Role Of Intraoperative Transesophageal Echocardiography Research Articles

The Role of Intraoperative Transesophageal Echocardiography in the Management of Renal Cell Carcinoma with Atrial Thrombus - Case Report.

Renal cell carcinoma is a common disease, and clear cell renal cell carcinoma is the most common histological type. Renal cell carcinoma has a tendency to infiltrate the venous system including the inferior vena cava and the right atrium of the heart. We present the cases of two patients with renal cell carcinoma with stage IV tumor thrombus according to the Mayo classification, who underwent surgery under transesophageal echocardiography guidance. Apart from standard imaging methods used in renal cancer with tumor thrombus reaching the right atrium of the heart, we consider transesophageal echocardiography to be a very useful tool in the diagnostic work-up, patient monitoring, and selection of appropriate surgical technique.

Anesthetic management and the role of TEE in the entrapment of a paradoxical embolus by a patent foramen ovale

BackgroundA paradoxical embolism arises when a venous thrombus passes through a cardiac right to left shunt and enters the arterial circulation. This can manifest as cardiovascular ischemia, cerebrovascular insults, increased right ventricular pressure, and/or volume overload leading to signs and symptoms of heart failure. While rare, paradoxical emboli carry high mortality and morbidity if diagnosis is missed and/or treatment is delayed. Transesophageal echocardiography can be diagnostic. Initial treatment revolves around anticoagulation and/or thrombolysis to prevent clot propagation. However, for clots in transit, emergent surgical removal is often necessary. Anesthetic induction can be tricky given the potential for rapid deterioration and the need to avoid increased right sided pressures and further clot migration.Case presentationIn this report, we present a 72-year-old obese female with a history of hypertension, hyperlipidemia, gout, and diabetes found to have a paradoxical embolism caught in transit, trapped in a patent foramen ovale, and managed surgically. We describe the role of intraoperative transesophageal echocardiography in successfully treating this patient.ConclusionsTEE plays an important role in the diagnosis and management of paradoxical PE. It can detect right and left heart thrombi and intracardiac shunts, can help in the successful closure of intracardiac shunts, and can impact intraoperative surgical decision making.

Severe mitral regurgitation following partial rupture of papillary muscle: The role of intraoperative transesophageal echocardiography

Papillary muscle rupture (PMR) is an uncommon mechanical complication of myocardial infarction which warrants timely diagnosis and urgent surgical intervention to maximize survival chances. Echocardiography is an essential diagnostic tool, whereas transesophageal echocardiography can provide accurate diagnosis and guide decision-making. We hereby present the case of a patient with partial PMR that presented for cardiac surgery in our institution, with the respective intraoperative echocardiographic findings.

A case of left ventricular apical thrombus extending into left ventricular outflow tract and role of intraoperative transesophageal echocardiography

A case of left ventricular apical thrombus extending into left ventricular outflow tract and role of intraoperative transesophageal echocardiography

Echocardiographic Evaluation of Successful Mitral Valve Repair or Need for a Second Pump Run in the Operating Room

Detailed preoperative and intraoperative echocardiographic assessment of the mitral valve apparatus is critical for a successful repair. The recent advent of 3-dimensional transesophageal echocardiography has added an extra pivotal role to transesophageal echocardiography in the assessment of mitral apparatus and mitral regurgitation. Because surgeons must rapidly decide whether cardiopulmonary bypass should be continued to be weaned off or a second pump run should be selected, the echocardiographer conducting intraoperative transesophageal echocardiography is required to be trained according to a certain algorithm. This review summarizes the current clinical role of intraoperative transesophageal echocardiography in mitral valve repair in the operating room.

Aortic Paravalvular Leaks. The Role Of Intraoperative Transesophageal Echocardiography In Diagnosis And Correction Guidance

Objective: Paravalvular leak (PVL) is a known and undesirable complication of prosthetic valve replacement. The presence of significant PVL is associated with comorbidities such as hemolysis, heart failure, and decreased long-term survival. The role of intraoperative transesophageal echocardiography (IOTEE) is the standard of care for valve repair surgery. However, its use in valve replacement is not universal. Methods: We performed a retrospective analysis of Aortic Valve Replacement (AVR) surgeries with IOTEE, from 2018-2020. Primary outcomes were the incidence of intraoperative PVL pre and post echocardiography guided correction. Secondary outcomes were PVL predictors factors, cardiopulmonary bypass time and cross clamp time. PVL was defined, according to circumferential extent of the regurgitant jet, as mild (<10%), moderate (10-20%) and severe (>20%). A PVL greater than mild was considered significant. Results: A total of 194 patients underwent surgical AVR (table 1); 73(37.6%) underwent minimally invasive aortic valve replacement and 121(62.4%) conventional aortic valve replacement. Of them, 87(4.8%) were isolated AVR and 107(55.1%) combined procedures. The overall incidence of significant PVL was 2.6% (n=5). All of them underwent echocardiography guided correction. Post correction IOTEE showed none significant PVL. Mild PVL was diagnosed in four of them. Cardiopulmonary bypass time was 119±37.9 minutes and cross clamp time was 81±26.1 minutes. There were no significant differences in these times between patients with PVL that needed correction and patients who did not. Diagnosis, etiology, bicuspid aortic valve, type of prosthesis and size number were not associated with PVL incidence. Conclusions: IOTEE allows early diagnosis of PVL. This enables intraoperative correction, without significant extension of surgical times, resulting in non-significant PVL. IOTEE should be the standard of care in AVR surgery. Table 1. Patients characteristics Patients n 194 Age (Mean±SD) 69.9 ± 11.4 Sex n (%) Male, Female 113(58.2%), 81(41.8) Diagnosis n (%)Aortic StenosisAortic InsufficiencyConcomitant stenosis and insufficiencyInfectious Endocarditis 146 (76%)28 (14.6%)16 (8.3%)2 (1%) Etiology n (%)CalcificationRheumatic diseaseAnulectasisProlapseInfectious EndocarditisProsthetic DysfunctionFibroelastomaOthers 160 (82.5%)3 (1.5%)6 (3.1%)10 (5.2%)6 (3.1%)2 (1%)2 (1%)5 (2.6%) Bicuspid valve n (%) 31 (16.1%) NYHA Functional Class n (%)No Heart failureIIIIIIIV 24 (13.6%)10 (5.6%)112 (63.3%)29 (16.4%)2 (1.1%) Angina 76 (40.9%) Left Ventricle Ejection Fraction (LVEF) n (%)Normal>50%30-50%<30% 143 (76.5)18 (9.6%)11 (5.9%)15 (8%) Euro Score II n (%)Low RiskIntermediate RiskHigh Risk 173 (89.6%)19 (9.8%)1 (0.5%)

Intra-operative trans-esophageal echocardiography in heart valve disease.

Peri-operative echocardiography is widely used because it provides information that significantly influences clinical/surgical management and improves outcome in patients undergoing cardiac surgery. The role of intra-operative trans-esophageal echocardiography (TEE) in valvular heart disease cannot be emphasized enough. Increasing use of newer surgical techniques-valve repairs and minimal invasive cardiac surgery also warrants intra-operative TEE. It gives us better insight into the anatomy and physiology of the valvular lesion by digital imaging. This manuscript provides an illustrative case based overview of intra operative TEE (IOTEE) in heart valve surgery.

Role of Intraoperative Transesophageal Echocardiography in Cardiac Surgery: an Observational Study.

AIM:This study is based on the hypothesis that the routine use of transesophageal echocardiography in cardiac surgery will influence the surgical decision taken by the surgeon intra-operatively in Kasr-Alainy hospitals.METHODS:Patients were examined with intraoperative transesophageal echocardiography (TEE) before and after cardiopulmonary bypass. Complete and comprehensive intraoperative TEE examinations will be performed by TEE certified cardiac anesthesiologists. Data that will be collected from the intraoperative examination and will be compared with preoperative transthoracic echocardiography, and the surgical decision that was taken preoperatively will be revised again with the cardiothoracic surgeon before the start of surgery. Also, TEE will be used again after weaning from bypass for revision and assessment of our decision.RESULTS:We examined the utility of TEE in 100 patients undergoing different types of cardiac procedures in Kasr Al-Ainy hospital. This prospective clinical investigation found that the pre- and post-CPB TEE examinations influenced surgical decision making in 10% of all evaluated patients.CONCLUSION:Intraoperative TEE has the potential to influence clinical decision making for cardiac surgical patients significantly. It is useful in surgical planning, guiding various hemodynamic interventions, and assessing the immediate results of surgery. Thus, IOTEE should be used routinely in all patients undergoing all types of cardiac surgeries.

Role of Intraoperative Transesophageal Echocardiography in the Management of Renal Cell Carcinoma with Cavoatrial Extension

Role of Intraoperative Transesophageal Echocardiography in the Management of Renal Cell Carcinoma with Cavoatrial Extension

The Role of Intraoperative Transesophageal Echocardiography in Identifying a Fenestrated Occlusion of the Inferior Vena Cava During Pulmonary Thromboendarterectomy

The Role of Intraoperative Transesophageal Echocardiography in Identifying a Fenestrated Occlusion of the Inferior Vena Cava During Pulmonary Thromboendarterectomy

Defining the Role of Intraoperative Transesophageal Echocardiography During Radical Nephrectomy With Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma

To determine the impact of transesophageal echocardiography on the surgical management of patients undergoing nephrectomy and inferior vena cava tumor thrombectomy for renal cell carcinoma. We retrospectively analyzed intraoperative records of 67 patients with renal cell carcinoma and level II-IV invasion of the inferior vena cava who underwent nephrectomy with tumor thrombectomy between 2007 and 2015. Based on preoperative imaging, patients were categorized according to vena cava thrombus level. Diagnostic utility and impact on surgical management were extracted from the operative note, anesthesia record, and intraoperative echocardiography report. Twelve of 34 patients (35%) with level II thrombus, 14 of 18 (78%) with level III thrombus, and 15 of 15 (100%) with level IV thrombus had intraoperative transesophageal echocardiography. With increasing level of tumor thrombus, the diagnostic yield and surgical impact increased. Echocardiography provided new diagnostic information in 7 of 12 (58%) patients with level II thrombus and altered surgical management in 16%. Among level III thrombus patients, echocardiography provided new diagnostic information in 12 of 14 (86%) and altered surgical management in 21%. Echocardiography provided new diagnostic information and impacted surgical management in all 15 (100%) patients with a level IV thrombus. The diagnostic yield of intraoperative transesophageal echocardiography increases in patients with greater vena caval tumor thrombus extension. This information has a significant influence on surgical decision-making.

Posterior Aortic Root Enlargement During Aortic Valve Replacement: Role of Intraoperative Transesophageal Echocardiography

Posterior Aortic Root Enlargement During Aortic Valve Replacement: Role of Intraoperative Transesophageal Echocardiography

PT250 Role of Intraoperative Transesophageal Echocardiography in Congenital Heart Diseases, 10 Years Experience

PT250 Role of Intraoperative Transesophageal Echocardiography in Congenital Heart Diseases, 10 Years Experience

Abstract 16138: Chest and Cardiac Compression on CT/MRI and on TEE Predicts Improvement in Right Heart Chamber Size and Right Ventricular Deformation Post Pectus Excavatum Repair Surgery

Background: Pectus excavatum (PE) deformity involves posterior depression of the sternum and adjacent costal cartilages. The relationship of CT/MRI chest cardiac compression indices used as indications for surgical repair of PE with echocardiographic findings and with improvement in cardiac chamber compression and function post PE repair is unknown. Methods: We evaluated right atrial (RA) size, tricuspid annulus (TA size, right ventricular (RV) outflow tract size as well as RV 2D strain on intra-operative trans-esophageal echocardiography (TEE) immediately pre and post surgical PE repair. Inspiratory and expiratory Haller Index (HI) and cardiac compression indices (CCI) were measured on pre op CT/MR scans (Figure). Offline measurement of chamber dimensions on TEE images was performed and Speckle tracking strain measurements were made using Syngo US Workplace software (Siemens). P&lt;0.05 was considered significant. Results: 60 patients, 73% male, 27% female, age 33.6±10.3 yrs underwent PE repair following CT/MRI from 2010-2014 (Figure). There was a strong correlation between expiratory CT/MRI chest AP diameter and pre-op RA size (panel A). Pre op RA and TA compression on TEE inversely correlated with pre op RV global longitudinal strain rate(RVGLSR) (panels B &amp; C). CCI predicted improvement in RA size post PE repair (panels D &amp; E). In addition pre op RA size on TEE correlated with improvement in RVGLSR post PE repair surgery (panel F). Conclusion: In patients with PE deformity, pre surgical CCI correlated with right-sided cardiac chamber compression on pre op TEE. Severity of chest and cardiac compression also predicted magnitude of improvement in right-sided chamber size and RV longitudinal deformation post PE repair. Our findings provide insight regarding the beneficial effects of PE surgery on right heart chamber compression and improvement in RV function and the important role of intraoperative TEE for patients undergoing PE repair surgery.

Role of intraoperative transesophageal echocardiography in pediatric cardiac surgery

BackgroundIntraoperative transesophageal echocardiography (TEE) has a major role in detecting residual lesions during and/or after pediatric cardiac surgery. MethodsAll pediatric patients who underwent cardiac surgery between July 2001 and December 2008 were reviewed. The records of surgical procedure, intraoperative TEE, and predischarge transthoracic echocardiograms were reviewed to determine minor and major residual cardiac lesions after surgical repair. ResultsDuring the study period, a total of 2268 pediatric cardiac patients were operated in our center. Mean age was 21months (from 1day to 14years). Of these patients, 1016 (48%) had preoperative TEE and 1036 (46%) were evaluated by intraoperative echocardiography (TEE or epicardial study). We identified variations between TEE and preoperative transthoracic echocardiography in 14 patients (1.3%). Only one surgical procedure was cancelled after atrial septal defect exclusion. The other 13 patients had minor variation from their surgical plan. Major residual lesions requiring surgical revision were detected in 41 patients (3.9%), with the following primary diagnoses: tetralogy of Fallot in 12 patients (29%), atrioventricular septal defect in seven patients (17%), ventricular septal defect in seven patients (17%), double outlet right ventricle in two patients (5%), Shone complex in two patients (5%), subaortic stenosis in two patients (5%), mitral regurgitation in two patients (5%), pulmonary atresia in two patients (5%), and five patients (12%) with other diagnoses. ConclusionIntraoperative TEE has a major impact in pediatric cardiac surgery to detect significant residual lesions. Preoperative TEE has a limited role in case of a high quality preoperative transthoracic echocardiography. We recommend routine use of intraoperative TEE during and/or after intracardiac repair in children.

OP-113 Residual Lesions after Pediatric Cardiac Surgery: Role of Intraoperative Transesophageal Echocardiography - A Single Center Experience In More than 1000 Studies

Intraoperative transesophageal echocardiography (TEE) has a major role in detecting residual lesions during and/or after pediatric cardiac surgery.

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

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. 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.

Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery.

The role of intraoperative transesophageal echocardiography (TEE) has increased tremendously since its first use in 1979. Today intraoperative TEE is a class I indication for surgical mitral valve reconstruction for evaluation of mitral valve pathology, graduation of mitral regurgitation and detection of potential risk factors as well as post-repair assessment. Real-time three-dimensional TEE offers anatomical visualization of the mitral valve apparatus, fundamental for virtual surgical planning of proper annuloplasty ring size. As minimally invasive and even off-pump techniques for mitral valve repair become more popular, image guidance by intraoperative TEE will play an essential role.

Role of intraoperative transesophageal echocardiography in patients undergoing robotic atrial myxoma excision

To evaluate the role of intraoperative transesophageal echocardiography (TEE) during robotic atrial myxoma excision. Thirty-eight consecutive patients undergoing robotic atrial myxoma excision from September 2007 to August 2012 were enrolled in the study. During the procedure, TEE was performed to document the myxoma position, its attachment, and hemodynamic information before cardiopulmonary bypass (CPB). During establishment of peripheral CPB, TEE was used to guide placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was performed to evaluate the effect of the procedure. The accuracy of TEE for the position or its attachment of the myxoma was 100%. All the cannulae in the SVC, IVC and AAO were located in correct position. In all patients, TEE confirmed successful excision. Intraoperative TEE is a valuable adjunct in patients undergoing robotic atrial myxoma excision.

The Contemporary Role of Intraoperative Echocardiography: Is it Underused or Overused?

Intraoperative echocardiography has become an invaluable diagnostic and monitoring tool. Especially during cardiac surgery, transesophageal echocardiography has a high capability to influence surgical decisions and the hemodynamic management of the patients. Based on current practice guidelines and studies, this article provides an analysis of the contemporary role of intraoperative transesophageal echocardiography.