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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][No of Hits : 771]


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


 
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][No of Hits : 627]


ABSTRACT

“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][No of Hits : 621]


ABSTRACT

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, 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][No of Hits : 597]


ABSTRACT

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
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][No of Hits : 597]


ABSTRACT

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


 
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][No of Hits : 550]


ABSTRACT

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


 
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][No of Hits : 507]


ABSTRACT

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
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][No of Hits : 1247]


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


 
CASE REPORT
Neeti Makhija, Kalpna Irpachi, Ujjwal K Chowdhury, Usha Kiran

Unusual Attachment of Left Atrial Myxoma: Role of Transesophageal Echocardiography

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:35] [Pages No:30-33][No of Hits : 1246]


ABSTRACT

Left atrial myxomas are usually attached to the interatrial septum. This case highlights the unusual site of attachment of left atrial myxoma. The site of attachment was via a broad stalk at the junction of mitral valve annulus close to anterior mitral leaflet and adjacent left atrial wall. Transesophageal echocardiography helped in the detection of site of attachment as well as in postoperative evaluation.

Keywords: Left atrial mass, Left atrial myxoma, TEE, TTE.

How to cite this article: Makhija N, Irpachi K, Chowdhury UK, Kiran U. Unusual Attachment of Left Atrial Myxoma: Role of Transesophageal Echocardiography. J Perioper Echocardiogr 2016;4(1):30-33.

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 1175]


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


 
CASE REPORT
Alok Kumar, VK Arya, Ajay Kumar, Goverdhan Dutt Puri, KST Shyam, Ajay Bahl

Echocardiographic Evaluation and Management of Right Ventricular Dysfunction during Cardiac Transplantation

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:35] [Pages No:10-13][No of Hits : 1050]


ABSTRACT

Cardiac allotransplantation has, over the years, become the established therapeutic modality for patients with end-stage heart failure. This case report focuses on the anesthetic challenges involved in the perioperative management of recipient with right ventricular dysfunction as well as echocardiographic assessment to assist in therapy.

Keywords: Cardiac transplant, Echocardiography, Right ventricle dysfunction.

How to cite this article: Kumar A, Arya VK, Kumar A, Puri GD, Shyam KST, Bahl A. Echocardiographic Evaluation and Management of Right Ventricular Dysfunction during Cardiac Transplantation. J Perioper Echocardiogr 2016;4(1):10-13.

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 979]


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


 
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][No of Hits : 955]


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


 
EDITORIAL
Kathirvel Subramaniam

Editorial

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:35] [Pages No:1-2][No of Hits : 896]


ABSTRACT

The use of cardiac ultrasound in medical practice has been well known for almost 60 years. Although primarily a domain of cardiologists, anesthesiologists got involved in the practice of diagnostic intraoperative transesophageal echocardiography (TEE) during cardiac surgery for nearly two decades.


 
REVIEW ARTICLE
Nicholas J Schott, Christopher K Schott

Perioperative Ultrasonography Review

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:35] [Pages No:3-9][No of Hits : 890]


ABSTRACT

Point-of-care ultrasonography (POCUS) has become increasingly utilized in modern medicine. Advancements in device technology and ease of use have dramatically broadened its clinical applications. The role in acute care specialties of a pointof- care device has allowed increased opportunities for patient assessment and management. The specialties of emergency medicine and critical care medicine have accepted POCUS in many aspects of clinical use as well as trainee education. Anesthesiology has begun to implement the use of POCUS, specifically transthoracic echocardiography, in the perioperative setting. Many elements of patient care can be addressed and modified using this as an assessment tool. This has led to in growth in ultrasonography training and the potential to be a staple of future anesthesiology care. Point-of-care ultrasonography may become vital to the forefront of management for improving perioperative patient care.

Keywords: Perioperative ultrasound, Point of care, Transthoracic.

How to cite this article: Schott NJ, Schott CK. Perioperative Ultrasonography Review. J Perioper Echocardiogr 2016; 4(1):3-9.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Vikas Dutta, Sunder L Negi, Goverdhan Dutt Puri, Rana S Singh

Perioperative Transesophageal Echocardiographic Diagnosis of Membranous Interventricular Septal Aneurysm in Two Patients

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:35] [Pages No:14-16][No of Hits : 583]


ABSTRACT

Aneurysms of interventricular septum are a rare anomaly usually seen as an incidental finding on echocardiography. Rarely, they can cause right ventricular outflow tract obstruction. They can present in patients having other cardiac lesions. Diagnosis of interventricular septal aneurysm is not straightforward. They can be confused with sinus of valsalva aneurysm or ventricular septal defect on transthoracic echocardiography. Transesophageal echocardiography (TEE) provides a better alternative to delineate the interventricular septal aneurysm. We describe the TEE diagnosis of membranous interventricular septal aneurysm in two dissimilar patients who presented for cardiac surgery at our cardiac center.

Keywords: Interventricular septum, Septal aneurysm, Transesophageal echocardiography.

How to cite this article: Dutta V, Negi SL, Puri GD, Singh RS. Perioperative Transesophageal Echocardiographic Diagnosis of Membranous Interventricular Septal Aneurysm in Two Patients. J Perioper Echocardiogr 2016;4(1):14-16.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Alok Kumar, Vikas Dutta, Sunder Negi, Goverdhan Dutt Puri

Role of Perioperative Echocardiographic in Surgical Correction of the Pulmonary Venous Anomalies (with Invited Commentary by Professor Rupa Sreedhar)

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:35] [Pages No:19-26][No of Hits : 581]


ABSTRACT

Anomalous pulmonary venous drainage is the anomalous drainage of one or more than one pulmonary vein draining into right atrium, superior vena cava, inferior vena cava, coronary sinus, or innominate vein. Right-sided pulmonary vein anomalous drainage is usually associated with sinus venosus type atrial septal defect. Pericardial patch repair and rerouting of the right pulmonary vein are commonly performed operations for such cases. These operations involve a risk of obstruction to the flow of superior vena cava or rerouted pulmonary vein in the postoperative period. The defects are well visualized on the transesophageal echocardiography (TEE). We are reporting three cases operated for anomalous drainage of right-sided pulmonary vein, highlighting the perioperative echocardiographic features.

Keywords: Anomalous pulmonary vein drainage, Sinus venosus defect, Transesophageal echocardiography.

How to cite this article: Kumar A, Dutta V, Negi S, Puri GD. Role of Perioperative Echocardiographic in Surgical Correction of the Pulmonary Venous Anomalies. J Perioper Echocardiogr 2016;4(1):19-26.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Neeti Makhija, Vandana Bhardwaj, Anita Saxena, Sachin Talwar

Transesophageal Echocardiographic Evaluation of Crisscross Heart with Atrioventricular Valve Regurgitation for Fontan Procedure

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:35] [Pages No:27-29][No of Hits : 565]


ABSTRACT

Crisscross heart (CCH) is a rare congenital cardiac malformation characterized by crossing of systemic and pulmonary venous blood streams at atrioventricular (A-V) level due to an apparent twisting of the heart about its long axis. In the literature, perioperative evaluation of CCH by transesophageal echocardiography (TEE) has not been described. Here we report a rare case of CCH, post Glenn procedure with A-V valve regurgitation, evaluated by TEE for valve repair/replacement followed by completion of Fontan surgery.

Keywords: Atrioventricular valve, Crisscross heart, Double outlet right ventricle, Fontan, Transesophageal echocardiography.

How to cite this article: Makhija N, Bhardwaj V, Saxena A, Talwar S. Transesophageal Echocardiographic Evaluation of Crisscross Heart with Atrioventricular Valve Regurgitation for Fontan Procedure. J Perioper Echocardiogr 2016;4(1):27-29.

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 561]


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


 
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][No of Hits : 2771]


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


 
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][No of Hits : 1360]


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


 
Review Article
Bahareh Khatibi, Nav Parkash Sandhu

Real-time Ultrasound-guided Axillary Vein Cannulation

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:28] [Pages No:42-47][No of Hits : 1342]


ABSTRACT

The axillary vein has been shown to be a safe and effective cannulation site for patients requiring central venous access. Compared to subclavian vein cannulation, axillary vein cannulation may reduce the rate of pneumothorax and hemothorax. Long-term complications, including the rate of infection or deep vein thrombosis, are comparable to internal jugular vein cannulation. The use of ultrasound for cannulation at traditional central vein sites, such as the internal jugular and femoral veins has been shown to aid in successful cannulation and potentially reduce complications. For axillary vein cannulation, however, when ultrasound is used only for localization of the axillary vein precannulation, it has not been shown to improve successful cannulation or decrease the rate of arterial puncture.
Real-time ultrasound-guided axillary vein cannulation has been described and may increase the rate of successful cannulation and decrease complications. Various techniques of real-time ultrasound-guided axillary vein cannulation have been studied over the past decade. They differ in various characteristics including technique for needle imaging (in-plane vs out-of-plane) and upper extremity positioning (neutral vs abducted). The in-plane technique, which images the axillary vein in longitudinal view and allows the needle to be visualized at all times, has been found to result in greater first-attempt success and easier overall placement than the transverse view technique. As for upper extremity positioning, 90° abduction may result a decreased risk of catheter misplacement after proximal axillary vein cannulation.
Ultrasound-guided axillary vein cannulation has many emerging uses, including use in oncology, cardiology, and nephrology.

Keywords: Axillary vein, Central venous access, Ultrasound.

How to cite this article: Khatibi B, Sandhu NP. Real-time Ultrasound-guided Axillary Vein Cannulation. J Perioper Echocardiogr 2015;3(2):42-47.

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 1144]


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


 
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][No of Hits : 867]


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


 
Case Report
Alok Kumar, V Rajkumar, Ajay Kumar, GD Puri

Role of Perioperative TEE in Diagnosing and Management of a Case of Dynamic LVOT Obstruction/SAM

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:28] [Pages No:58-61][No of Hits : 695]


ABSTRACT

Systolic anterior motion (SAM) of the mitral leaflets can lead to hemodynamic instability in post bypass period. Perioperative transesophageal echocardiography (TEE) plays a crucial role in the management of SAM. Perioperative echocardiography helps to (a) identify cause of left ventricular outflow tract obstruction, (b) assess SAM and diagnose severity and (c) management of SAM. A case is presented illustrating identification and management of SAM in post bypass period.

Keywords: LVOT obstruction, Perioperative TEE, SAM.

How to cite this article: Kumar A, Rajkumar V, Kumar A, Puri GD. Role of Perioperative TEE in Diagnosing and Management of a Case of Dynamic LVOT Obstruction/SAM. J Perioper Echocardiogr 2015;3(2):58-61.

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 693]


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


 
Case Report
Pankaj Kumar, Suruchi Hasija, Usha Kiran

Unidirectional Valved Patch Closure of Ventricular Septal Defect with Eisenmenger Physiology

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:28] [Pages No:62-65][No of Hits : 666]


ABSTRACT

Pulmonary hypertension in left-to-right shunt lesions, such as ventricular septal defect (VSD), patent ductus arteriosus, atrial septal defect (ASD) and atrioventricular canal defect is termed hyperkinetic pulmonary hypertension. Hyperkinetic pulmonary hypertension is usually reversible if the cause is treated before development of permanent changes in pulmonary arterioles. A unidirectional flap valve (UVP) VSD patch closure is a good alternative in children with large VSD with Eisenmenger physiology. The technique of unidirectional valved patch VSD closure obviates the need for extracorporeal membrane oxygenation and nitric oxide ventilation in patients who are at risk of pulmonary hypertensive crises postoperatively.

Keywords: Eisenmenger physiology, Pulmonary hypertension, Unidirectional valved patch, Ventricular septal defect.

How to cite this article: Kumar P, Hasija S, Kiran U. Unidirectional Valved Patch Closure of Ventricular Septal Defect with Eisenmenger Physiology. J Perioper Echocardiogr 2015;3(2):62-65.

Source of support: Nil

Conflict of interest: None


 
Case Report
Shrinivas Gadhinglajkar, Rupa Sreedhar, Pravin Lovhale, Thomas Mathew, Neeraj Tapdia

Iatrogenic Narrowing of Inferior Vena Cava after Atrial Septal Defect Closure: The Role of Intraoperative Echocardiography

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:28] [Pages No:48-51][No of Hits : 665]


ABSTRACT

Single-patch closure of a superior sinus venosus atrial septal defect (SVASD) may be complicated with narrowing of inferior vena cava (IVC). If the pressure gradient across the narrowed portion of superior vena cava (SVC) exceeds 6 mm Hg, widening of SVC lumen is considered. No such guidelines are available in literature for narrowing of inferior vena cava in cardiac surgical patients. We describe an incident of inferior narrowing of inferior vena cava in a 10-year-old girl, who was operated for closure of an inferior type of ostium secundum ASD (OSASD). There was hepatic venous dilatation accompanied with gradient of 3 mm Hg at the junction of inferior vena cava and right atrium (RA). The cardiopulmonary bypass was reestablished and the surgical closure of the septal defect was revised to rectify the problem.

Keywords: Atrial septal defect, Inferior vena cava, Transesophageal echocardiography.

How to cite this article: Gadhinglajkar S, Sreedhar R, Lovhale P, Mathew T, Tapdia N. Iatrogenic Narrowing of Inferior Vena Cava after Atrial Septal Defect Closure: The Role of Intraoperative Echocardiography. J Perioper Echocardiogr 2015;3(2):48-51.

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 570]


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


 
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][No of Hits : 561]


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


 
Case Report
S Subash, Divya Gopal, Ashwini Thimmarayappa

Incidental Detection of Persistent Left Superior Vena Cava during Transvenous Pacing

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:28] [Pages No:52-54][No of Hits : 544]


ABSTRACT

Patients with persistent left superior vena cava (PLSVC) are usually asymptomatic, but due to its anatomical defects, difficulties in establishing central venous access, pacemaker implantation and cardiothoracic surgery are common. We report a case of 65 years old patient who presented with complete heart block in cardiac critical care and, after emergency transvenous pacing, the chest X-ray showed unusual course of the transvenous pacing lead, which on further transthoracic echocardiographic (TTE) evaluation demonstrated dilated coronary sinus with PLSVC.

Keywords: Dilated coronary sinus, Persistent left superior vena cava, Transvenous pacing.

How to cite this article: Subash S, Gopal D, Thimmarayappa A. Incidental Detection of Persistent Left Superior Vena Cava during Transvenous Pacing. J Perioper Echocardiogr 2015; 3(2):52-54.

Source of support: Nil

Conflict of interest: None


 
Editorial
Rupa Sreedhar

Editorial

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:28] [Pages No:39-41][No of Hits : 527]


ABSTRACT

Indications for transesophageal echocardiography (TEE) in patients with congenital heart disease (CHD) include.


 
REVIEW ARTICLE
Manchula Navaratham, Rajesh Punn, Theresa A Tacy

Imaging Congenital Heart Disease in the Perioperative Period using Transesophageal Echocardiography

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:10-28][No of Hits : 3060]


ABSTRACT

Intraoperative transesophageal echocardiography (TEE) for pediatric congenital heart disease has become a standard of care in most institutions in the USA and across Europe. Advances in technology have facilitated the safe use of this tool in patients as small as 2.5 kg and have proved invaluable in guiding surgical repair of congenital cardiac lesions as well as guiding anesthesia management for cardiac and noncardiac procedures. This article describes a systematic approach to image acquisition in children with congenital heart disease (CHD). Specific congenital heart lesions are also described with an emphasis on intraoperative TEE data acquisition and analysis.

Keywords: Transesophageal, Echocardiography, Congenital heart disease.

How to cite the article: Navaratham M, Punn R, Tacy TA. Imaging Congenital Heart Disease in the Perioperative Period using Transesophageal Echocardiography. J Perioper Echocardiogr 2014;2(1):10-28.

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 3022]


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


 
ORIGINAL ARTICLE
Abhi Mishra, J Sethu Madhavan, BPS Ghuman, Ravi Raj, Ajay Kumar, Vikas Dutta, Sunder Negi, Yamini Tandon, Amit Kumar, VK Arya, Bhupesh Kumar, Aveek Jayant, Goverdhan Dutt Puri

Impact and Cost Effectiveness of Routine Intraoperative Transthoracic and Transesophageal Echocardiography on Surgical Decision Making in Pediatric Cardiac Surgery

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:3-9][No of Hits : 2285]


ABSTRACT

Introduction: Congenital heart diseases (CHD) present with wide spectrum of lesions leading to diagnostic dilemmas and it is quite possible to miss correct diagnosis during preoperative transthoracic echocardiography (TTE) in an inadequately sedated child, especially in a busy outpatient setting. It is a routine practice in our center to do baseline TTE after induction of anesthesia followed by pre and postcardiopulmonary bypass (CPB) transesophageal echocardiography (TEE) in all CHD patients thus helping us review our surgical plan.

Materials and methods: All pediatric patients <18 years undergoing cardiac surgery from January 2013 to December 2013 at our tertiary care center in whom perioperative echocardiograhy was done were included. Appropriate sized TTE and TEE probes were used with the Philips iE33 echocardiography platform (Philips, Andover, MA) .

Results: Out of total 352 pediatric cardiac surgical patients, perioperative echocardiography was done in 347(98.5%) patients. Baseline TTE showed new findings leading to change in surgical plan in 11 (3.1%) patients while additional new findings in baseline TEE were seen in 9 (2.6%). Post bypass TEE showed residual lesions requiring a CPB rerun in 19 (5.5%) patients. Intraoperative echocardiography was found to be cost effective with an estimated savings per patient of ` 3950 to 5373($61 - 83).

Conclusion: Intraoperative echocardiography is an important tool in armamentarium of perioperative physician which can be used to review diagnosis and help to formulate an informed surgical plan. Post-bypass transesophageal echocardiography is also useful as it identifies the residual lesions and establishes anatomical correction, which ultimately translates to lesser redo surgeries and a better postoperative outcome.

Keywords: Intraoperative echocardiography, Pediatric cardiac surgery, Congenital heart diseases, Transesophageal echocardiography.

How to cite the article: Mishra A, Madhavan JS, Ghuman BPS, Raj R, Kumar A, Dutta V, Negi S, Tandon Y, Kumar A, Arya VK, Kumar B, Jayant A, Puri GD. Impact and Cost Effectiveness of Routine Intraoperative Transthoracic and Transesophageal Echocardiography on Surgical Decision Making in Pediatric Cardiac Surgery. J Perioper Echocardiogr 2014;2(1):3-9.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Prashanth Panduranga

Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:29-31][No of Hits : 2270]


ABSTRACT

Acute ischemic mitral regurgitation is due to complete or partial rupture of either anterolateral or posteriomedial papillary muscles occurring within a week of acute myocardial infarction. Chronic ischemic mitral regurgitation is due to postinfarct remodeling leading to imbalance between tethering and closing forces of mitral valve apparatus. We present a 64-year-old male, presenting with acute pulmonary edema secondary to severe mitral regurgitation, a week after his myocardial infarction. Transthoracic echocardiogram detected a mobile intracardiac mass near anterior mitral leaflet with no clear-cut intracardiac origin of this mass. Perioperative transesophageal echocardiography detected rupture of one of the heads of posteriomedial papillary muscle. This case illustrates a rare presentation of postinfarct rupture of one of the heads of posteriomedial papillary muscle occurring late after infarction presenting as an intracardiac mass, which can have surgical implications.

Keywords: Mitral regurgitation, Intracardiac mass, Papillary muscle rupture, Transesophageal echocardiography.

How to cite the article: Panduranga P. Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle. J Perioper Echocardiogr 2014;2(1)29-31.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Andrew W Murray, Stephen M McHugh

TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:34-37][No of Hits : 2265]


ABSTRACT

Thymectomies have traditionally been performed via a midline sternotomy but are now increasingly being conducted via a thoracoscopic approach. Insufflation of CO2 into the hemithorax during this procedure can create severe compression of the right atrium and ventricle with resultant hemodynamic instability as well as lead to hypercapnia with possible pulmonary vasoconstriction and right heart strain. Transesophageal echocardiography allows monitoring of both the effects of CO2 insufflation on the heart and the efficacy of interventions to restore hemodynamic stability.

Keywords: Transesophageal echocardiography, Video-assisted thoracoscopic surgery, Video-assisted thoracoscopic surgery, Thymectomy, Pneumothorax.

How to cite the article: Murray AW, McHugh SM. TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy. J Perioper Echocardiogr 2014;2(1):34-37.

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 1894]


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


 
FELLOW’S CORNER
A Subramanian, V Malik, R Sreedhar

Assessment of Pulmonary Valve and Pulmonary Stenosis

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:40-41][No of Hits : 1892]


ABSTRACT

The Fellow’s Corner is a short treatise on material relevant for the learning of trainees in cardiac anesthesia. The first in this series is on the TEE assessment of the pulmonary valve.

Keywords: Assessment, Transesophageal, Pulmonary valve.

How to cite the article: Subramanian A, Malik V, Sreedhar R. Assessment of Pulmonary Valve and Pulmonary Stenosis. J Perioper Echocardiogr 2014;2(1):40-41

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 1814]


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


 
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][No of Hits : 1813]


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


 
Abstract
Ravi Raj, Goverdhan Dutt Puri

Selected Abstracts of the TEEPGI 2014 Workshop

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:42-48][No of Hits : 1585]



 
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][No of Hits : 1516]


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


 
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][No of Hits : 1481]


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


 
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][No of Hits : 1468]


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


 
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][No of Hits : 1459]


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


 
CASE REPORT
Navparkash S Sandhu, Levon M Capan

Role of Transesophageal Echocardiography in Management of Thoracic Stab Wound

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:32-33][No of Hits : 1447]


ABSTRACT

Transesophageal echocardiography (TEE) is useful in diagnosing cardiac and aortic injuries. A case of stab chest is described in which TEE ruled out cardiac injury, located the knife in the left lung and had potential to change the surgical plan.

Keywords: Echocardiography, Stab chest, Impaled foreign bodies thorax.

How to cite the article: Sandhu NS, Capan LM. Role of Transesophageal Echocardiography in Management of Thoracic Stab Wound. J Perioper Echocardiogr 2014;2(1):32-33.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Sambhunath Das, Kalpna Irpachi, V Devagourou

Transesophageal Echocardiography Guided Ligation of Right Pulmonary Artery to Left Atrial Fistula

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:38-39][No of Hits : 1426]


ABSTRACT

Right pulmonary artery to left atrial fistula is a rare congenital cardiac anomaly. A 23 years old man visited an ophthalmologist for complains of diplopia and diminished vision with cyanosis. Computerized tomography angiography diagnosed the presence of right pulmonary artery to left atrium fistula. Intraoperative use of transesophageal echocardiography confirmed the diagnosis and guided in real time for the successful ligation of fistula. Transesophageal echocardiography helped to perform the surgery without cardiopulmonary bypass.

Keywords: Right pulmonary artery to left atrial fistula, Diplopia, Transesophageal echocardiography, Computerized tomography angiography.

How to cite the article: Das S, Irpachi K, Devagourou V. Transesophageal Echocardiography Guided Ligation of Right Pulmonary Artery to Left Atrial Fistula. J Perioper Echocardiogr 2014;2(1):38-39.

Source of support: Nil

Conflict of interest: None


 
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][No of Hits : 1360]


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


 
EDITORIAL
Manojkumar Rohit, Ankur Gupta

Pediatric Cardiac Anesthesiologist as Perioperative Transesophageal Echocardiographer

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:48] [Pages No:1-2][No of Hits : 1333]


ABSTRACT

How to cite the article: Rohit M, Gupta A. Pediatric Cardiac Anesthesiologist as Perioperative Transesophageal Echocardiographer. J Perioper Echocardiogr 2014;2(1)1-2.

Source of support: Nil

Conflict of interest: None declared


 
REVIEW ARTICLE
Kathirvel Subramaniam, Stephen A Esper

Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:48-56][No of Hits : 4727]


ABSTRACT

Lung transplantation is the only option for patients with end-stage lung disease. Chronic obstructive lung disease, idiopathic pulmonary fibrosis, cystic fibrosis and primary pulmonary hypertension are few common indications for lung transplantation. Patients with end-stage lung disease may have pre-existing cardiovascular compromise related to pulmonary hypertension and other cardiovascular lesions, such as coronary artery disease or valvular heart disease. Preoperative evaluation and optimization of hemodynamics is expected to improve outcomes from lung transplantation. Intraoperative hemodynamic instability is common during lung transplantation and requires highest level of cardiovascular monitoring. After transplantation, vascular anastomosis should be evaluated for flow patterns to rule out obstruction from stenosis or thrombosis. Postoperative complications are common and include bleeding, cardiac failure and hypoxemia from right to left shunt. Primary graft dysfunction may necessitate mechanical cardiorespiratory support. Transesophageal echocardiography plays a central role in preoperative evaluation, intraoperative hemodynamic management, evaluation of pulmonary vascular anastomosis, diagnosis of postoperative complications and also in the critical care management of mechanical cardiorespiratory support.

Keywords: Lung transplantation, Transesophageal echocardiography, Perioperative management.

How to cite this article:Subramaniam K, Esper SA. Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery. J Perioper Echocardiogr 2013;1(2):48-56.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORT
Amit Bardia, Balachundhar Subramaniam

Systolic Anterior Motion: An Illustrative Case and Discussion of Management Strategy

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:62-65][No of Hits : 3252]


ABSTRACT

Systolic anterior motion (SAM) of the mitral leaflets can lead to hemodynamic instability following mitral valve repair. Perioperative echocardiography plays a crucial role in the management of SAM. Perioperative echocardiography helps to (a) identify patients at high risk for SAM before repair, (b) assess SAM and diagnose severity and (c) follow-up management efficacy. An illustrative case is shown in this report to take the reader through the current management strategy of SAM following mitral valve repair.

Keywords: SAM, Mitral repair, Myxomatous.

How to cite this article:Bardia A, Subramaniam B. Systolic Anterior Motion: An Illustrative Case and Discussion of Management Strategy. J Perioper Echocardiogr 2013;1(2): 62-65.

Source of support: Nil

Conflict of interest: None declared


 
REVIEW ARTICLE
Sundar Krishnan, Dallen Mill

Transesophageal Echocardiography in the Intensive Care Unit

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:4-15][No of Hits : 3120]


ABSTRACT

Management of shock in the intensive care unit involves advanced hemodynamic monitoring. Invasive monitoring with central venous lines and pulmonary artery catheters may be inadequate in guiding therapy and improving outcomes. Echocardiography is a reasonably-safe, minimally-invasive diagnostic technique that provides rapid bedside evaluation of ventricular filling and function. While transthoracic echocardiography is the method of choice initially, images can be suboptimal in up to a third of intensive care patients. Transesophageal echocardiography is then required to better evaluate the cause of hemodynamic instability. In addition, transesophageal echocardiography can be used to diagnose other causes of hemodynamic failure (for e.g., pericardial tamponade, pulmonary embolism and left ventricular outflow tract obstruction) and to diagnose intracardiac shunt. Echocardiography is also vital in diagnosing the cause and guiding management in patients with cardiac arrest. Specific training is required for physicians in order to achieve competence in probe insertion, completion of a comprehensive examination and interpretation of the images. In this article, we provide an overview of the indications and complications of the technique and training pathways for the intensivist, followed by transesophageal echocardiography-guided hemodynamic assessment and diagnosis of specific cardiac disorders commonly encountered in the intensive care unit.

Keywords:Transesophageal echocardiography, Hypotension, Intensive care unit, Preload, Contractility, Pericardial tamponade, Left ventricular outflow tract obstruction, Aortic dissection, Blunt chest trauma.

How to cite this article:Krishnan S, Mill D. Transesophageal Echocardiography in the Intensive Care Unit. J Perioper Echocardiogr 2013;1(1):4-15.

Source of Support: Nil

Conflict of Interest: None Declared


 
ORIGINAL ARTICLE
Ashok Kumar Badamali, J Sethu Madhavan, BPS Ghuman, S Subash, Ravi Raj, Abhi Mishra, Ajay Mishra, VK Arya, Bhupesh Kumar, Aveek Jayant, KST Shyam, Sandeep Singh Rana, Harkant Singh, Anand Mishra, Sachin Kuthe, Sachin Mahajan, Shiva Prasad, Sarin Mathew, Inderjeet Arora, Goverdhan Dutt Puri

Routine Intraoperative Transesophageal Echocardiography: Impact on Intraoperative Surgical Decision Making, a Single Center Interim Analysis

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:16-20][No of Hits : 2870]


ABSTRACT

Transesophageal echocardiography (TEE) has become an important part of armamentarium for anesthesiologists in the management of patients undergoing cardiac surgery. Many studies have demonstrated the safety and utility of TEE in cardiac surgery. With advances in hardware and software, easy availability of resources for learning and optimal understanding of image generation and interpretation, many new findings crop up in the operating room (OR) which may have been missed in preoperative transthoracic echocardiography (TTE), leading to necessary changes in planned surgical procedure. In our retrospective analysis of 726 cases in which TEE was performed over the last 1 year, changes in decision was made in 65 (8.9%) of cases. This included 42 unanticipated findings prior to cardiopulmonary bypass and 23 new findings after CPB, requiring revision in 15 cases. With the increasing use and further impending advances of TEE, the number of cases in which surgical decision will be altered may increase in near future.

Keywords:Transesophageal echocardiography, Cardiac surgery, Intraoperative echocardiography.

How to cite this article:Badamali AK, Madhavan JS, Ghuman BPS, Subash S, Raj R, Mishra A, Mishra A, Arya VK, Kumar B, Jayant A, Shyam KST, Rana SS, Singh H, Mishra A, Kuthe S, Mahajan S, Prasad S, Mathew S, Arora I, Puri GD. Routine Intraoperative Transesophageal Echocardiography: Impact on Intraoperative Surgical Decision Making, a Single Center Interim Analysis. J Perioper Echocardiogr 2013;1(1):16-20.

Source of Support: Nil

Conflict of Interest: None


 
CASE SERIES
Usha Kiran, Arindam Choudhury, Neeti Makhija, Kulbhushan Saini, Randhir Singh Rajput, Balram Airan

Infective Endocarditis: The Anesthesiologist’s Perspective

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:57-61][No of Hits : 2856]


ABSTRACT

Infective endocarditis (IE) usually involves one or more heart valves resulting in vegetation, perforation, abscess, fistula and/or pseudoaneurysm formation. In IE, the mainstay of treatment remains antimicrobial agent for 4 to 6 weeks. However, 40 to 60% requires surgical intervention because of some complications. Surgery could be risky in the active stage of the disease, but it becomes essential to avoid preoperative heart failure, irreversible structural damage and also to prevent systemic embolization. Perioperative transesophageal echocardiography (TEE) examination is an important diagnostic modality for guiding therapeutic decisions. We recently managed four patients of IE. Two of them presented with mitral valve vegetations resulting in severe mitral regurgitation and one with aortic root abscess. We monitored TEE in all the four cases throughout the surgery.

Keywords:Infective endocarditis, Vegetation, Aortic root abscess, Transesophageal echocardiography.

How to cite this article:Kiran U, Choudhury A, Makhija N, Saini K, Rajput RS, Airan B. Infective Endocarditis: The Anesthesiologist's Perspective. J Perioper Echocardiogr 2013; 1(2):57-61.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORT
Kelly T Peretich, Jeffrey C Liu, Samir Saba, Heather Byrd, Kathirvel Subramaniam

A Case of Delayed Cardiac Tamponade: Highlighting the Importance of Transthoracic Echocardiography Training for Anesthesiologists

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:69-71][No of Hits : 2386]


ABSTRACT

This echo report describes a patient who developed cardiac temponade in the post-anesthesia care unit after laser lead extraction at electrophysiology laboratory. Diagnosis was readily established by transthoracic echocardiography and this lead to good outcome. Transthoracic ultrasound helps in preoperative evaluation of non-cardiac surgical patients and also postoperative care of hemodynamically unstable patients. This describes the importance of training and competence in transthoracic ultrasound for anesthesiologists.

Keywords: Transthoracic ultrasound, Cardiac tamponade, Laser lead extraction.

How to cite this article:Peretich KT, Liu JC, Saba S, Byrd H, Subramaniam K. A Case of Delayed Cardiac Tamponade: Highlighting the Importance of Transthoracic Echocardiography Training for Anesthesiologists. J Perioper Echocardiogr 2013; 1(2):69-71.

Source of support: Nil

Conflict of interest: None declared


 
EDITORIAL
Kathirvel Subramaniam, Balachundhar Subramaniam, Goverdhan Dutt Puri

Perioperative Transesophageal Echocardiography: Advances and Challenges

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:1-3][No of Hits : 2315]


ABSTRACT

The history of perioperative transesophageal echocardiography (PTE) dates back to the 1980s when intraoperative transesophageal echocardiography (TEE) was found to be a preferable modality for evaluation of repaired or reconstructed mitral valve.1,2 It was also found to be an extremely useful tool to monitor for ischemia in high-risk cardiac and noncardiac surgery.3 The potential for diagnostic use of TEE during routine cardiac surgery was recognized soon after. Cardiac anesthesiologists (some of them trained cardiologists who became anesthesiologists) at major cardiovascular surgical institutions in North America promoted the practice and education in diagnostic intraoperative TEE for anesthesiologists in the early 1990s. The American Society of Anesthesiologists (ASA) and the Society for Cardiovascular Anesthesiologists (SCA) jointly published PTE guidelines in 1996; the SCA and the American Society for Echocardiography (ASE) have published several updates to the guidelines since then.4,5 Over the years, cardiologists and cardiac anesthesiologists have worked together tirelessly to standardize the practice of intraoperative TEE; the results are evident in the improved outcomes of cardiac surgical patients.

How to cite this article: Subramaniam K, Subramaniam B, Puri GD. Perioperative Transesophageal Echocardiography: Advances and Challenges. J Perioper Echocardiogr 2013; 1(1):1-3.

Source of Support: Nil

Conflict of Interest: None Declared


 
CASE REPORTS
Susie J Cho, Stephen O Bader, James W Heitz

Venous Air Embolism during Anterior Lumbar Surgery

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:30-32][No of Hits : 2262]


ABSTRACT

The use of transesophageal echocardiography (TEE) has improved the detection of venous air embolism (VAE), especially in the case of small VAE where clinical changes can be subtle and erroneously attributed to volume status or cardiac function. We present a case of VAE in a 62 years old female that occurred during anterior lumbar spine surgery that was diagnosed with the aid of TEE. As anterior lumbar spines surgery is traditionally not associated with VAE, we believe this is the first reported case of VAE in this type of procedure.

Keywords:TEE, Air embolism, Spine surgery, Intraoperative hypotension.

How to cite this article:Cho SJ, Bader SO, Heitz JW. Venous Air Embolism during Anterior Lumbar Surgery. J Perioper Echocardiogr 2013;1(1):30-32.

Source of Support: Nil

Conflict of Interest: None declared


 
ORIGINAL ARTICLE
Shrinivas Gadhinglajkar, Rupa Sreedhar, Sabarinath Menon, S Omprakash

Pulmonary Venous Doppler Flow Profile before and after Surgical Closure of Atrial Septal Defect in Children

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:42-47][No of Hits : 2105]


ABSTRACT

Objectives: A secundum atrial septal defect is associated with a characteristic pattern of continuous antegrade wave on a pulmonary venous Doppler flow profile. It is replaced with a regular S and D wave after the closure of defect. Although, a few published reports have described these features in adults, there are not enough studies in pediatric patients under anesthesia.

Setting: A tertiary referral center.

Participants: A total of 12 children with uncomplicated secundum atrial septal defect participated in the evaluation process.

Interventions: After anesthesia induction, three of them were excluded from detailed pulmonary venous study as they did not satisfy selection criteria. In remaining nine children, the intraoperative pulmonary venous Doppler changes were assessed before and after the defect closure, manually tracing the pulmonary venous waveforms.

Measurements and main results: The antegrade wave was observed in 9/9 patients before surgery that characteristically lacked distinct systolic and diastolic waves, although in seven patients, a larger systolic peak and a smaller diastolic peak were identified.
Normal S and D waves were seen after termination of cardiopulmonary bypass with S/D ratio > in all cases. The maximum velocity of atrial retrograde wave increased and heart rate decreased significantly after surgery.

Conclusion: The continuous antegrade wave is a consistent pulmonary venous Doppler feature of an uncomplicated secundum ASD in anesthetized children. The Doppler pattern is normalized immediately after termination of cardiopulmonary bypass.

Keywords:Transesophageal echocardiography, Atrial septal defect, Doppler.

How to cite this article:Gadhinglajkar S, Sreedhar R, Menon S, Omprakash S. Pulmonary Venous Doppler Flow Profile before and after Surgical Closure of Atrial Septal Defect in Children. J Perioper Echocardiogr 2013;1(2):42-47.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORTS
J Sethumadhavan, H Singh, A Jayant

Tricuspid Valve Dilation in a Case of Ostium Secundum Atrial Septal Defect: Therapeutic Dilemmas in the Perioperative Period and a Call for Building the Evidence

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:24-26][No of Hits : 2028]


ABSTRACT

The adult literature on managing tricuspid regurgitation (TR) in left heart disease is in evolution. Tricuspid valve repair in pediatrics, on the other hand has more or less been restricted to disease subsets, such as children developing TR secondary to right ventricular disease or tricuspid valve anomalies. The pediatric literature on ‘acquired’ TR [as in congenital heart diseases, such as atrial septal defect (ASD)] is sparse. Some of the concerns that need to be addressed are thresholds for intervention, optimal annular reduction and methods of surgical reduction (DeVega vs ring annuloplasty). We present a case of a 5 years old female child who primarily presented for closure of her ostium secundum ASD. However, intraoperative transesophageal echocardiography (TEE) revealed TR and a tricuspid annular dimension beyond z +3 for her size. The surgeon chose to perform a DeVega annuloplasty and both the ASD closure and the annuloplasty were uneventful, postoperative TEE revealed no residual defect, no TR or stenosis. We seek to highlight this case in order to urge a more systematic study of such patients with a local focus since patients in our country present later than usual with asymptomatic heart disease and are more likely to undergo progressive right heart enlargement for a given shunt.

Keywords:TEE evaluation of tricuspid valve, TEE measurement of tricuspid annulus, TR in pediatric patients, DeVega in pediatric patients, TEE in congenital heart surgery.

How to cite this article:Sethumadhavan J, Singh H, Jayant A. Tricuspid Valve Dilation in a Case of Ostium Secundum Atrial Septal Defect: Therapeutic Dilemmas in the Perioperative Period and a Call for Building the Evidence. J Perioper Echocardiogr 2013;1(1):24-26.

Source of Support: Nil

Conflict of Interest: None declared


 
CASE REPORTS
S Subash, BM Shivaprasad, A Jayant, Goverdhan Dutt Puri

Incidentally Detected Coronary Artery Fistula Detected on Routine Perioperative Transesophageal Echocardiography

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:27-29][No of Hits : 1691]


ABSTRACT

Coronary artery fistulae (CAF) are rare anomalies. Herein, we describe the use of intraoperative transesophageal echocardiography (TEE) in the diagnosis and management of CAF. A 3-year-old child diagnosed to have ostium secundum atrial septal defect (OS ASD) was posted for surgical closure under cardiopulmonary bypass (CPB). Post procedure TEE revealed a single continuous turbulent jet toward right atrium near the lateral wall of tricuspid region and was diagnosed as CAF communicating right coronary artery and right atrium. Surgical ligation of the CAF under CPB was done and the child was discharged postoperatively without complications. This case highlights the utility of intraoperative TEE in the diagnosis and management of CAF.

Keywords:Coronary artery fistula, Coronary cameral fistula, Coronary arterial fistula, Coronary anomaly, Transesophageal echocardiography.

How to cite this article:Subash S, Shivaprasad BM, Jayant A, Puri GD. Incidentally Detected Coronary Artery Fistula Detected on Routine Perioperative Transesophageal Echocardiography. J Perioper Echocardiogr 2013;1(1):27-29.

Source of Support: Nil

Conflict of Interest: None declared


 
EDITORIAL
Kathirvel Subramaniam, Vinay Badhwar

Systolic Anterior Motion after Mitral Valve Repair: Hemodynamic Optimization or Provocation for Surgical Correction in the Operating Room?

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:40-41][No of Hits : 1682]


ABSTRACT

How to cite this article: Subramaniam K, Badhwar V. Systolic Anterior Motion after Mitral Valve Repair: Hemodynamic Optimization or Provocation for Surgical Correction in the Operating Room? J Perioper Echocardiogr 2013;1(2):40-41.

Source of support: Nil

Conflict of interest: None declared


 
CASE REPORTS
Stephen M McHugh, Stephen O Bader

Intraoperative Transesophageal Echocardiography in the Management of a Right Coronary Artery to Coronary Sinus Fistula

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:21-23][No of Hits : 1628]


ABSTRACT

Coronary artery fistulas are rare but can have significant perioperative consequences. We describe the case of a 65- year-old man found to have a coronary artery fistula from the anterior right coronary artery to the coronary sinus. We discuss the unique advantages that transesophageal echocardiography offers in the monitoring and management of coronary artery fistulas.

Keywords:Transesophageal echocardiography, Coronary artery fistula, Monitoring, Bacterial endocarditis.

How to cite this article:McHugh SM, Bader SO. Intraoperative Transesophageal Echocardiography in the Management of a Right Coronary Artery to Coronary Sinus Fistula. J Perioper Echocardiogr 2013;1(1):21-23.

Source of Support: Nil

Conflict of Interest: None declared


 
CASE REPORT
Bhupesh Kumar, Vikas Goswami, SS Rana, GD Puri

Utility of Transesophageal Echocardiography in Confirmation of Spread of Local Anesthetic in the Epidural Space

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:72-74][No of Hits : 1454]


ABSTRACT

A 30-years-old female with diagnosis of carcinoid tumor of right bronchus was planned to undergo right pneumonectomy under combined epidural and general anesthesia. A pediatric transesophageal echocardiography (TEE) probe was inserted for intraoperative monitoring of the right ventricular function. It also showed spinal canal structures (dura matter, epidural and subarachnoid space and spinal cord) and helped in visualization of local anesthetic spread in the epidural space.

Keywords: Epidural, Local anesthetic spread, Transesophageal echocardiography.

How to cite this article: Kumar B, Goswami V, Rana SS, Puri GD. Utility of Transesophageal Echocardiography in Confirmation of Spread of Local Anesthetic in the Epidural Space. J Perioper Echocardiogr 2013;1(2):72-74.

Source of support: Nil

Conflict of interest: None declared


 
Selected Abstracts
Goverdhan Dutt Puri, Bala Subramaniam, Kathirvel Subramaniam

Selected Abstracts of the TEEPGI 2013 Workshop (1st to 3rd March 2013)

[Year:2013] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:37] [Pages No:33-37][No of Hits : 1381]


ABSTRACT

Background: Paravalvular or paraprosthetic leak (PVL) is a complication associated with the surgical/transcatheter implantation of a prosthetic heart valve, more commonly a mechanical than a bioprosthetic valve. Transthoracic echocardiography (TTE) is the most important diagnostic modality for prosthetic valve function/dysfunction. However, TTE often cannot differentiate the PVL from prosthetic regurgitation. Transesophageal echocardiography (TEE) is the modality of choice which is also able to detect small, nonsignificant jets.

How to cite this article:Singh R, Tandon R, Kumbhkarni S, Aslam N, Mohan B, Gautam PL, Wander GS. A Case of Paraprosthetic Leak diagnosed with the Help of 3D TEE. J Perioper Echocardiogr 2013;1(1):33-37.

Source of Support: Nil

Conflict of Interest: None declared


 
CASE REPORT
Sambhunath Das, Randhir Singh Rajput

Coexistence of Chronic Constrictive Pericarditis can make the Echocardiographic Diagnosis of Atrial Septal Defect Challenging

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:66-68][No of Hits : 1165]


ABSTRACT

Missing the diagnosis of atrial septal defect (ASD) increases morbidities to patient and may require second surgery or intervention. Chronic constrictive pericarditis produces thickening and calcification of pericardium. The detection of any intracardiac lesion may be difficult by echocardiography due to the masking or shadowing effect of calcified pericardium. We report a case of 30-year-old male presented with congestive heart failure, dyspnea and abdominal swelling. Transthoracic echocardiography diagnosed constrictive pericarditis with no evidence of ASD. The contrast enhanced computed tomography (CECT) showed extensive diffuse pericardial calcification with a large ASD. In the operating room initial transesophageal echocardiography (TEE) examination was not able to detect any ASD. Agitated saline injected through the central venous line into right atrium showed bubbles in the left atrium under TEE monitoring. Subsequent movement of TEE probe in deeper position detected the ASD. It is recommended that all the views and methods of echocardiography examination may be practiced in difficult moments to avoid missing the presence of ASD.

Keywords: Transesophageal echocardiography, Chronic constrictive pericarditis, Atrial septal defect.

How to cite this article: Das S, Rajput RS. Coexistence of Chronic Constrictive Pericarditis can make the Echocardiographic Diagnosis of Atrial Septal Defect Challenging. J Perioper Echocardiogr 2013;1(2):66-68.

Source of support: Nil

Conflict of interest: None declared


 
EDITORIAL
R Krishna Kumar

Physiological Insights from Doppler Flow Patterns

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:36] [Pages No:39][No of Hits : 968]


ABSTRACT

How to cite this article:Kumar RK. Physiological Insights from Doppler Flow Patterns. J Perioper Echocardiogr 2013;1(2):39.

Source of support: Nil

Conflict of interest: None declared


 
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][No of Hits : 498]


ABSTRACT

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


 
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][No of Hits : 441]


ABSTRACT

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


 
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][No of Hits : 410]


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


 
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][No of Hits : 409]


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


 
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][No of Hits : 396]


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


 
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][No of Hits : 363]


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


 
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][No of Hits : 323]


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


 
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][No of Hits : 288]


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


 
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][No of Hits : 247]


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


 
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][No of Hits : 233]


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


 
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][No of Hits : 494]


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


 
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][No of Hits : 472]


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


 
Editorial
Goverdhan Dutt Puri

Strain Measurements in Perioperative Settings

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:43] [Pages No:35-36][No of Hits : 411]


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


 
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][No of Hits : 377]


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


 
CASE REPORT
Neeti Makhija, Jitin Narula, Sanjay Kumar, Sameer Taneja, Milind P Hote

Pulmonary Artery Perforation: Rare reported Complication of Pericardiectomy for Chronic Constrictive Pericarditis recorded on Transesophageal Echocardiography

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:35] [Pages No:17-18][No of Hits : 343]


ABSTRACT

Major vessel injury is a possible complication during pericardiectomy for chronic constrictive pericarditis (CCP). We present a case of CCP, who while undergoing radical pericardiectomy incurred an iatrogenic injury of a major vessel with profuse bleeding. A rent in main pulmonary artery (MPA) was detected by the surgical team and simultaneously confirmed on transesophageal echocardiography (TEE), and a timely intervention was done. Importance of monitoring TEE in a patient undergoing pericardiectomy for CCP is highlighted.

Keywords: Constrictive pericarditis, Monitoring, Pericardiectomy, Pulmonary artery perforation, Transesophageal echocardiography.

How to cite this article: Makhija N, Narula J, Kumar S, Taneja S, Hote MP. Pulmonary Artery Perforation: Rare reported Complication of Pericardiectomy for Chronic Constrictive Pericarditis recorded on Transesophageal Echocardiography. J Perioper Echocardiogr 2016;4(1):17-18.

Source of support: Nil

Conflict of interest: None


 
Case Report
Sambhunath Das, Suruchi Ladha, Balram Airan

Role of Intraoperative Transesophageal Echocardiography in Evaluation of Fontan Conduit for Thrombosis

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:28] [Pages No:55-57][No of Hits : 436]


ABSTRACT

The formation of thrombus after Fontan operation is a lifethreatening situation. The clinical manifestations by the patient may not reflect the true diagnosis of thrombosis. Transesophageal echocardiographic evaluation is an option to delineate the vena cava anastomosis and the Fontan conduit in different views. We used transesophageal echocardiography (TEE) to detect the thrombus site prior to surgery and guided for a successful removal of thrombus. The successful surgical revision of the anastomosis was confirmed by TEE.

Keywords: Fontan operation, Single ventricle, Thrombosis, Transesophageal echocardiography.

How to cite this article: Das S, Ladha S, Airan B. Role of Intraoperative Transesophageal Echocardiography in Evaluation of Fontan Conduit for Thrombosis. J Perioper Echocardiogr 2015;3(2):55-57.

Source of support: Nil

Conflict of interest: None


 
Photo Assay
Brett Cronin, Euqene Golts, Victor Pretorius

Unique Regurgitant Jet in a Patient with Takayasu Arteritis

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:28] [Pages No:66-67][No of Hits : 375]


ABSTRACT

A 37-year-old female with a history of Takayasu arteritis was admitted for repair of a descending thoracic aortic aneurysm with penetrating ulcer and left ventricular outflow track (LVOT) pseudoaneurysm. A unique regurgitant jet was subsequently identified by transesophageal echocardiography after induction of anesthesia and endotracheal intubation.

Keywords: Left ventricular outflow track pseudoaneurysm, LVOT, Takayasu arteritis, TEE, Transesophageal echocardiography.

How to cite this article: Cronin B, Golts E, Pretorius V. Unique Regurgitant Jet in a Patient with Takayasu Arteritis. J Perioper Echocardiogr 2015;3(2):66-67.

Source of support: Nil

Conflict of interest: None



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