Esophageal Doppler: noninvasive cardiac output monitor

In this article we describe the esophageal Doppler, a noninvasive, instantaneous cardiac output monitor. Its reliability has been demonstrated to be comparable to that of other current techniques used in the clinical arena to measure cardiac output. It helps guiding intravascular fluid resuscitation by quantifying the increase in flow in response to fluid challenges and by indicating the plateau of the patient's cardiac function curve. When the plateau has been reached, further fluid loading may result in congestion without improvement in systemic flow. Thus, measuring cardiac output is the only way to determine the upper limit for fluid intake. In addition, a strategy based on cardiac output optimization has proven beneficial in high-risk surgical patients.     

CO2气腹中肾动脉阻力指数和肾血流量的变化

目的 观察CO2气腹中肾动脉阻力指数和肾血流量的变化及二者关系,探讨肾动脉阻力指数在临床监测的意义.方法 择期行腹腔镜胆囊切除术(LC术)32例,术中经食管超声心动图分别于气腹前(To),气腹1min(T1)、5 min(T5)、10 min(T10)、15 min(T15)、20 min(T20)、30 min(T30),解除气腹后1 min(TE1)、5 min(TE)测量左肾动脉主干内径(RAD)、左肾动脉主干血流速度(Vs、Vd、Vm)及血流速度时间积分(VTI),计算阻力指数(RI)、搏动指数(PI)、左肾血流量(LRBF)及左肾血流灌注阻力(LRPR),分析影响RI、PI的相关因素.结果 与T0比较,RI、PI在T1下降(P＜0.05),其余各时点间无明显变化(P＞0.05);LRBF、LRPR在气腹中各时点下降(P＜0.05),解除气腹后5 min恢复(P＞0.05).CO2气腹中,RI、PI与LRBF、LRPR之间无直线相关关系(P＞0.05),与脉压指数(PPI)、心率(HR)之间有直线相关关系(P＜0.05).结论 CO2气腹中肾动脉阻力指数和肾血流量变化没有相关关系,肾动脉阻力指数不能反映肾血流量的变化.     

Diagnosis and Management of Complicated Left Atrial Mural Endocarditis: The Role of Transesophageal Echocardiography

Mural endocarditis that involves the left atrial wall is rare. We report on the transesophageal findings in a patient with left atrial mural endocarditis and discuss its recognition, complications, and treatment.     

经胸微创室间隔缺损封堵术21例临床分析

目的探讨经胸微创治疗小儿室间隔缺损（ventrlcular septal defect,VSD）的临床价值。方法 2009年1月～2010年12月,采用经胸小切口封堵术治疗VSD 21例。男13例,女8例。体重8～15kg,平均（15士5kg）,经胸超声心动图（TTE）提示VSD破口直径5～11 mm。全麻后经胸部切口显露右室,在超声食道探头引导下经右室放置封堵器。出院前和术后1个月进行经胸超声心动图、心电图、x线胸片等检查。结果 21例均成功进行封堵,无传导阻滞,无主动脉瓣关闭不全,无封堵器移位、脱落,无血栓形成,三尖瓣无反流,无残余分流。结论经胸微创行VSD封堵效果良好,安全可靠。     

Usefulness of Transesophageal Echocardiography in Diagnosing Valve Leakage of Left Ventricular Assist Device

In this case report, we present the utility of transesophageal echocardiography in the detection of two uncommon complications of left ventricular assist devices: regurgitation of the bioprosthetic valve in the inflow conduit and a tear of a Dacron conduit with hematoma formation and compression of the right ventricular free wall.     

TEE引导下经胸微创封堵治疗先天性心脏病

目的探讨TEE引导下经胸介入封堵治疗先天性心脏病(CHD)的临床应用价值。方法回顾50例接受TEE引导下经胸介入封堵治疗的CHD患者的资料,包括29例室间隔缺损(VSD)、12例房间隔缺损(ASD)、1例ASD合并VSD及8例动脉导管未闭(PDA),封堵前均经TEE再次明确诊断并观察心脏缺损情况,术中超声实时监测并引导导丝、鞘管等到达指定位置及封堵伞放置,术后超声观察有无残余分流、瓣膜功能障碍评以价封堵效果,并通过心电图监测患者有无心律失常、传导阻滞。结果 49例介入封堵成功,其中11例术后即刻TEE可见残余分流;术后1、3、6个月复查TEE,49例均显示封堵器位置良好,无残余分流及封堵术导致的瓣膜反流,复查心电图未见心律失常及传导阻滞。1例VSD介入封堵失败。结论 TEE用于引导经胸介入封堵治疗CHD安全、有效且创伤小、无辐射、无需对比剂,操作简便,值得临床推广应用。     

Transesophageal Echocardiographic Findings Are Independent and Relevant Predictors of Ischemic Stroke in Patients with Nonvalvular Atrial Fibrillation

Background and Purpose

Not only clinical factors, including the CHADS₂ score, but also echocardiographic findings have been reported to be useful for predicting the risk of ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, it remains to be determined which of these factors might be more relevant for evaluation of the risk of stroke in each patient.

Methods

In 490 patients with NVAF who underwent transesophageal echocardiography (TEE), we examined the long-term incidence of ischemic stroke events (mean follow-up time, 5.7±3.3 years). For each patient, the predictive values of gender, the CHADS₂ risk factors (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, history of cerebral ischemia), the CHADS₂ score, and the findings on echocardiography, including TEE risk markers, were assessed.

Results

The ischemic stroke rate was significantly correlated with the CHADS₂ score (p<0.05). According to the results of univariate analyses, age ≥75 years, history of cerebral ischemia, CHADS₂ score ≥2, and presence of TEE risk were significantly correlated with the incidence of ischemic stroke. Cox proportional hazards regression analyses identified age ≥75 years and presence of TEE risk as significant predictors of subsequent ischemic stroke events in patients with NVAF. As compared with that in persons below 75 years of age without TEE risk, the ischemic stroke rate was significantly higher in persons who were ≥75 years of age with TEE risk (4.3 vs. 0.56%/year, adjusted hazard ratio=8.94, p<0.001).

Conclusions

TEE findings might be more relevant predictors of ischemic stroke than the CHADS₂ score in patients with NVAF. The stroke risk was more than 8-fold higher in patients aged ≥75 years with TEE risk.     

A randomized-controlled study of ultrasound prelocation vs anatomical landmark-guided cannulation of the internal jugular vein in infants and children

Background: A specifically designed ultrasound scanner may be helpful in percutaneous cannulation of the internal jugular vein in pediatric patients. We report a new two‐dimensional (2D) ultrasound prelocation (UL) technique using a transesophageal echocardiography (TEE) intraoperative probe instead of the portable scanner, and have compared the new technique with conventional anatomical landmark method (AL) for central venous catheterization in infants and children. Methods: Sixty‐two infants (body weight <12 kg) undergoing elective surgery for congenital heart disease were randomized into two groups. In the AL group, the landmark for cannulation was the palpation of the common carotid pulsation or the sternocleidomastoid triangle. In the UL group, the central vein was located by 2D ultrasonic imaging using a TEE intraoperative probe for HP SONOS 4500. The number of cannulation attempts, success rate, and complication rate were recorded. Results: For the UL and AL groups, the cannulation success rate was 100% and 80% (P < 0.05), the incidence of arterial puncture was 3.1% and 26.7% (P < 0.025), and the number of attempts was 1.57 ± 1.04 and 2.55 ± 1.76 (P < 0.001), respectively. Conclusions: Two‐dimensional ultrasound prelocated central venous catheterization in infants and children is convenient and can markedly increase cannulation success rate and reduce the incidence of complications.