Aortic transsection after blunt chest trauma

We report a case of an 18-year-old female who developed an extensive hemothorax after blunt chest trauma. Transesophageal echocardiography (TEE) showed transsection of the aorta at the level of the isthmus and turbulent flows in several places around the aorta. We discuss the contribution of TEE for detecting traumatic injuries to the thoracic aorta.     

Transesophageal echocardiographic identification of thrombus producing obstruction of left pulmonary artery descending lobar branches and bronchial artery dilatation

We report an elderly patient in whom a thrombus in the distal left pulmonary artery was shown by transesophageal echocardiography to extend and produce obstruction of the descending lobar branches as well as dilatation of the left bronchial artery.     

经食管超声心动图在微创心脏外科直视手术中的应用

目的 探讨经食管超声心动图(TEE)在微创心脏外科直视手术(MIDCS)中的应用价值。方法 回顾性研究。纳入淮北矿工总医院2018年7月-2019年11月接受MIDCS的患者20例,其中男8例、女12例,年龄(57.5±10.2)岁。术前诊断:先天性心脏病6例,瓣膜病13例,左心房黏液瘤1例。20例患者术前均常规行经胸超声心动图(TTE)检查,术中均采用TEE监测。麻醉诱导后TEE检查修正诊断,指导建立体外循环,开放升主动脉前指导心腔排气;术中,于病变处理完成后即时TEE监测心内血流、瓣膜及心功能情况;于手术操作完成、心脏复跳后,应用TEE评价手术疗效,以无残余分流、瓣周漏、瓣膜关闭不全及左心室射血分数(LVEF)>50%为治愈。结果 经术中引导,20例患者均准确置于引流管、排空心脏。经TEE检查修正诊断5例:1例下腔型房间隔缺损术中发现另有一小的房间隔缺损,术中一并予以修补;1例房间隔缺损者房水平仅有微量分流,无需处理;2例三尖瓣关闭不全患者合并三尖瓣前叶裂,均行瓣叶修复后再予三尖瓣成形术;另1例则排除了左心房血栓。病变处理完成后,因术中TEE即时评估疗效不满意而更改手术方式2例:1例三尖瓣成形术后瓣膜关闭不满意者改行三尖瓣置换术,1例室间隔修补术后残余分流者改行胸骨正中切口继续修补。另有2例术毕即时通过TEE发现低心排血综合征,行主动脉内球囊反搏术。全组未见食管损伤和相关并发症,无手术死亡病例。术后均无残余分流、瓣周漏及少量以上反流,黏液瘤完全切除;术后患者症状明显缓解,LVEF为54%~69%(61.40%±3.65%),与术前[44%~67%(58.70%±5.19%)]比较差异有统计学意义(t=2.896, P<0.05)。本组患者治愈率100%。结论 术中TEE监测应用于MIDCS中,在补充修正诊断、引导体外循环建立、手术操作完成后监测心内排气、评价手术疗效等方面具有明显优势,为微创心脏外科直视手术的成功提供重要保障。     

Left anterior descending coronary artery pseudoaneurysm compressing the main pulmonary artery in a patient with Behçet's disease

Behçet's disease is a systemic inflammatory vascular disorder that may affect the cardiovascular system. Left anterior descending (LAD) artery aneurysm is a rare but potentially fatal complication of Behçet's disease. An accurate diagnosis of this clinical entity requires multimodal imaging (computerized tomography, angiography, and echocardiography) and is essential to guide appropriate therapeutic management. We report the case of a 22‐year‐old female with LAD pseudoaneurysm who underwent surgical repair with transesophageal echocardiography guidance. We describe the importance of the use of an alternative view to define the origin and location of this unusual pathology. (Echocardiography 2012;29:E91‐E93)     

Metastatic Testicular Cancer to Left Atrium via the Left Inferior Pulmonary Vein: A Case Report

Testicular cancer is one of the most common cancers diagnosed in young men. Frequent sites of metastasis include the retroperitoneum, lungs, liver, brain, and bone. Intracardiac metastasis has also been described. An 18-year-old boy with a history of mixed testicular germ cell tumor presented to our institution for surgical resection of his metastatic disease. Intraoperative transesophageal echocardiography during his surgery confirmed a tumor thrombus into the left atrium coming from the left pulmonary vein. We report a case of metastatic testicular cancer with rare tumor extension from the left inferior pulmonary vein into the left atrium. Perioperative transesophageal echocardiography was necessary to aid intraoperative diagnosis and confirmation of the intracardiac tumor, providing data to guide surgical strategy.     

The Role of Invasive Hemodynamics in Guiding Contemporary Transcatheter Valvular Interventions

Recent advances in transcatheter interventions have refueled the interest in utilizing invasive hemodynamics in the catheterization laboratory. The authors review contemporary invasive techniques used to confirm valve disease and guide transcatheter valve interventions. They also discuss the available data and the remaining questions on the role of invasive hemodynamics in current practice and in the future.