Thrombus in left ventricle discovered by transoesophageal echocardiography (TOE) in a patient with acute abdomen: how TOE can be crucial for decision-making in non-cardiac surgery

Transoesophageal echocardiography uses the oesophagus and upper stomach as echo windows on the heart and thoracic vessels via an endoscopic probe. It is indicated when transthoracic echocardiography is unable or unlikely to answer the clinical question. Indications where transoesophageal echocardiography has a proven superiority include diagnosis of left atrial and appendage thrombi, morphological evaluation of the atrial septum, infective endocarditis, in particular abscesses, mitral and aortic valve disease, prosthetic valves, aortic diseases, and intraoperative monitoring of cardiac surgery or interventions.

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Cardiac Surgery in Trisomy 13 and 18: A Guide to Clinical Decision-Making

Pediatric Cardiology ◽

10.1007/s00246-020-02444-6 ◽

2020 ◽

Vol 41 (7) ◽

pp. 1319-1333 ◽

Cited By ~ 3

Author(s):

Horacio G. Carvajal ◽

Connor P. Callahan ◽

Jacob R. Miller ◽

Bethany L. Rensink ◽

Pirooz Eghtesady

Keyword(s):

Decision Making ◽

Cardiac Surgery ◽

Clinical Decision Making ◽

Clinical Decision ◽

Trisomy 13

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Intraoperative Transoesophageal Echocardiography for Paediatric Cardiac Surgery—An Audit of 200 Cases

Anaesthesia and Intensive Care ◽

10.1177/0310057x9902700606 ◽

1999 ◽

Vol 27 (6) ◽

pp. 591-595 ◽

Cited By ~ 30

Author(s):

M. L. K. Sheil ◽

D. B. Baines

Keyword(s):

Cardiac Surgery ◽

Transoesophageal Echocardiography ◽

Paediatric Cardiac Surgery

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High Risk Committee for Cardiac Surgery Decision-Making: Results from 110 Consecutive Patients

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2020.09.014 ◽

2020 ◽

Author(s):

Lauren V. Huckaby ◽

Thomas G. Gleason ◽

Francis Ferdinand ◽

Ibrahim Sultan ◽

Danny Chu ◽

...

Keyword(s):

Decision Making ◽

Cardiac Surgery ◽

High Risk ◽

Risk Committee

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543 Automated detection of mitral annular plane systolic excursion in transoesophageal echocardiography based on deep learning

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.277 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

T Nordal ◽

E A R Berg ◽

G Kiss

Keyword(s):

Deep Learning ◽

Left Ventricle ◽

Vital Signs ◽

Transoesophageal Echocardiography ◽

Vertical Movement ◽

Left Ventricular ◽

Cardiac Monitoring ◽

Major Surgery ◽

Intraobserver Variability ◽

Manual Input

Abstract Introduction Major surgery and interventions may impact cardiac function. Perioperative monitoring is currently based on vital signs and clinical observations. However, this does not offer a complete monitoring of left ventricular function throughout the intervention. We hypothesize that functional monitoring of the heart can be performed automatically based on transoesphageal echocardiography (TOE) images. One parameter that has been shown to correlate well with ejection fraction is mitral annular plane systolic excursion (MAPSE). To aid functional monitoring of the left ventricle perioperatively, we propose a technique for detecting MAPSE in TOE images of the left ventricle. Purpose The purpose of this study is to automatically track the movement of the mitral annular plane in TOE sequences of the left ventricle and detect MAPSE via a deep learning approach. Method Recordings from 131 consecutive complete TOE exams from the Echocardiography Unit were anonymized and used for training. Recordings from 23 consecutive TOE exams, also anonymized, were used as test set. All recordings were manually annotated with the location of the landmarks indicated in both 4-chamber (4C) and 2-chamber (2C) views. All recordings were made using state-of-the-art clinical scanners. The captures include 3 to 5 heart cycles of standard 4C and 2C views. An approach based on a fully convolutional neural network was implemented and trained in a supervised manner to predict the location of two landmarks on the mitral annular plane in B-mode TOE images from 4C and 2C views. The model was also trained to account for noise by recognizing when detecting the landmarks is not feasible due to poor image quality. We have implemented all necessary post processing calculations to automatically estimate MAPSE based only on raw TOE B-mode sequences. Results Preliminary results on the test data show that the landmark detector is able to track the vertical movement of landmarks on the mitral annular plane with a mean error of 0.88 mm and a standard deviation of 0.27 mm (Fig. 1: Upper left and lower left: tracked mitral attachment points on a sample case presented upper right. Lower right: all measured Y-axis excursion values versus the reference). The classifier for detecting ultrasound frames where landmark detection is not feasible has a sensitivity of 0.82 and a specificity of 0.91. Conclusion The landmark detector is showing promising results in tracking of the mitral annular plane excursion. This can provide a fast calculation of MAPSE and eliminate intraobserver variability. This may be included in a more extensive cardiac monitoring for any type of surgery without the need of manual input from echocardiographers. Further research is ongoing and a comparison with clinical MAPSE values is underway. Abstract 543 Figure 1

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