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Access Statistics 2015 | January-June | Issue 1

 

REVIEW ARTICLE
Ravi Raj

Echocardiographic Assessment of Mitral Stenosis: Key Learning Points for Fellows/Residents in Training

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:38] [Pages No:17-24]


ABSTRACT

Mitral stenosis is most commonly due to rheumatic heart disease, even in western countries. Transthoracic echocardiography is the modality of choice for establishing diagnosis, underlying cause, assessment of severity, staging of disease, valve morphology and other associated lesions. Transesophageal echocardiography is recommended in patients considered for percutaneous balloon mitral valvotomy to rule out LA clot, significant MR and to better assess mitral valve morphology. Three-dimensional echocardiography is now increasingly used for estimating mitral valve area and suitability for percutaneous balloon mitral valvotomy. We provide a brief discussion on echocardiographic assessment of mitral stenosis.

Keywords: Rheumatic mitral stenosis, Transthoracic echocardiography, Transesophageal echocardiography, Threedimensional echocardiography, Mitral valve.

How to cite this article: Raj R. Echocardiographic Assessment of Mitral Stenosis: Key Learning Points for Fellows/Residents in Training. J Perioper Echocardiogr 2015;3(1):17-24.

Source of support: Nil

Conflict of interest: None

2463

REVIEW ARTICLE
Kathirvel Subramaniam, Balachundhur Subramaniam

Role of Perioperative Echocardiography Leadership in a Tertiary University Hospital

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:38] [Pages No:4-16]


ABSTRACT

Echocardiography has been shown to improve the perioperative outcomes of surgical and critically ill patients. Several modalities of echocardiography (transthoracic, transesophageal, epicardial and epiaortic) are being utilized clinically for the hemodynamic management of surgical patients. They can be collectively described as perioperative echocardiography (PEC). Because of such a wider scope of practice in perioperative echocardiography, there is a need for leadership to maintain equipment, good clinical practice, education, research, quality, documentation, billing and reimbursement. American Society of Echocardiography (ASE) and Society of Cardiovascular Anesthesiologists (SCA) published guidelines for performance, reporting, education and quality improvement in PEC. The major role of echocardiography leadership is to ensure PEC team follows the guidelines published by ASE/SCA in their practice and utilize the potential of the various modalities to the benefit and safety of their patients. This article explores the key roles of the director for perioperative echocardiography service at a tertiary university hospital.

Keywords: Perioperative echocardiography, Leadership role, University hospital.

How to cite this article: Subramaniam K, Subramaniam B. Role of Perioperative Echocardiography Leadership in a Tertiary University Hospital. J Perioper Echocardiogr 2015;3(1):4-16.

Source of support: Nil

Conflict of interest: None declared

1296

CASE REPORT
Vikas Dutta, Ravi Raj, Ajay Bahl, Shyam Singh Thingnum, Goverdhan Dutt Puri

Hypertrophied Papillary Muscle causing Mid Cavity Left Ventricular Obstruction after Cardiac Surgery

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:38] [Pages No:32-34]


ABSTRACT

A rare cause of mid cavity left ventricular obstruction can be a hypertrophied and/or a malformed papillary muscle. Hypertrophy of papillary muscle can be atypical presentation of hypertrophic obstructive cardiomyopathy. Most of these patients do not have a resting gradient, but a dynamic gradient can occur in hypovolumia or increased contractile state. We present a case of elderly patient who had a hypertrophied anterolateral papillary muscle and developed mid left ventricular obstruction after weaning the patient from cardiopulmonary bypass.

Keywords: Papillary muscle hypertrophy, Cardiac surgery, Mid left ventricular gradient.

How to cite this article: Dutta V, Raj R, Bahl A, Thingnum SS, Puri GD. Hypertrophied Papillary Muscle causing Mid Cavity Left Ventricular Obstruction after Cardiac Surgery. J Perioper Echocardiogr 2015;3(1):32-34.

Source of support: Nil

Conflict of interest: None

1040

CASE REPORT
Imran Hussain Bhat, Ravi Raj, Goverdhan Dutt Puri

Unanticipated Ruptured Sinus of Valsalva Aneurysm in a Patient with Subpulmonic Ventricular Septum Defect: Suspected by Intraoperative Transthoracic Echo; Confirmed by Intraoperative Transesophageal Echo

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:38] [Pages No:25-28]


ABSTRACT

A sinus of valsalva (SOV) aneurysm is a rare cardiac anomaly that may be congenital or acquired and may be associated with other cardiac lesions. If the aneurysm ruptures, it causes acute symptoms of dyspnea. Echocardiography is a useful diagnostic tool that can guide in proper management of these patients. We present a case of subpulmonic ventricular septal defect (VSD) in which ruptured SOV was detected by intraoperative transthoracic echocardiography and confirmed by transesophageal echocardiography (TEE) which helped in adequate surgical repair and good outcome for the patient. This case report emphasizes the importance of routine transthoracic and TEE in operating room by cardiac anesthesiologist to confirm the original diagnosis and look for new unanticipated findings, especially in a patient with strong clinical suspicion.

Keywords: Ruptured sinus of valsalva aneurysm, Subpulmonic ventricular septum defect, Transesophageal echocardiography, Transthoracic echocardiography.

How to cite this article: Bhat IH, Raj R, Puri GD. Unanticipated Ruptured Sinus of Valsalva Aneurysm in a Patient with Subpulmonic Ventricular Septum Defect: Suspected by Intraoperative Transthoracic Echo; Confirmed by Intraoperative Transesophageal Echo. J Perioper Echocardiogr 2015;3(1): 25-28.

Source of support: Nil

Conflict of interest: None

825

CASE REPORT
Rajkumar K Vishwakarma, Ravi Raj, Goverdhan Dutt Puri

Intraoperative Detection of Ascending Aortic Dissection by Transesophageal Echocardiography in a Patient with Bicuspid Aortic Valve and Ascending Aortic Aneurysm

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:38] [Pages No:29-31]


ABSTRACT

Bicuspid aortic valve is a common congenital heart defect frequently associated with complications of aortic valve and dilatation of ascending aorta. High index of suspicion is required for diagnosis of aortic dissection in patient with bicuspid aortic valve and ascending aortic dilatation. We present a case of bicuspid aortic valve with ascending aortic aneurysm in which aortic dissection was detected by intraoperative transesophageal echocardiography (TEE). A careful review of patient’s preoperative computed tomography (CT) scan showed dissection flap in the ascending aorta, which was overlooked in CT reporting. We present how intraoperative TEE helped in surgical planning for the patient.

Keywords: Aortic aneurysm, Aortic dissection, Bicuspid aortic valve, Computed tomography, Transesophageal echocardiography.

How to cite this article: Vishwakarma RK, Raj R, Puri GD. Intraoperative Detection of Ascending Aortic Dissection by Transesophageal Echocardiography in a Patient with Bicuspid Aortic Valve and Ascending Aortic Aneurysm. J Perioper Echocardiogr 2015;3(1):29-31.

Source of support: Nil

Conflict of interest: None

652

EDITORIAL
Goverdhan Dutt Puri, JS Madhavan

Anesthesiologist as Perioperative Echocardiographer

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:38] [Pages No:1-3]


ABSTRACT

Advances in technology have led to new equipments being introduced into the operating room (OR) and intensive care units (ICUs). Ultrasound machine is one such equipment which plays a vital contribution to both monitoring and interventions.1

How to cite this article: Puri GD, Madhavan JS. Anesthesiologist as Perioperative Echocardiographer. J Perioper Echocardiogr 2015;3(1):1-3.

Source of support: Nil

Conflict of interest: None

540

CASE REPORT
Sunder Lal Negi, Vikas Dutta, Goverdhan Dutt Puri, Sethu Madhavan, Ravi Mohan

Role of Transesophageal Echocardiography in Detection of Residual Tumor in Renal Cell Carcinoma Extending into Right Atrium

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:38] [Pages No:35-38]


ABSTRACT

Renal cell carcinoma (RCC) has a tendency to invade inferior vena cava and thereby reach the right heart. This may necessitate a combined surgical procedure. These procedures impose a challenge to the anesthesiologist and may require the use of veno-venous or cardiopulmonary bypass (CPB). Among the serious and feared complication is embolization of the thrombus during mobilization of the tumor causing a massive pulmonary embolism. Transesophageal echocardiography (TEE) not only provide accurate identification and definition of the cranial extent of the tumor, but may also provide continuous monitoring of the hemodynamic status and cardiac complications during surgical manipulation of tumor. In this case report, we have described TEE helped in recognizing not only the extent of the tumor but also (the adequacy of removal of the tumor thrombus) diagnose the residual tumor after removal during right radical nephrectomy.

Keywords: Transesophageal echocardiography, Renal cell carcinoma, Residual right atrial tumor.

How to cite this article: Negi SL, Dutta V, Puri GD, Madhavan S, Mohan R. Role of Transesophageal Echocardiography in Detection of Residual Thrombus in Renal Cell Carcinoma extending into Right Atrium. J Perioper Echocardiogr 2015;3(1):35-38.

Source of support: Nil

Conflict of interest: None

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