Current Issue Volume 5, Number 2 , July-December 2017

EDITORIAL
Goverdhan D Puri, Neeti Dogra

Perioperative Point of Care Cardiac Ultrasound for Anesthetists

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:46] [Pages No:39-41]



“Every work has to pass through three stages— ridicule, opposition and then acceptance.”

—Swami Vivekananda

How to cite this article: Puri GD, Dogra N. Perioperative Point of Care Cardiac Ultrasound for Anesthetists. J Perioper Echocardiogr 2017;5(2):39-41.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Imran H Bhat, Alok Kumar, Balbir Kumar, Rajarajan Ganesan, Banashree Mandal, Vikas Dutta

Echocardiographic Evaluation of Right Ventricular Function in the Immediate Postoperative Period after Major Pulmonary Resections: A Prospective Observational Study

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:46] [Pages No:42-48]



Aim: We aimed to identify the impact through the use of standard and novel echocardiographic parameters, i.e., speckle tracking echocardiography (STE) to evaluate the right and left ventricular (LV) myocardial function in patients who underwent lung resections.

Materials and methods: We identified patients that underwent lobectomy or pneumonectomy at our institution in 2016 to 2017. We performed preoperative transthoracic echocardiography (TTE) in each patient and on postoperative days (PODs) 2, 7, and 30 when available.

Results: Of a total of 26 patients included in the study, 5 underwent pneumonectomy, while the rest underwent lobectomy. Left and right pneumonectomy was performed in 38 and 62% of the patients respectively. None of the patients had right ventricular (RV) dilation or dysfunction on preoperative echocardiograms. Postoperatively, mean LV ejection fraction (LVEF) was 52 (±7.5) %. Mean RV strain in immediate postoperative period (day 2) was -15.1% (reduction of more than 20%). None of the patients progressed to RV failure or had mortality. Estimated RV systolic pressure was 41 (±20) mm Hg. The differences in RV echocardiographic parameters were significantly different pre- and postsurgery. The RV function decreased significantly on POD 2, which improved slightly thereafter. Extent of resection and side of resection did not make a difference in the RV functions.

Conclusion: After lung resection, patients developed deterioration in RV function that may be reflected by any of the echocardiographic parameters used to assess RV function. Deterioration in RV function is maximum in the immediate postoperative period (day 2), which improves to preoperative level by 4 weeks.

Keywords: Lobectomy, Lung resection, Pneumonectomy, Right ventricle function, Speckle tracking echocardiography.

How to cite this article: Bhat IH, Kumar A, Kumar B, Ganesan R, Mandal B, Dutta V. Echocardiographic Evaluation of Right Ventricular Function in the Immediate Postoperative Period after Major Pulmonary Resections: A Prospective Observational Study. J Perioper Echocardiogr 2017;5(2): 42-48.

Source of support: This work was supported by the Society of Transesophageal Echocardiography.

Conflict of interest: None


REVIEW ARTICLE
M Ganesh Kumar, Goverdhan D Puri

Transesophageal Echocardiographic Approach to a Patient with Suspected Pulmonary Hypertension in the Intraoperative Period

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:46] [Pages No:49-63]



Pulmonary hypertension (PH) defined by a mean pulmonary artery pressure (MPAP) >25 mm Hg at rest is confirmed by right heart catheterization (RHC). With the rapid development of surgical methods and cardiopulmonary bypass strategies, many children and adults are undergoing surgical correction for their cardiac pathologies. Presence of PH in these patients contributes to a major morbidity and poses a great challenge for the operative team during its surgical and postoperative management. With the universal use of transesophageal echocardiography (TEE) in almost all cardiac surgeries, the etiology, severity of PH, and its effect on cardiac structures and function can be evaluated in patients suspected of having PH. Since there is no established algorithm for the intraoperative TEE evaluation of such patients, we proposed an algorithm for the evaluation of PH in patients suspected of having raised pulmonary pressure using TEE in the intraoperative period.

Keywords: Pulmonary hypertension, Right ventricle in pulmonary hypertension, Transesophageal echocardiography.

How to cite this article: Kumar MG, Puri GD. Transesophageal Echocardiographic Approach to a Patient with Suspected Pulmonary Hypertension in the Intraoperative Period. J Perioper Echocardiogr 2017;5(2):49-63.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
M Ganesh Kumar, Rajarajan Ganesan, Goverdhan D Puri

Transesophageal Echocardiographic Diagnosis and Imaging of Cardiac Situs and Malposition

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:46] [Pages No:64-69]



Dextrocardia (DC) is a rare cardiac anomaly that can be associated with other congenital abnormalities. Transesophageal echocardiographic imaging for evaluating these patients requires modification of the omniplane angle from the standard angles used. We describe the imaging technique in this condition when it is associated with situs solitus (SS) and situs inversus.

Keywords: Dextrocardia, Echocardiography, Situs inversus, Transesophageal.

How to cite this article: Kumar MG, Ganesan R, Puri GD. Transesophageal Echocardiographic Diagnosis and Imaging of Cardiac Situs and Malposition. J Perioper Echocardiogr 2017;5(2):64-69.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Suruchi Ladha, Uma Balasubramaniam, Usha Kiran, Neeti Makhija, Velayoudam Devagourou

Gerbode Defect following Tetralogy of Fallot Repair: The Role of Transesophageal Echocardiography

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:46] [Pages No:70-73]



Gerbode defect is a rare type of left ventricle (LV) to right atrium (RA) shunt. It is congenital in origin, but acquired cases are also described, usually following infective endocarditis, valve replacement, trauma, or myocardial infarction. We, hereby, report two cases of acquired Gerbode defect after tetralogy of Fallot (TOF) repair, and describe the role of echocardiography in the complete visualization of the anatomical defect, and in differentiation of this shunt from other conditions. The role of transesophageal echocardiography (TEE) is highlighted during reintervention for successful shunt closure.

Keywords: Gerbode defect, Tetralogy of fallot, Transesophageal echocardiography, Tricuspid regurgitation.

How to cite this article: Ladha S, Balasubramaniam U, Kiran U, Makhija N, Devagourou V. Gerbode Defect following Tetralogy of Fallot Repair: The Role of Transesophageal Echocardiography. J Perioper Echocardiogr 2017;5(2):70-73.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Imran H Bhat, Srinath Damodaran, Banashree Mandal

Rare Case of Membranous Obstruction at the Origin of Left Pulmonary Artery: Role of Perioperative Echocardiography to Evaluate the Anatomy of Pulmonary Artery

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:46] [Pages No:74-76]



Branch pulmonary artery (PA) stenosis may occur as an isolated finding or in conjunction with other cardiac malformations; it may be congenital or acquired postoperatively. Branch PAs need to be assessed individually to determine the adequacy of their size, whether they are confluent or nonconfluent, any stenosis at origin or distally, and severity of stenosis. Certain lesions, such as supravalvar pulmonary stenosis, or stenosis at the branch PAs bifurcation, are better dealt with at surgery. Thus, perioperative transthoracic and transesophageal echocardiography (TEE) assume a very important role in precisely evaluating the anatomy of main and branch PAs.

Keywords: Branch pulmonary artery stenosis, Intracardiac repair, L eft p ulmonary a rtery s tenosis, Tetralogy o f F allot, Transesophageal echocardiography.

How to cite this article: Bhat IH, Damodaran S, Mandal B. Rare Case of Membranous Obstruction at the Origin of Left Pulmonary Artery: Role of Perioperative Echocardiography to Evaluate the Anatomy of Pulmonary Artery. J Perioper Echocardiogr 2017;5(2):74-76.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Imran H Bhat, Banashree Mandal, Srinath Damodaran, Rupesh Kumar

Role of Perioperative Echocardiography in Revision of Assessment: A Condition of Severe Aortic Stenosis leading to Left Ventricular Dysfunction and Apical Clot

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:46] [Pages No:77-81]



The prevalence of discrete subaortic stenosis (SAS) in adults with congenital heart disease (CHD) is 8 to 20%, with a male to female ratio of 2:1. Fixed SAS may be due to a discrete fibrous membrane, a muscular narrowing, or a combination of the two. The discrete form of fibromuscular SAS is most frequently encountered (90%), but the tunnel-type lesions are associated with a greater degree of stenosis. We report the case of a 16-year-old boy scheduled for double valve replacement (DVR) based on the preoperative echocardiographic report of rheumatic heart disease (RHD) with severe aortic stenosis (AS), severe aortic regurgitation (AR) and moderate mitral stenosis (MS), and moderate mitral regurgitation (MR) with severe left ventricular (LV) systolic dysfunction and LV apical clot. Preoperative transthoracic echocardiography (TTE) in the operation theater revealed discrete subaortic membrane (SAM) causing severe LV outflow tract obstruction (LVOTO). The patient underwent open heart surgery with resection of the discrete membrane and removal of apical clot.

Keywords: Cardiomyopathy dilated, Congenital, Discrete subaortic stenosis, Echocardiography, Heart auscultation, Heart defects, Perioperative.

How to cite this article: Bhat IH, Mandal B, Damodaran S, Kumar R. Role of Perioperative Echocardiography in Revision of Assessment: A Condition of Severe Aortic Stenosis leading to Left Ventricular Dysfunction and Apical Clot. J Perioper Echocardiogr 2017;5(2):77-81.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Neeti Makhija, Kalpna Irpachi, Palleti Rajashekar, Ch Bharat Siddharth

Fungal Infective Endocarditis mimicking Atrial Myxoma: Transesophageal Echocardiography Assessment

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:46] [Pages No:82-85]



Infective endocarditis (IE) accounts for 0.5 to 1 of every 1,000 hospital admissions. This case describes a left atrial mass of fungal etiology mimicking an atrial myxoma. At times, the diagnosis of mass in left atrium can be a challenge, which is discussed in this report.

Keywords: Infective endocarditis, Myxoma, Transesophageal echocardiography.

How to cite this article: Makhija N, Irpachi K, Rajashekar P, Siddharth CB. Fungal Infective Endocarditis mimicking Atrial Myxoma: Transesophageal Echocardiography Assessment. J Perioper Echocardiogr 2017;5(2):82-85.

Source of support: Nil

Conflict of interest: None


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