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Access Statistics 2016 | July-December | Issue 2

 

REVIEW ARTICLE
Alok Kumar, Vikas Dutta, Goverdhan Dutt Puri, Parag Barwad

Perioperative Echocardiographic Features of Total Anomalous Pulmonary Venous Connection

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:51-58]


ABSTRACT

Total anomalous pulmonary venous connection (TAPVC) refers to when all four pulmonary veins connect anomalously to the right atrium, directly or indirectly. Perioperative echocardiography, both transthoracic and transesophageal (TEE) with color flow imaging and Doppler interrogation, can identify the venous confluence, its connections, obstructions if any in the pathway, and any interatrial communication. They supplement each other in delineating the anatomy of such anomalous pulmonary venous connections. Perioperative TEE evaluation of patients with repaired TAPVC confirms the adequacy of repair, leaks or stenosis of the venous baffle. We summarize the role of perioperative echocardiography in understanding cases of TAPVC.

Keywords: Perioperative transesophageal echocardiography, Pulmonary veins, Total anomalous pulmonary venous connection, Transesophageal echocardiography, Transthoracic echocardiography.

How to cite this article: Kumar A, Dutta V, Puri GD, Barwad P. Perioperative Echocardiographic Features of Total Anomalous Pulmonary Venous Connection. J Perioper Echocardiogr 2016;4(2):51-58.

Source of support: Nil

Conflict of interest: None

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CASE REPORT
Michael L Boisen, Stephen M McHugh, Robert H Boretsky, Dennis P Phillips, Li Meng, Mathew W Caldwell, A Murat Kaynar, Kathirvel Subramaniam

Perioperative Echocardiographic Diagnosis of Regional Wall Motion Abnormalities: Not All of Them are Ischemic!

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:70-73]


ABSTRACT

We present three noncardiac surgical patients with regional left ventricular dysfunction diagnosed by bedside echocardiography: One intraoperative, another immediate postoperative, and a third one with preoperative hemodynamic instability. We review the differential diagnosis and the growing role of perioperative transthoracic echocardiography.

Keywords: Ischemia, Perioperative, Transthoracic echocardiography, Wall motion.

How to cite this ar ticle: Boisen ML, McHugh SM, Boretsky RH, Phillips DP, Meng L, Caldwell MW, Kaynar AM, Subramaniam K. Perioperative Echocardiographic Diagnosis of Regional Wall Motion Abnormalities: Not All of Them are Ischemic! J Perioper Echocardiogr 2016;4(2):70-73.

Source of support: Nil

Conflict of interest: None

1045

CASE REPORT
Elizabeth Ungerman, Wendy Haft

Giant Right Atrial Myxoma: The Importance of Transesophageal Echocardiography during Diagnosis, Evaluation, and Resection

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:74-78]


ABSTRACT

Most cardiac tumors are benign myxomas, and are most commonly found in the left atrium. Such tumors are identified either during symptomatic workup or found incidentally. We present a case in which a patient with recurrent transient ischemic attacks and syncope was found to have a giant right atrial myxoma with subsequent right atrial outflow obstruction. The mass was initially diagnosed on transthoracic echocardiography and its full scope was detailed utilizing transesophageal echocardiography (TEE). With swift intervention, the mass was successfully removed with the help of TEE guidance and the patient made a full recovery. The importance of TEE both preoperatively and intraoperatively during resection of giant cardiac masses is highlighted.

Keywords: Atrial masses, Cardiac tumors, Myxoma, Transesophageal echocardiography.

How to cite this article: Ungerman E, Haft W. Giant Right Atrial Myxoma: The Importance of Transesophageal Echocardiography during Diagnosis, Evaluation, and Resection. J Perioper Echocardiogr 2016;4(2):74-78.

Source of support: Nil

Conflict of interest: None

930

ORIGINAL ARTICLE
Alok Kumar, Banashree Mandal, Ravi Raj, Imran Bhat

Comparison of Two Different Methods of obtaining Strain by Perioperative Transesophageal Echocardiography in Patients undergoing Coronary Artery Bypass Graft Surgery: A Prospective Observational Study

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:37-44]


ABSTRACT

Introduction: Tissue deformation imaging enables the objective assessment of regional myocardial deformation assessed by ultrasound-based strain and strain rate. There are two ways to compute myocardial deformation (strain) using echocardiography: One-dimensional tissue Doppler (DTI)-derived strain and two-dimensional (2D) strain derived from B-mode images (speckle tracking, 2D-ST). This study compares the myocardial deformation parameter (i.e., strain) by these two techniques in the perioperative period using transesophageal echocardiography (TEE) in patients undergoing surgery for coronary artery bypass graft (CABG).

Materials and methods: We performed preoperative global longitudinal strain (GLS) of left ventricle (LV) using 2D-ST and DTI, three-dimensional (3D) left ventricular ejection fraction (LVEF) and 2D LVEF in a consecutive series of 50 adult patients scheduled for on-pump CABG.

Result: There was no difference between 2D and 3D LVEF (p < 0.0001), GLS using 2D-ST and DTI (p-value = 0.0005). The 3D LVEF correlated well with GLS using 2D-ST (r = 0.54, p < 0.0001) and less with tissue Doppler-derived GLS (r = 0.35, p-value = 0.0131).

Conclusion: The LV GLS calculated using 2D-ST correlates well with LV GLS derived from DTI using TEE. The LV GLS also correlated well with the 3D LVEF.

Keywords: Global longitudinal strain, Speckle tracking, Three-dimensional transesophageal echocardiography, Tissue doppler strain, Transesophageal echocardiography.

How to cite this article: Kumar A, Mandal B, Raj R, Bhat I. Comparison of Two Different Methods of obtaining Strain by Perioperative Transesophageal Echocardiography in Patients undergoing Coronary Artery Bypass Graft Surgery: A Prospective Observational Study. J Perioper Echocardiogr 2016;4(2):37-44.

Source of support: This study was partially supported by the Society of Transesophageal Echocardiography Research Fellowship, awarded to Dr Alok Kumar. Clinical-Trials.gov ID: NCT02692131.

Conflict of interest: None

850

CASE REPORT
Shakeel AM Kunju, Ivan L Rapchuk

The Value of a Systematic Transesophageal Echocardiography Examination: An Isolated Finding mimicking a Pleural Effusion

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:64-66]


ABSTRACT

An interesting case report of presumed pleural fluid collection observed during routine intraoperative transesophageal echocardiography examination is presented here. Acquisition of an isolated image without giving due consideration to the technique used in obtaining that image may be misleading and result in avoidable patient intervention.

Keywords: Intraperitoneal fluid, Pleural fluid, Transesophageal echocardiography.

How to cite this article: Kunju SAM, Rapchuk IL. The Value of a Systematic Transesophageal Echocardiography Examination: An Isolated Finding mimicking a Pleural Effusion. J Perioper Echocardiogr 2016;4(2):64-66.

Source of support: Nil

Conflict of interest: None

512

CASE REPORT
Bhupesh Kumar, Ganesh K Munirathinam, Preeti Sharma, Goverdhan Dutt Puri, Harkant Singh

Role of Transesophageal Echocardiography in Rupture of Sinus of Valsalva Aneurysm with Associated Infective Endocarditis

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:59-63]


ABSTRACT

Introduction: Sinus of Valsalva aneurysm (SOVA) may have associated infective endocarditis in which case single aneurysm may drain into adjacent chamber of heart via multiple openings. We report a rare case of congenital SOVA with associated infective endocarditis where intraoperative transesophageal echocardiogram (TEE) helped in localizing two separate openings in the SOVA draining into right ventricle and an associated perforation in the larger rightward cusp of bicuspid aortic valve (BAV) causing severe aortic regurgitation.

Case report: A 28-year-old male presented with grade III to IV dyspnea with previous history of infective endocarditis. Preoperative transthoracic echocardiogram (TTE) showed calcified BAV with severe aortic valve regurgitation and stenosis, severe tricuspid regurgitation, and pulmonary artery hypertension along with ruptured SOVA arising from right coronary sinus and draining into the right ventricle. Intraoperative TEE confirmed the TTE findings and in addition showed the presence of two jets arising from the SOVA draining into right ventricle, a subaortic membrane, and a perforation in the aortic cusp opening into left ventricle. The ruptured SOVA was repaired using single patch technique and aortic valve was replaced. The completeness of the repair was checked using TEE to exclude failure of closure of additional opening if any and the patient was discharged from hospital after 7 days of uneventful postoperative course.

Conclusion: Sinus of Valsalva aneurysm may have multiple openings draining into adjacent chamber, particularly if associated with infective endocarditis. Intraoperative TEE plays a crucial role in identification of multiple opening, involvement of adjacent structure, and assessment of completeness of repair.

Keywords: Infective endocarditis, Sinus of Valsalva aneurysm, Transesophageal echocardiogram.

How to cite this article: Kumar B, Munirathinam GK, Sharma P, Puri GD, Singh H. Role of Transesophageal Echocardiography in Rupture of Sinus of Valsalva Aneurysm with Associated Infective Endocarditis. J Perioper Echocardiogr 2016;4(2):59-63.

Source of support: Nil

Conflict of interest: None

457

CASE REPORT
Sanjay Kumar, Alok Kumar, Vikas Dutta

Unusual Embolization of Atrial Septal Defect Device in Left Ventricle and its Successful Retrieval

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:67-69]


ABSTRACT

Atrial septal defect (ASD) transcatheter occlusion techniques are now established as the preferred method and have become an alternative to surgery under extracorporeal circulation. In this study, we aimed to present our emergency surgical approach to an unusual case of device embolization to left ventricle due to migration of the ASD occluder. The diagnosis was made via transthoracic echocardiography postprocedure. No early or late complication was seen. Transesophageal echocardiography (TEE) examinations showed no residual interatrial shunting. Transcatheter occlusion of secundumtype ASD has drawbacks, such as distal migration and residual shunts. Consequently, we think that unfavorable anatomy (deficient or floppy rim, septal malalignment) and device diameter are major issues in device migration. Careful follow-up and TEE monitoring perioperatively can lead to successful management of such cases.

Keywords: Amplatzer septal occluder, Embolization, Migration, Secundum-type atrial septal defect.

How to cite this article: Kumar S, Kumar A, Dutta V. Unusual Embolization of Atrial Septal Defect Device in Left Ventricle and its Successful Retrieval. J Perioper Echocardiogr 2016; 4(2):67-69.

Source of support: Nil

Conflict of interest: None

429

Editorial
Goverdhan Dutt Puri

Strain Measurements in Perioperative Settings

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:35-36]


ABSTRACT

Recent interest in strain has led to use of this emerging technology for perioperative purpose. Speckle tracking echocardiography (tissue tracking, two-dimensional strain, three-dimensional strain, and strain rate) shows a promise not only to monitor myocardial function but also prognosticate the outcomes in both cardiac surgery and noncardiac surgery

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ORIGINAL ARTICLE
Sunder L Negi, Kriti Puri, Banashree Mandal, Sandeep S Rana, Parag Barwad

Right Ventricle Segmental Strain Trends in Patients undergoing Tetralogy of Fallot Repair: An Observational Study

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:45-50]


ABSTRACT

Introduction: Incidence of right ventricular (RV) dysfunction in early postoperative period after Tetralogy of Fallot (TOF) repair ranges from 28 to 63%. Echocardiography is the first-line tool for the assessment of RV function in early postoperative period. As speckle tracking echocardiography (STE) has emerged as a new promising tool for assessing myocardial performance and is independent of geometric assumptions and angle dependence, it is more sensitive for detecting changes in myocardial performance than conventional echocardiographic parameters of RV function. The current study demonstrates echocardiographic parameters assessed by conventional twodimensional (2D) echocardiography and STE in patients before and after TOF repair.

Materials and methods: Fifty-nine consecutive patients planned for complete intracardiac repair for TOF were enrolled in this prospective cohort study. The 2D echocardiography and STE were performed a day prior to TOF repair, in the early postoperative period between days 3 and 7 and after discharge at 3 months.

Results: The median age of patients was 6 years, with 57.6% males (34/59). Baseline hemoglobin and room air oxygen saturation were 17.7 ± 3.7 gm% and 79.4% ± 8% respectively. Two patients did not survive the procedure (3.4%). Right ventricular longitudinal peak systolic strain (RV LPSS) in early postoperative period was significantly decreased in all segments of both septal and lateral wall. However, RV LPSS assessed at midterm follow-up at 3 months postoperatively significantly improved in all segments of RV compared with assessment done in the early postoperative period, and was significantly better than preoperative values in all three segments of the septal wall.

Conclusion: Our study shows that the use of 2D strain or speckle tracking is a feasible and easy-to-implement technique for the evaluation of RV function after TOF repair.

Keywords: Echocardiography, Right ventricle, Right ventricular longitudinal segmental strain, Tetralogy of Fallot.

How to cite this article: Negi SL, Puri K, Mandal B, Rana SS, Barwad P. Right Ventricle Segmental Strain Trends in Patients undergoing Tetralogy of Fallot Repair: An Observational Study. J Perioper Echocardiogr 2016;4(2):45-50.

Source of support: Nil

Conflict of interest: None

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