

CASE REPORT
Prashanth Panduranga

Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:29-31]


ABSTRACT

Acute ischemic mitral regurgitation is due to complete or partial rupture of either anterolateral or posteriomedial papillary muscles occurring within a week of acute myocardial infarction. Chronic ischemic mitral regurgitation is due to postinfarct remodeling leading to imbalance between tethering and closing forces of mitral valve apparatus. We present a 64-year-old male, presenting with acute pulmonary edema secondary to severe mitral regurgitation, a week after his myocardial infarction. Transthoracic echocardiogram detected a mobile intracardiac mass near anterior mitral leaflet with no clear-cut intracardiac origin of this mass. Perioperative transesophageal echocardiography detected rupture of one of the heads of posteriomedial papillary muscle. This case illustrates a rare presentation of postinfarct rupture of one of the heads of posteriomedial papillary muscle occurring late after infarction presenting as an intracardiac mass, which can have surgical implications.

Keywords: Mitral regurgitation, Intracardiac mass, Papillary muscle rupture, Transesophageal echocardiography.

How to cite the article: Panduranga P. Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle. J Perioper Echocardiogr 2014;2(1)29-31.

Source of support: Nil

Conflict of interest: None

2232

CASE REPORT
Andrew W Murray, Stephen M McHugh

TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:34-37]


ABSTRACT

Thymectomies have traditionally been performed via a midline sternotomy but are now increasingly being conducted via a thoracoscopic approach. Insufflation of CO2 into the hemithorax during this procedure can create severe compression of the right atrium and ventricle with resultant hemodynamic instability as well as lead to hypercapnia with possible pulmonary vasoconstriction and right heart strain. Transesophageal echocardiography allows monitoring of both the effects of CO2 insufflation on the heart and the efficacy of interventions to restore hemodynamic stability.

Keywords: Transesophageal echocardiography, Video-assisted thoracoscopic surgery, Video-assisted thoracoscopic surgery, Thymectomy, Pneumothorax.

How to cite the article: Murray AW, McHugh SM. TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy. J Perioper Echocardiogr 2014;2(1):34-37.

Source of support: Nil

Conflict of interest: None

2219

FELLOW’S CORNER
A Subramanian, V Malik, R Sreedhar

Assessment of Pulmonary Valve and Pulmonary Stenosis

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:40-41]


ABSTRACT

The Fellow’s Corner is a short treatise on material relevant for the learning of trainees in cardiac anesthesia. The first in this series is on the TEE assessment of the pulmonary valve.

Keywords: Assessment, Transesophageal, Pulmonary valve.

How to cite the article: Subramanian A, Malik V, Sreedhar R. Assessment of Pulmonary Valve and Pulmonary Stenosis. J Perioper Echocardiogr 2014;2(1):40-41

Source of support: Nil

Conflict of interest: None

1711

Abstract
Ravi Raj, Goverdhan Dutt Puri

Selected Abstracts of the TEEPGI 2014 Workshop

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:42-48]


1563

CASE REPORT
Navparkash S Sandhu, Levon M Capan

Role of Transesophageal Echocardiography in Management of Thoracic Stab Wound

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:32-33]


ABSTRACT

Transesophageal echocardiography (TEE) is useful in diagnosing cardiac and aortic injuries. A case of stab chest is described in which TEE ruled out cardiac injury, located the knife in the left lung and had potential to change the surgical plan.

Keywords: Echocardiography, Stab chest, Impaled foreign bodies thorax.

How to cite the article: Sandhu NS, Capan LM. Role of Transesophageal Echocardiography in Management of Thoracic Stab Wound. J Perioper Echocardiogr 2014;2(1):32-33.

Source of support: Nil

Conflict of interest: None

1425

CASE REPORT
Sambhunath Das, Kalpna Irpachi, V Devagourou

Transesophageal Echocardiography Guided Ligation of Right Pulmonary Artery to Left Atrial Fistula

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:38-39]


ABSTRACT

Right pulmonary artery to left atrial fistula is a rare congenital cardiac anomaly. A 23 years old man visited an ophthalmologist for complains of diplopia and diminished vision with cyanosis. Computerized tomography angiography diagnosed the presence of right pulmonary artery to left atrium fistula. Intraoperative use of transesophageal echocardiography confirmed the diagnosis and guided in real time for the successful ligation of fistula. Transesophageal echocardiography helped to perform the surgery without cardiopulmonary bypass.

Keywords: Right pulmonary artery to left atrial fistula, Diplopia, Transesophageal echocardiography, Computerized tomography angiography.

How to cite the article: Das S, Irpachi K, Devagourou V. Transesophageal Echocardiography Guided Ligation of Right Pulmonary Artery to Left Atrial Fistula. J Perioper Echocardiogr 2014;2(1):38-39.

Source of support: Nil

Conflict of interest: None

1396

EDITORIAL
Manojkumar Rohit, Ankur Gupta

Pediatric Cardiac Anesthesiologist as Perioperative Transesophageal Echocardiographer

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:1-2]


ABSTRACT

How to cite the article: Rohit M, Gupta A. Pediatric Cardiac Anesthesiologist as Perioperative Transesophageal Echocardiographer. J Perioper Echocardiogr 2014;2(1)1-2.

Source of support: Nil

Conflict of interest: None declared

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