Perioperative Transesophageal Echocardiography Research Articles

Practical Perioperative Transoesophageal Echocardiography, 3rd Edition

Practical Perioperative Transoesophageal Echocardiography, 3rd Edition

Anesthetist-delivered intraoperative transesophageal echocardiography in pediatric cardiac surgery.

This article reviews the evidence for anesthetist-delivered perioperative transesophageal echocardiography for children undergoing cardiac surgery. It addresses the additional issues of training, developing practice, accreditation, and the requirement for collaboration with pediatric cardiologists, surgeons and other members of the perioperative team. Finally an overview of the potential structure of an anesthetist-delivered perioperative transesophageal echocardiography service is presented.

Transoesophageal echocardiography (TOE): contra-indications, complications and safety of perioperative TOE

Transoesophageal echocardiography (TOE) has, in certain clinical situations, become an almost universal monitor and diagnostic tool. In the perioperative environment, TOE is frequently used to guide anaesthetic management and assist with surgical decision making for, but not limited to, cardiothoracic, major vascular and transplant operations. The use of TOE is not limited to the theatre environment being frequently used in outpatient clinics, emergency departments and intensive care settings. Two case reports, one of oesophageal perforation and another of TOE utilization in a patient having previously undergone an oesophagectomy, introduce the need for care while using TOE and highlight the need for vigilance. The safe use of TOE, the potential complications and the suggested contraindications are then considered together with suggestions for improving the safety of TOE in adult and paediatric patients.

Perioperative Two-Dimensional Transesophageal Echocardiography

Perioperative Two-Dimensional Transesophageal Echocardiography

VD20 TWO-STAGES POSITIONING AND INFLATION OF THE BALLOON EXPANDING THE BIOPROSTHESIS IN TRANSCATHETER AORTIC VALVE IMPLANTATION IN A SMALL PORCELAIN AORTA

Abstract We propose a two-stages positioning and inflation of the balloon expanding the Edwards SAPIEN 3 prosthesis during Transcatheter Aortic Valve Implantation (TAVI) in case of a small porcelain aorta, to avoid aortic root (AR) rupture. We scheduled for Trans-apical TAVI an 85-year-old high-risk woman with a narrow and heavily calcified AR (19 × 20 mm at sino-tubular junction). A 23 mm Edwards Sapien3 prosthesis was directly implanted (without pre-valvuloplasty). First balloon-dilatation was performed in standard position till 70% of nominal inflation volume, in order to hook the prosthesis within the native calcified valve in the correct position. Then the balloon was completely deflated and withdrawn down into the left ventricle, with the distal tip just below the calcified and small aortic sino-tubular junction. In this position, a second balloon-dilatation was performed till 100% of nominal inflation volume to complete prosthesis expansion. Peri-operative trans-esophageal echocardiography showed no paravalvular leak and good trans-prosthesis gradients.

Transesophageal ultrasonography during orthotopic liver transplantation: Show me more.

The first perioperative transesophageal echocardiography (TEE) guidelines published 21years ago were mainly addressed to cardiac anesthesiologists. TEE has since expanded its role outside this setting and currently represents an invaluable tool to assess chamber sizes, ventricular hypertrophy, and systolic, diastolic, and valvular function in patients undergoing orthotopic liver transplantation (OLT). Right-sided microemboli, right ventricular dysfunction, and patent foramen ovale (PFO) are the most common intra-operative findings described during OLT. However, left ventricular outflow tract obstruction and left ventricular ballooning syndrome are more difficult to recognize and less frequent. Transesophageal ultrasonography (TEU) during OLT is also underused. Its applications are as follows: (1) assistance in the difficult placement of pulmonary arterial catheters; (2) help with catheterization of great vessels for external veno-venous bypass placement; (3) intra-operative evaluation of surgical liver anastomosis patency, if feasible, through the liver window; and (4) intra-operative investigation of "acute hypoxemia" due to pulmonary and cardiac issues using trans-esophageal lung ultrasound (TELU). The aims of this review are as follows: (1) to summarize the uses of TEE and TEU throughout all phases of OLT, and (2) to describe other new feasible applications.

LEAD CHARACTERISTICS ARE NOT ASSOCIATED WITH INCIDENTAL THROMBUS FORMATION ON TRANSVENOUS LEADS

The conditions leading to thrombus formation on transvenous leads are not well understood. We prospectively performed peri-operative transesophageal echocardiography (TEE) to evaluate the incidence of lead thrombi and the associated clinical and lead characteristics in patients undergoing lead

Percutaneous ventricular septal defect closure causing acute aortic regurgitation

Intravascular hemolysis and aortic regurgitation (AR) are rare complications of transcatheter closure of perimembranous ventricular septal defects. The current study reports a case of an acute AR, which resulted from acute right coronary cusp perforation by the ventricular septal defect occluder. The current manuscript discusses the possible causes of early cusp erosion owing to occluder, advantages of early operation in such cases, and role of thorough perioperative transesophageal echocardiography in identifying acute AR.

Role of Comprehensive Perioperative Transesophageal Echocardiography in Ebstein\'s Anomaly

Role of Comprehensive Perioperative Transesophageal Echocardiography in Ebstein\'s Anomaly

Role of Perioperative Transesophageal Echocardiography in Left Ventricular Apical Pseudoaneurysm Surgery

Role of Perioperative Transesophageal Echocardiography in Left Ventricular Apical Pseudoaneurysm Surgery

Early Clinical Results of Perceval Sutureless Aortic Valve in 139 Patients: Freeman Experience.

ObjectiveThe aim of this retrospective study is to evaluate the safety and performance of the Perceval sutureless valve in patients undergoing aortic valve replacement. We report the 30-day clinical outcomes of 139 patients.MethodsFrom January 2014 to December 2016, 139 patients underwent sutureless aortic valve replacement. Their operation notes, National Adult Cardiac Surgery Database and perioperative transoesophageal echocardiography findings were studied retrospectively.ResultsNinety-two patients underwent isolated aortic valve replacement (group A) with Perceval valve and 47 patients had combined procedures of aortic valve replacement and coronary artery bypass grafting (group B). The patients received a size S (n=23), M (n=39), L (n=42) or XL (n=35) prosthesis. Perceval valve was successfully implanted in 135 (97.1%) patients. Mean cross-clamping time and bypass time were 40 and 63 minutes for isolated cases, while 68 and 107 minutes for combined cases. Three (2.1%) patients died within 30 days. Four patients suffered stroke and 5 patients went into acute renal failure. Median intensive care unit and hospital stay was 2 and 8.5, respectively. Four valves were explanted due to significant paravalvular leak after surgery. Five patients had permanent pacemaker as a result of complete heart block and mean postoperative drainage was 295 mL for isolated case and 457 mL for combined cases. The mean gradient across Perceval valve was 12.5 mmHg while its effective orifice area was 1.5 cm2.ConclusionEarly postoperative results showed that Perceval valve is safe. Further follow up is needed to evaluate the long-term outcome with this bioprosthesis.

Perioperative transesophageal echocardiography for non-cardiac surgery.

The use of transesophageal echocardiography (TEE) has evolved to include patients undergoing high-risk non-cardiac procedures and patients with significant cardiac disease undergoing non-cardiac surgery. Implementation of basic TEE education in training programs has increased across a broad spectrum of procedures in the perioperative arena. This paper describes the use of perioperative TEE in non-cardiac surgery and provides an overview of the basic TEE examination. Perioperative TEE is used to monitor hemodynamic parameters in non-cardiac procedures where there is a high risk of hemodynamic instability. Its use extends to include moderate-risk procedures for patients with significant cardiac diseases such as low ejection fraction, hypertrophic cardiomyopathy, severe valve lesions, or congenital heart disease. Vascular procedures involving the aorta, blunt trauma, and liver transplantation are all examples of procedures that may benefit from TEE. Transesophageal echocardiography examination allows assessment of volume status, ventricular function, diagnosis of gross valvular pathology and pericardial tamponade, as well as close monitoring of cardiac output, response to therapy, and the impact of ongoing surgical manipulation. In patients with unexplained and unexpected hemodynamic instability, "rescue TEE" can be used to help identify the underlying cause. Perioperative TEE is emerging as a preferred tool to manage hemodynamics in high-risk procedures and in high-risk patients undergoing non-cardiac surgery. A rescue TEE examination protocol is a helpful approach for early identification of the etiology of hemodynamic instability.

Consensus on Perioperative Transesophageal Echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology

Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), created a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.

Comparison of right ventricular measurements by perioperative transesophageal echocardiography as a predictor of hemodynamic instability following cardiac surgery

BackgroundThe relationship between perioperative right ventricular (RV) performance and hemodynamic instability after cardiac surgery seemed less portrayed. Therefore, we sought to elucidate this relationship and compare the accuracy of different RV systolic indices in predicting outcome of cardiac surgery. MethodsThis study enrolled consecutive patients referred for cardiac surgeries. Exclusion criteria were non-sinus rhythm or contraindications to transesophageal echocardiography (TEE). TEE exam and simultaneous pulmonary hemodynamics were recorded in two stages: after induction of anesthesia and before sternotomy (stage 1), and after sternal closure (stage 2). RV measurements performed offline included fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), peak systolic tricuspid annular velocity (RVS′), myocardial performance index (RVMPI), and global longitudinal strain (RVGLS). The end point was defined as prolonged use (>24 h) of postoperative inotropic agent in the intensive care unit (ICU). ResultsThe study population included 68 patients (mean age 61 ± 11 y; 49 men). Twenty-two of these patients (32%) were administered inotropic agents for a prolonged period with a mean duration of 63.9 ± 5.3 h, accompanied with significantly longer ventilator use (p = 0.006) and longer ICU stay (p = 0.001) than patients without a prolonged inotropic agent use. Multivariable analysis demonstrated that only RVGLS in either stage 1 (odds ratio [OR] 1.11, p = 0.048) or stage 2 (OR 1.15, p = 0.018) was significantly associated with the outcome, especially a RVGLS > −13.5% in stage 2 demonstrating high risk of prolonged inotropic agent use after cardiac surgery (OR 7.37, p = 0.016). ConclusionRVGLSs performed using perioperative TEE are reliably associated with hemodynamic instability following cardiac surgery. This finding adds substantial information to postoperative critical care.

Perioperative Transesophageal Echocardiography in Myectomy Procedure -4 Cases Report

Perioperative Transesophageal Echocardiography in Myectomy Procedure -4 Cases Report

Standard Setting for Clinical Performance of Basic Perioperative Transesophageal Echocardiography

Credible methods for assessing competency in basic perioperative transesophageal echocardiography examinations have not been reported. The authors' objective was to demonstrate the collection of real-world basic perioperative transesophageal examination performance data and establish passing scores for each component of the basic perioperative transesophageal examination, as well as a global passing score for clinical performance of the basic perioperative transesophageal examination using the Angoff method. National Board of Echocardiography (Raleigh, North Carolina) advanced perioperative transesophageal echocardiography-certified anesthesiologists (n = 7) served as subject matter experts for two Angoff standard-setting sessions. The first session was held before data analysis, and the second session for calibration of passing scores was held 9 months later. The performance of 12 anesthesiology residents was assessed via the new passing score grading system. The first standard-setting procedure resulted in a global passing score of 63 ± 13% on a basic perioperative transesophageal examination. The global passing score from the second standard-setting session was 73 ± 9%. Three hundred seventy-one basic perioperative transesophageal examinations from 12 anesthesiology residents were included in the analysis and used to guide the second standard-setting session. All residents scored higher than the global passing score from both standard-setting sessions. To the authors' knowledge, this is the first demonstration that the collection of real-world anesthesia resident basic perioperative transesophageal examination clinical performance data is possible and that automated grading for competency assessment is feasible. The authors' findings demonstrate at least minimal basic perioperative transesophageal examination clinical competency of the 12 residents.

The role of peri-operative transoesophageal echocardiography

Cardiac surgery and anaesthesia have come a long way since the late 1970s when Transoesophageal Echocardiography (TOE) was introduced into the peri-operative arena. The development of many surgical procedures and the reduction in peri-operative morbidity and mortality can be directly related to the use of TOE. In complicated surgery it has the benefit of providing real time interrogation of cardiac structures and function that can be reliable and repeatable. As with many interventions a full understanding of the limitations, possible artefacts and operating environment is required to benefit patient care. In 1996 an American Society of Anaesthesiologists/Society of Cardiovascular Anaesthesiologists Task Force published guidelines on the indications for intra-operative TOE. These published guidelines have been updated in 2003 and have recently been reviewed once again in the USA and Europe. In this document we discuss the role of peri-operative TOE and its use and value during some Category I procedures.

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.

Strategies for surgical treatment of ischemic mitral incompetence

Treatment of ischemic mitral incompetence (IMI) is an important problem in cardiovascular surgery, and it is arguing to the best strategies for surgical treatment of IMI. IMI can be quantitative assessment precisely by three-dimensional ultrasonic sound. Perioperative transesophageal echocardiography can acquire detailed information about IMI, but it is possible to underestimate the degree of IMI. The effective mitral regurgitation area at resting are the independently prognosis factor in patients with IMI. So it is necessary to sufficiently evaluate the patients before operation in order to predict the operative effect and risk. It is the choice for the best strategies for surgical treatment of IMI regarding to patients symptom, the degree of IMI, cardiac reconstruction. The therapy strategies should be weighed the operative risk and long-term benefit for moderate IMI, so that combining CABG with concomitant mitral surgery or not would be decided. It is arguing to mitral valve replacement or repair for surgical treatment of severe IMI. The surgical methods should be chosen carefully according to left ventricular remodeling and pathological changes of mitral valve. The effect of mitral valve repair is dependent on correctly perform. The suitable repair technique and plasty ring should be selected actively.

Tips and Tricks of TEE in CHD Intervention

Transesophageal echocardiography (TEE) now is considered an essential part of diagnostic and monitoring during modern cardiac and thoracic aortic surgery. Perioperative TEE is a major component of patient management, and important for surgical and anesthetic decision making. Frazin first introduced the clinical use of transesophageal echocardiography (TEE) in 1976. However, the pediatric TEE probe was established and use clinically in 1990. In 2009, the new microTEE probe (s8-3t Philip) was developed and brings benefits of the TEE to use in patients under 3Kg. Clinical management of congenital heart lesions by using the TEE can be achieved by surgical repair, via catheter-based device closure and during hybrid surgery. Therefore, in this presentation we review our experiences of using intraoperative TEE in pediatric patients who underwent different types of congenital heart surgery, interventional therapy and hybrid surgery. We reported that intraoperative TEE for 256 consecutive neonates and infants undergoing complex congenital heart surgery. TEE was successful performed in 97% of infants with CHD during surgery and only 3% failed due to systemic arterial hypotension and saturation in 7 infants (4 in TAPVC and 3 in CoA) only 5.6 % patients with inadequate surgical repair and need immediate revised. Interventional techniques for treatment of congenital heart disease are evolving rapidly and have become established routine in a large number of centers worldwide. TEE image was used to evaluate the size, number and location of the defects, selection of appropriate device, guiding the procedures and confirmed the results. Hybrid surgery for CHD, a new medical trend. It combined minimally-invasive method with traditional surgical techniques and catheter based procedure. Hybrid for HLHS (single ventricle palliation combing surgical PAB with catheter ductal stenting), periventricular closure of VSD, periventricular pulmonary stenosis, periventricular aortic valve replacement. In conclusion, TEE is routinely and successfully used during pediatric CHD surgery repair, intervention procedures and hybrid surgery to improve the quality of surgical repair and to potentially reduce the morbidity and mortality.