Intraoperative transesophageal echocardiography for the evaluation of mitral, aortic and tricuspid valve repair A tool to optimize surgical outcome

The present study reviews the clinical applicability and usefulness of intraoperative transesophageal echocardiography (TEE) during valve repair. Intraoperative TEE was performed in 48 consecutive patients, who were divided into three groups: 1. mitral valve repair (MVR), 2. aortic valve repair (AVR), 3. tricuspid valve repair (TVR). Residual valve regurgitation was assessed by color Doppler echocardiography on a scale from 0 to 4. The ratios of the jet area (JA) to the left- and right-atrial areas (JA/LAA and JA/RAA) were analyzed before and after cardiopulmonary bypass (CPB). In group 1, 14 patients were scheduled for MVR, of which 4 patients underwent valve replacement and 10 MVR. Post-repair TEE studies showed a significant decrease of mitral regurgitation. In 2 of the 10 patients, TEE demonstrated severe residual regurgitation requiring valve replacement during the same thoracotomy. In group 2, 11 patients underwent aortic commissurotomy. Post-repair TEE showed an increase in the systolic opening diameter and opening area of the aortic valve. One patient underwent valve substitution because of severe aortic regurgitation. In group 3, 23 patients were scheduled for TVR. In 3 of them TEE showed no significant regurgitation thus rendering tricuspid valve surgery unnecessary. Twenty patients underwent TVR of whom two showed unacceptable post-repair regurgitation requiring further surgery. Eighteen patients showed a significant reduction of valve regurgitation after TVR, and a further reduction was achieved by adjusting the tricuspid annuloplasty under TEE guidance.     

Impaired coronary flow velocity reserve and aortic distensibility in patients with untreated hypercholesterolemia—an echocardiographic study

Introduction Hypercholesterolemia is a primary risk factor for the development of atherosclerosis and leading to severe stages of coronary artery disease (CAD) and aortic atherosclerosis (AA). The objective of this investigation was to measure elastic modulus [(E(p), in 10³ mmHg] and Young’s circumferential static elastic modulus [(E(s), in 10³ mmHg] as aortic distensibility indices and coronary flow velocity reserve (CFR) in untreated hypercholesterolemic (HC) patients in the course of the same stress transesophageal echocardiography (TEE) and to compare their results to normochole- sterolemic (NC) subjects. Patients and methods The following patient populations were compared: 17 NC subjects with negative coronary angiograms, 18 patients with untreated hypercholesterolemia with a negative coronary angiogram and 23 HC patients with significant left anterior descending coronary artery (LAD) disease. All patients underwent coronary angiography, transthoracic and stress TEE examinations. Results CFR was significantly reduced in patients of both groups with hypercholesterolemia as compared to NC subjects (1.99±0.76 and 1.79±0.32 vs. 2.58±0.63, P < 0.05, respectively). E(p) was significantly increased in HC patients with negative coronary angiograms as compared to NC subjects (0.39±0.18 vs. 0.67±0.19, P < 0.05), while further increase was found in HC patients with LAD disease (0.67±0.19 vs. 1.09±0.52, P < 0.05). E(s) behaved similarly (4.06±2.73 vs. 7.60±3.70 vs. 11.38±6.91, P < 0.05, respectively). Conclusion In conclusion it may be stated that CFR and aortic distensibility indices can be evaluated simultaneously by stress TEE in HC patients. CFR and aortic distensibility were impaired in HC patients as compared to NC subjects.     

经食管左心房调搏术引发心律失常的分析及纠治

目的 :探讨经食管左心房调搏术 (TEAP)引发心律失常的纠治措施。方法 :对我院 73 0例行TEAP检查引发的5 3例心律失常进行分类。并分析其发生机制及制订纠治方案。结果 :5类心律失常分别为房性过早搏动、室性过早搏动、心房颤动、心房扑动、心脏停搏。若各种类型早搏在数分钟后不能自行终止 ,则可应用阻断植物神经的药物 ;对持续时间较长的房颤、房扑 ,可静脉注射西地兰 ;在心脏停搏时间≥ 2 5s时 ,应进行保护性起搏。结论 :TEAP引发的心律失常 ,可以得到有效的纠治。     

应用经食管超声肺静脉流速定量诊断左房压心脏手术中与心导管同步性研究

应用经食管脉冲多普勒超声在术中测定了７６例不同心脏病患者的左上肺静脉血流频谱。结果显示：Ｒｖ和ＳＦ％分别与同步测定的平均左房压间存在高度相关性（ｒ＝－０．８８和ｒ＝－０．８７）；以ＳＦ％小于５２％预测平均左房压大于２．０ＫＰａ时，其敏感性和特异性分别为９３％和８５％。结论认为，应用经食管脉冲多普勒测定肺静脉血流频谱能准确估测平均左房压，为定量评价左室舒张功能提供了新途径     

经食道超声心动图应用于房颤患者左心耳封堵术的初步探索任群 刘彦君 陈晶

目的 初步探讨经食道超声心动图（TEE）应用于左心耳封堵术预防心房颤动患者脑栓塞的临床意义。方法 3例房颤患者（CHA2DS2VAS评分均≥2分）行左心耳封堵术,术前应用TEE观察左心耳形态、功能,测量左心耳（LAA）最大入口径及深度,术中TEE引导房间隔穿刺,鞘管定位及封堵器的释放,术后评价效果,术后45天左右运用TEE随访,观察疗效。结果 3例患者均封堵成功,均选择型号为27mm的Watchman封堵器,1例可见4mm残余分流。术后随访无并发症,结论 TEE在左心耳封堵术的术前、术中、术后发挥着重要的应用价值,为房颤患者预防脑栓塞提供技术支持。     

Color Doppler Splay: A Clue to the Presence of Significant Mitral Regurgitation

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Morphology of Mitral Annular Disjunction in Mitral Valve Prolapse

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Transesophageal echocardiography for the diagnosis of pulmonary embolism with acute cor pulmonale: a comparison with radiological procedures

Objective: The goal of the study was to assess prospectively the value of transesophageal echocardiography (TEE) for the diagnosis of massive pulmonary embolism complicated by acute cor pulmonale. Design: A prospective study conducted on 44 consecutive patients. Setting: A general intensive care unit (ICU) of a university hospital. Patients and methods: Between May 95 and October 96, 44 consecutive patients with clinically suspected acute pulmonary embolism underwent transthoracic echocardiography (TTE), completed by TEE when acute cor pulmonale was present (30 patients). The results of the echocardiographic studies were compared with radiological investigations by helical CT or contrast angiography. Results: The high sensitivity and specificity of the presence of acute cor pulmonale on TTE for the diagnosis of pulmonary embolism was confirmed. Nineteen patients only underwent TEE. The sensitivity and the specificity of TEE in detecting a proximal pulmonary embolism were 84 % and 84 %, respectively. Its main limitation concerned the left pulmonary artery, in which only one thrombus was visualized by TEE whereas six were present on helical CT, and lobar pulmonary arteries which could not be visualized with TEE. Thus, the overall sensitivity of TEE for the detection of pulmonary embolism with acute cor pulmonale was only 58 %. Conclusion: In comparison with radiological procedures, TEE had limited accuracy for detecting pulmonary embolism with acute cor pulmonale. When the pulmonary embolism was located in the main or right pulmonary artery, TEE could clarify the diagnosis within a few minutes without further invasive diagnostic procedures. However, a negative TEE did not exclude left proximal or lobar pulmonary embolism. Received: 28 April 1997 Accepted: 28 November 1997     

Anesthetic issues for robotic cardiac surgery

As innovative technology continues to be developed and is implemented into the realm of cardiac surgery, surgical teams, cardiothoracic anesthesiologists, and health centers are constantly looking for methods to improve patient outcomes and satisfaction. One of the more recent developments in cardiac surgical practice is minimally invasive robotic surgery. Its use has been documented in numerous publications, and its use has proliferated significantly over the past 15 years. The anesthesiology team must continue to develop and perfect special techniques to manage these patients perioperatively including lung isolation techniques and transesophageal echocardiography (TEE). This review article of recent scientific data and personal experience serves to explain some of the challenges, which the anesthetic team must manage, including patient and procedural factors, complications from one-lung ventilation (OLV) including hypoxia and hypercapnia, capnothorax, percutaneous cannulation for cardiopulmonary bypass, TEE guidance, as well as methods of intraoperative monitoring and analgesia. As existing minimally invasive techniques are perfected, and newer innovations are demonstrated, it is imperative that the cardiothoracic anesthesiologist must improve and maintain skills to guide these patients safely through the robotic procedure.     

Large left ventricular pseudoaneurysm and spontaneous recanalized coronaries

35 year old with ruptured lateral wall of Left ventricle (LV) resulting in large pseudo aneurysm contained within the pericardium [Figure 1]. There was free flow of blood between the LV and pseudoaneurysm.He underwent endoventricular patch plasty of the defect after opening the wall of aneurysm [Figure 2].Open in a separate windowFigure 1Mid esophageal four chamber view showing pseudoaneurysmOpen in a separate windowFigure 2Opened pseudoaneurysmal cavity and the defect in left ventricle lateral wall