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Access Statistics 2017 | January-June | Issue 1

 

CASE REPORT
GN Chennakeshavallu, Shrinivas Gadhinglajkar, Rupa Sreedhar, Prashanth P Bhaskar, Varghese T Panicker

Anatomical vs Anti-anatomical Placement of a Tilting-disk Mechanical Valve in Mitral Position

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:37] [Pages No:12-15]


ABSTRACT

Anatomical and anti-anatomical placement of a prosthetic mechanical valve in mitral position has been described in the literature. In mitral position, it is preferred to place the tiltingdisk valve with its large orifice directed posteriorly, which is called as “anatomical position.” We report an incident wherein a Chitra heart valve prosthesis (CHVP) implanted in anatomical position had limited motion of tilting disk with inadequate angle of opening. This was addressed by rotating the prosthesis occluder mechanism by 180° in situ in such a way that the large orifice was directed anteriorly (anti-anatomical position) and this resulted in the adequate opening of the tilting disk. Transesophageal echocardiography (TEE) played a decisive role in identifying the problem and ensuring adequacy of disk opening after repositioning the prosthesis.

Keywords: Anatomical position, Anti-anatomical position, Chitra heart valve prosthesis, Mitral valve prosthesis, Transesophageal echocardiography.

How to cite this article: Chennakeshavallu GN, Gadhinglajkar S, Sreedhar R, Bhaskar PP, Panicker VT. Anatomical vs Antianatomical Placement of a Tilting-disk Mechanical Valve in Mitral Position. J Perioper Echocardiogr 2017;5(1):12-15.

Source of support: Nil

Conflict of interest: None

635

CASE REPORT
Julie Wyrobek, Chales H Brown IV, Megan P Kostibas, Susan A Mayer, Duke E Cameron, Heather K Hayanga

Double Interatrial Septum appearing as an Atrial Myxoma: A Case Report and Review of the Literature

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:37] [Pages No:16-20]


ABSTRACT

A double interatrial septum (DIS) is a rare finding during echocardiographic evaluation and can often be mistaken for other more common atrial anomalies. The interatrial cavity created by the septum creates a low-flow state that increases risk of thrombus formation and thromboembolic events. Transesophageal echocardiography (TEE) plays a vital role in accurate diagnosis as a DIS is often not seen during transthoracic echocardiography (TTE). In this case, we report a patient who presented for surgery with a preoperative diagnosis of an atrial myxoma, was instead discovered to have a DIS, and then subsequently underwent DIS resection without complication. We discuss the differential of a DIS, including an atrial septal pouch, cor triatriatum, atrial myxoma, and aneurysmal interatrial septum and the classic features of each anomaly for appropriate diagnosis and management.

Keywords: Case repor t, Double interatrial septum, Transesophageal echocardiography.

How to cite this article: Wyrobek J, Brown CH IV, Kostibas MP, Mayer SA, Cameron DE, Hayanga HK. Double Interatrial Septum appearing as an Atrial Myxoma: A Case Report and Review of the Literature. J Perioper Echocardiogr 2017;5(1):16-20.

Source of support: Nil

Conflict of interest: None

338

CASE REPORT
Minati Choudhary, Shivani Aggarwal, Amolkumar Bhoje

New Intracardiac Mass in Right Atrium Postcardiac Surgery: Thrombus or Artifact?

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:37] [Pages No:25-26]


ABSTRACT

Intracardiac masses namely thrombus, vegetation, and tumors may have overlapping echocardiographic appearance. Differentiating them from artifacts and normal anatomic structures further adds to the confusion. We report a similar scenario about the appearance of a new hyperechoic mass in the right atrium (RA) after mitral valve replacement (MVR) surgery.

Keywords: Image artifact, Right atrium, Thrombus, Transesophageal echocardiography.

How to cite this article: Choudhary M, Aggarwal S, Bhoje A. New Intracardiac Mass in Right Atrium Postcardiac Surgery: Thrombus or Artifact? J Perioper Echocardiogr 2017;5(1):25-26.

Source of support: Nil

Conflict of interest: None

338

ORIGINAL ARTICLE
Ganesh K Munirathinam, Alok Kumar, Rajarajan Ganesan, Goverdhan Dutt Puri

Derivation and Validation of Formula relating Pulmonary Acceleration Time and Mean Pulmonary Artery Pressure in Indian Population

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:37] [Pages No:3-11]


ABSTRACT

Background: Pulmonary acceleration time (PAT) forms a valuable echocardiographic parameter in deriving the mean pulmonary artery pressure (MPAP). The present study aims to derive and validate a formula relating MPAP and PAT in an Indian population.

Materials and methods: Preoperative echocardiography was performed in 22 adult cardiac surgery patients undergoing coronary artery bypass grafting (CABG) and/or mitral valve replacement. The PAT, PAT/right ventricular ejection time (RVET), PAT corrected for heart rate [(HR) HRcPAT], and tricuspid regurgitation (TR) peak velocity were correlated with MPAP measured from pulmonary artery (PA) catheter, and a new formula relating MPAP and PAT was derived and subsequently validated in another cohort of 21 patients.

Results: The PAT, HRcPAT, and PAT/RVET correlated well (r2 = 0.69, 0.68 and 0.47 respectively, p < 0.0001), while TR velocity correlated poorly with MPAP (r2 = 0.20, p = 0.046). The cutoff values of PAT and HRcPAT for diagnosing pulmonary artery hypertension (PAH) (MPAP = 25 mm Hg) were 74 and 99 respectively, with 92% sensitivity and 100% specificity. The derived formula (MPAP = 62.4 - 0.3 PAT) correlated well with the standard formula (79-0.45 PAT) on applying in the validation cohort (Bland-Altman plot, bias <10%). In subgroup analysis, patients with severe PAH (MPAP = 50 mm Hg) showed better correlation than patients with less than severe PAH (r2 = 0.633, p =0.038 a nd r 2 = 0.46, p = 0.108 respectively). Similarly, the formula for deriving pulmonary vascular resistance index (PVRI) from PAT [(PVRI = 14.9-0.09 pulmonary artery acceleration time (PAAT)] correlated well with the existing formula (PVRI = 9 - 0.07 PAAT). The inter- and intraobserver variabilities were not significant.

Conclusion: The indexed formula is better in predicting MPAP from PAT in Indian population, particularly in patients with severe PAH (MPAP = 50 mm Hg) and the cutoffs of PAT and HRcPAT in predicting PAH (MPAP = 25 mm Hg) in an Indian population are 74 and 99 msec respectively.

Keywords: Mean pulmonary artery pressure, Pulmonary acceleration time, Pulmonary artery hypertension.

How to cite this article: Munirathinam GK, Kumar A, Ganesan R, Puri GD. Derivation and Validation of Formula relating Pulmonary Acceleration Time and Mean Pulmonary Artery Pressure in Indian Population. J Perioper Echocardiogr 2017;5(1):3-11.

Source of support: Nil

Conflict of interest: None

335

CASE REPORT
Rajarajan Ganesan, Bhupesh Kumar, Ganesh K Munirathinam, Imran Bhat, Sachin Mahajan

Modification in Surgical Plan following Intraoperative Detection of Co-existent Right Atrial Thrombus by Transesophageal Echocardiography in Chronic Constrictive Pericarditis

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:37] [Pages No:34-37]


ABSTRACT

Introduction: Chronic constrictive pericarditis (CCP) is common in developing countries, tuberculosis being the most common cause. Dyspnea and congestive symptoms are the most common nonspecific presenting symptoms that require further evaluation for clinching the diagnosis. Coexistent right atrial (RA) thrombus and CCP are rare occurrences. Preoperative detection of RA thrombus is very important to avoid the risk of pulmonary thromboembolism during pericardiectomy or cannulation for establishing cardiopulmonary bypass (CPB). Perioperative echocardiography may play a crucial role in this setting. We report a case of CCP in which preoperative transesophageal echocardiography (TEE) detected RA thrombus that led to change in surgical plan and provided continuous monitoring during surgery.

Case report: A 14-year-old male presented with a history of abdominal distension and pedal edema for 5 months. Physical examination revealed raised jugular venous pulse with normal heart sounds and no murmurs. Transthoracic echocardiography (TTE) revealed constrictive physiology and thickened pericardium. After induction of anesthesia, TEE revealed an irregular hyperechoic mass (50 × 36 × 30 mm) in the RA free wall that was not detected on preoperative TTE and computerized tomography (CT). Thickened pericardium all around mandated limited pericardiectomy under TEE guidance to allow bicaval cannulation for establishing CPB. This was followed by surgical removal of the thrombus and remaining pericardiectomy using CPB. His postoperative period was uneventful and the patient was discharged home on postoperative day 7.

Conclusion: The TEE may be instrumental in diagnosis of coexistent RA thrombus in the case of CCP resulting in major change in surgical plan and providing perioperative monitoring to avert significant morbidity and mortality.

Keywords: Constrictive pericarditis, Pericardiectomy, Right atrial thrombus, Transesophageal echocardiography.

How to cite this article: Ganesan R, Kumar B, Munirathinam GK, Bhat I, Mahajan S. Modification in Surgical Plan following Intraoperative Detection of Co-existent Right Atrial Thrombus by Transesophageal Echocardiography in Chronic Constrictive Pericarditis. J Perioper Echocardiogr 2017;5(1):34-37.

Source of support: Nil

Conflict of interest: None

313

CASE REPORT
Sambhunath Das, Ashok Kumar

Intraoperative Echocardiographic Detection of Septal Aneurysm and Additional Ventricular Septal Defect in a Child with Tetralogy of Fallot

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:37] [Pages No:21-24]


ABSTRACT

A 2-year-old child was diagnosed with subaortic ventricular septal defect (VSD) with severe infundibular and valvular pulmonary stenosis (PS) by transthoracic echocardiography. Intraoperative transesophageal echocardiography (TEE) detected aneurysmal interventricular and interatrial septum (IAS), subaortic VSD, and right ventricular outflow tract (RVOT) with an additional midmuscular VSD. The aneurysmal interventricular septum (IVS) was repaired. An accessory tricuspid papillary muscle was attached to RVOT, which was augmented with a transannular pericardial patch to have minimal postoperative gradient without sacrificing the accessory papillary muscle (APM). This rare case poses a challenge to the anesthetist and surgeon in the form of diagnostic differences, severe right ventricle (RV) dysfunction with aneurysmal IVS, and difficulty in reconstruction of RVOT. Intraoperative TEE played a greater role to diagnose the IVS aneurysm, additional VSD and guide for appropriate surgery.

Keywords: Accessory septal tricuspid papillary muscle, Interatrial septum aneurysm, Interventricular septum aneurysm, Tetralogy of fallot, Transesophageal echocardiography.

How to cite this article: Das S, Kumar A. Intraoperative Echocardiographic Detection of Septal Aneurysm and Additional Ventricular Septal Defect in a Child with Tetralogy of Fallot. J Perioper Echocardiogr 2017;5(1):21-24.

Source of support: Nil

Conflict of interest: None

276

EDITORIAL
Yehushua Liora, Cynthia Wells, Kathirvel Subramaniam

Preinduction-focused Transthoracic Echocardiography by Anesthesiologists in Cardiac Surgical Patients: “Checks and Balances” Approach improves Patient Care!

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:37] [Pages No:1-2]


ABSTRACT

Transthoracic echocardiography (TTE) has historically been the domain of cardiologists, but physicians in other specialties, such as emergency medicine and critical care medicine started using TTE at the patient bedside to diagnose the etiology of hemodynamic instability and guide few interventions.

How to cite this article: Liora Y, Wells C, Subramaniam K. Preinduction-focused Transthoracic Echocardiography by Anesthesiologists in Cardiac Surgical Patients: “Checks and Balances” Approach improves Patient Care!. J Perioper Echocardiogr 2017;5(1):1-2.

Source of support: Nil

Conflict of interest: None

245

CASE REPORT
Vandana Bhardwaj, Neeti Makhija, Amolkumar Bhoje, Kamal K Chitara

Left Atrial Myxoma with an Unusual Origin near Right Pulmonary Vein

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:37] [Pages No:31-33]


ABSTRACT

Atrial myxoma is the most frequent intracardiac tumor, accounting for nearly 50% of benign cardiac tumours in adults. We present here a rare case report of a solitary left atrial myxoma attached to the left atrial wall near the origin of the right pulmonary vein. The stalk of tumor was not attached to the interatrial septum, which is the most common site of attachment. Instead, it was attached on the wall of left atrium adjacent to the interatrial septum. Surgical exploration confirmed its attachment in the left atrium near the origin of right upper pulmonary vein.

Keywords: Intracardiac tumor, Left atrial myxoma, Transesophageal echocardiography.

How to cite this article: Bhardwaj V, Makhija N, Bhoje A, Chitara KK. Left Atrial Myxoma with an Unusual Origin near Right Pulmonary Vein. J Perioper Echocardiogr 2017;5(1):31-33.

Source of support: Nil

Conflict of interest: None

209

CASE REPORT
Banashree Mandal, Sandeep S Rana, Ganesh K Munirathinam, Gurpinder S Ghotra

Role of Perioperative Echocardiography in the Diagnosis of Hypertrophic Cardiomyopathy: Decoding Special Problem in the Background of Commoners

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:37] [Pages No:27-30]


ABSTRACT

We present a case posted for CABG with double valve replacement (DVR) for triple-vessel coronary artery disease (CAD), rheumatic severe mitral regurgitation, and severe aortic stenosis. However, preprocedure echocardiography in the operation theater confirmed the diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) instead of valvular aortic stenosis, thereby altering the procedure performed to CABG, mitral valve replacement (MVR), and myectomy.

Keywords: Coronary artery bypass graft, Hypertrophic cardiomyopathy, Perioperative echocardiography.

How to cite this article: Mandal B, Rana SS, Munirathinam GK, Ghotra SS. Role of Perioperative Echocardiography in the Diagnosis of Hypertrophic Cardiomyopathy: Decoding Special Problem in the Background of Commoners. J Perioper Echocardiogr 2017;5(1):27-30.

Source of support: Nil

Conflict of interest: None

205



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