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Access Statistics 2014 | July-December | Issue 2

 

REVIEW ARTICLE
Goverdhan Dutt Puri, Ravi Raj, Theresa A Tacy

Transesophageal Echocardiography for Tetralogy of Fallot Repair: What a Perioperative Physician need to know?

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:51-57]


ABSTRACT

Transesophageal echocardiography (TEE) is now an integral part of intraoperative management of TOF patients undergoing intracardiac repair. With the availability of micro TEE probes, intraoperative TEE care can now be provided to even the smallest of patients. It provides live images of the anatomical and pathophysiological state of the heart and allows perioperative physicians to modify surgical and medical treatment perioperatively.
During pre-bypass period, TEE confirms preoperative diagnosis and can provide additional information which might be missed on transthoracic echocardiography (TTE). It also helps in modifying intraoperative surgical plan if new findings are detected intraoperatively. In addition, real time information on volume status and inotropy helps in management of hemodynamics and preventing hypercyanotic spells in prebypass period.
Adequacy of surgical repair can be assessed in immediate post-bypass period and any residual defect can be corrected before patient leaves the operating room. Post repair information on anatomical and pathophysiologic status helps guiding management in intensive care unit.

Keywords: Perioperative, Transesophageal echocardiography, Tetralogy of fallot, Intracardiac repair.

How to cite this article: Puri GD, Raj R, Tacy TA. Transesophageal Echocardiography for Tetralogy of Fallot Repair: What a Perioperative Physician need to know?. J Perioper Echocardiogr 2014;2(2):51-57.

Source of support: Nil

Conflict of interest: None

2916

CASE REPORT
Ravi Raj, Sarin Mathew, Goverdhan Dutt Puri

Iatrogenic Mitral Valve Perforation following CABG and Aortic Valve Replacement: A Rare Complication detected by Post-bypass Transesophageal Echocardiography

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:75-76]


ABSTRACT

Iatrogenic mitral valve perforation following aortic valve replacement is a rare complication. We present a case of anterior mitral leaflet perforation following coronary artery bypass grafting (CABG) and aortic valve replacement detected by intraoperative transesophageal echocardiography (TEE). A 57-year-old male patient with preoperative diagnosis of coronary artery disease, sclerodegenerative aortic valve with severe aortic stenosis and mild central mitral regurgitation (MR) underwent CABG and aortic valve replacement. A post bypass TEE in midesophageal long axis view showed an additional MR jet across the body of the anterior mitral leaflet. We present intraoperative TEE images with a discussion on role of TEE in detection of mitral valve perforation and surgical decision making.

Keywords: Iatrogenic, Mitral valve perforation, Aortic valve replacement, Coronary artery bypass grafting, Transesophageal echocardiography.

Abbreviations: AVR: Aortic valve replacement; CABG: Coronary artery bypass grafting; 2D: Two-dimensional; MR: Mitral regurgitation; TEE: Transesophageal echocardiography; TTE: Transthoracic echocardiography.

How to cite this article: Raj R, Mathew S, Puri GD. Iatrogenic Mitral Valve Perforation following CABG and Aortic Valve Replacement: A Rare Complication detected by Post-bypass Transesophageal Echocardiography. J Perioper Echocardiogr 2014;2(2):75-76.

Source of support: Nil

Conflict of interest: None declared

1846

CASE REPORT
Soumendu Pal

Perforation of Bicuspid Aortic Valve mimicking Trileaflet Aortic Valve on Transesophageal Echocardiography

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:77-79]


ABSTRACT

Endocarditis of bicuspid aortic valve (BAV) can lead to valve perforation and result in severe aortic incompetence. Perforation of valve cusps should be considered in the differential diagnosis of BAV patients presenting with AR, and the condition should not be mistaken as a regurgitant trileaflet AV on transesophageal echocardiography (TEE). Accurate preoperative characterization of the mechanism of aortic regurgitation by TEE is important for determining the type of surgical repair.

Keywords: Bicuspid aortic vlave, Endocarditis, Transesophageal echocardiography.

How to cite this article: Pal S. Perforation of Bicuspid Aortic Valve mimicking Trileaflet Aortic Valve on Transesophageal Echocardiography. J Perioper Echocardiogr 2014;2(2):77-79.

Source of support: Nil

Conflict of interest: None declared

1781

CASE REPORT
Vikas Dutta, Ravi Raj, Bhupesh Kumar, Ajay Bahl, Shyam KS Thingam, Sunder Lal Negi, Goverdhan Dutt Puri

Midventricular Hypertrophic Obstructive Cardiomyopathy with Left Ventricular Aneurysm and Clot: The Role of Transesophageal Echocardiogram in Assessment and Management of Myomectomy

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:58-60]


ABSTRACT

Hypertrophic obstructive cardiomyopathy (HOCM) with mid ventricular obstruction leading to apical aneurysm and clot is very rare. Intraoperative transesophageal echocardiogram (TEE) can be used to know the maximum thickness of the septum, its distance from the aortic annulus and the apical extent of septal bulge. Postresection TEE can provide information about residual obstruction or any complications. We present a case of 65-year-old male patient who underwent CABG, septal myectomy, Dor’s procedure for aneurysm and clot removal. Septal resection was done under TEE guidance.

Keywords: Hypertrophic cardiomyopathy, Midventricular obstruction, Transesophageal echocardiography.

How to cite this article: Dutta V, Raj R, Kumar B, Bahl A, Thingam SKS, Negi SL, Puri GD. Midventricular Hypertrophic Obstructive Cardiomyopathy with Left Ventricular Aneurysm and Clot: The Role of Transesophageal Echocardiogram in Assessment and Management of Myomectomy. J Perioper Echocardiogr 2014;2(2):58-60.

Source of support: Nil

Conflict of interest: None

1758

CASE REPORT
Jitin Narula, Minati Choudhury, Ujjwal Kumar Chowdhary, Usha Kiran

Pulmonary Artery-Pulmonary Vein Fistula: Contrast Echocardiography using Agitated Saline for Indirect Evaluation of Adequacy of Surgical Repair

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:61-64]


ABSTRACT

Direct right pulmonary artery-left atrial communications are rare causes of congenital cyanotic heart disease. Bypassing of the pulmonary circulation and the filtering function of the lung predisposes these patients to high risk of stroke or cerebral embolism. Contrast echocardiography using transesophageal echocardiography helps in detection and/or confirmation of diagnosis of these extracardiac shunts as two-dimensional echocardiography of the heart is essentially normal in such patients. Additionally, it can help in the assessment of adequacy of surgical repair in the postoperative period.

Keywords: Pulmonary artery-pulmonary vein fistula, Contrast echocardiography, Nontranspulmonary contrast agents, Bubble contrast.

How to cite this article: Narula J, Choudhury M, Chowdhary UK, Kiran U. Pulmonary Artery-Pulmonary Vein Fistula: Contrast Echocardiography using Agitated Saline for Indirect Evaluation of Adequacy of Surgical Repair. J Perioper Echocardiogr 2014;2(2):61-64.

Source of support: Nil

Conflict of interest: None declared

1478

CASE REPORT
Neeti Makhija, Sarvesh Pal Singh, Jitin Narula, Arin Choudhury, Usha Kiran

Transesophageal Echocardiography in a Case of Dextro-Transposition of Great Arteries with Regressed Left Ventricle

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:71-74]


ABSTRACT

Patients with dextro-transposition of the great arteries (d-TGA) with an intact ventricular septum (IVS) beyond 21 days of age may develop left ventricular (LV) regression. Perioperative echocardiography-guided assessment of LV for signs of regression is crucial in decision-making for definitive corrective surgery, namely arterial switch operation (ASO), as a regressed LV may not be capable of sustaining the load of systemic circulation. We hereby present transesophageal echocardiography (TEE) findings in a child with d-TGA and regressed LV where decision to perform a primary ASO with integrated extracorporeal membrane oxygenation (ECMO)- cardiopulmonary bypass (CPB) circuit was made. Use of ECMO was planned as a standby technique in the event of LV failure. ECMO was eventually used as the LV was unable to sustain the load of systemic circulation after ASO.

Keywords: Dextro-transposition of great arteries, Arterial switch operation, Regressed left ventricle, Transesophageal echocardiography, Extracorporeal membrane oxygenation.

How to cite this article: Makhija N, Singh SP, Narula J, Choudhury A, Kiran U. Transesophageal Echocardiography in a Case of Dextro-Transposition of Great Arteries with Regressed Left Ventricle. J Perioper Echocardiogr 2014;2(2):71-74.

Source of support: Nil

Conflict of interest: None

1424

CASE REPORT
Arun Subramanian, Minati Choudhary, Ujjwal Chowdhary

Renal Cell Carcinoma presenting as a Right Atrial Mass

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:65-67]


ABSTRACT

Renal cell carcinoma (RCC) has a tendency to invade the renal vein and thereby reach the right heart through inferior vena cava (IVC). This may necessitate a combined surgical procedure usually under cardiopulmonary bypass (CPB). In the following discussion, we shall present a case of right RCC extending into the right atrium. The patient underwent a radical nephrectomy followed by removal of the tumor from right atrium, IVC and hepatic vein under CPB.

Keywords: Renal cell carcinoma, Inferior vena cava, Right atrium, Transesophageal echocardiography.

How to cite this article: Subramanian A, Choudhary M, Chowdhary U. Renal Cell Carcinoma presenting as a Right Atrial Mass. J Perioper Echocardiogr 2014;2(2):65-67

Source of support: Nil

Conflict of interest: None

1419

CASE REPORT
Balbir Kumar, Sethu Madhavan J, Goverdhan Dutt Puri, Sandeep Singh Rana

Role of TEE in Improving Diagnostic Accuracy of Congenital Heart Disease

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:68-70]


ABSTRACT

Complex congenital heart diseases (CHD) often present as multiple cardiac lesions. The presence of one anomaly should stimulate the physician to perform a comprehensive assessment and look for other associated anomalies.1 Multimodal imaging may be necessary to diagnose such associated lesions as single imaging may occasionally miss them. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are complimentary to each other. Routine use of TEE during intraoperative period may help us to refine diagnosis, detect the missing components and guide effective surgical repair. We present one such case where diagnosis and management were optimized by multimodal imaging.

Keywords: Congenital heart diseases, Pediatric TEE, Shone complex.

How to cite this article: Kumar B, Madhavan JS, Puri GD, Rana SS. Role of TEE in Improving Diagnostic Accuracy of Congenital Heart Disease. J Perioper Echocardiogr 2014;2(2):68-70.

Source of support: Nil

Conflict of interest: None

1414

EDITORIAL
Kathirvel Subramaniam, Cynthia MQ Wells

Intraoperative Transesophageal Echocardiography: A Safeguard for Cardiovascular Surgery!

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:31] [Pages No:49-50]


ABSTRACT

How to cite this article: Subramaniam K, Wells CMQ. Intraoperative Transesophageal Echocardiography: A Safeguard for Cardiovascular Surgery!. J Perioper Echocardiogr 2014;2(2):49-50.

Source of support: Nil

Conflict of interest: None

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