Rescue transoesophageal echocardiography for refractory haemodynamic instability during transvenous lead extraction

Abstract Background Transcatheter aortic valve implantation inside a previously implanted bioprosthesis is an alternative treatment for patients with degenerated surgical aortic bioprosthesis (AB) at high surgical risk. Pre-operative computed tomography (CT) scan provides essential information to the procedure planning, although in case of acute presentation it is not always feasible. Case summary A 32-year-old man with history of surgical treatment of aortic coarctation and Bio-Bentall procedure was transferred to our department in cardiogenic shock with a suspected diagnosis of acute myocarditis. A transthoracic echocardiogram (TTE) revealed a severely impaired biventricular function and AB degeneration causing severe stenosis. It was decided to undertake an urgent trans-apical valve-in-valve (ViV) procedure. Due to haemodynamic instability, a preoperative CT scan was not performed and transoesophageal echocardiography (TOE) was the main intraprocedural guiding imaging technique. Neither intraprocedural nor periprocedural complications occurred. Serial post-procedural TTE exams showed good functioning of the bioprosthesis and progressive improvement of left ventricular ejection fraction. Patient was discharged from the hospital 8 days after the intervention. Discussion A patient with cardiogenic shock due to severe degeneration of the AB was treated with urgent transapical ViV procedure. In this case, where urgent ViV technique was needed, TOE appeared to be a crucial alternative to CT scan and allowed us to perform a successful procedure.

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The use of intraoperative transoesophageal echocardiography as a monitor for haemodynamic instability during pulmonary hydatid cyst excision

Southern African Journal of Anaesthesia and Analgesia ◽

10.1080/22201173.2013.10872919 ◽

2013 ◽

Vol 19 (3) ◽

pp. 174-177

Author(s):

G Picken ◽

A Myburgh

Keyword(s):

Hydatid Cyst ◽

Transoesophageal Echocardiography ◽

Haemodynamic Instability ◽

Cyst Excision ◽

Pulmonary Hydatid Cyst

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Endocardial lead extraction with transoesophageal echocardiography guidance for cardiovascular implantable electronic device (CIED) related infections: four cases report

10.21203/rs.3.rs-230838/v1 ◽

2021 ◽

Author(s):

Qiaoyu Han ◽

Yi Feng ◽

Hui Ju ◽

Yan Jiang ◽

Feng Ze ◽

...

Keyword(s):

Electronic Device ◽

Complete Removal ◽

Transoesophageal Echocardiography ◽

Pericardial Tamponade ◽

Lead Extraction ◽

Monitoring Methods ◽

Recommended Treatment ◽

Routine Monitoring ◽

Endocardial Lead ◽

Older Populations

Abstract Background With the expanding use of cardiac implantable electronic device (CIEDs) in older populations with more complicated conditions have bring about higher rates of CIED infections. The recommended treatment of which involves the complete removal of all hardware, followed by antibiotic therapy and re-implant. Application of transoesophageal echocardiography (TEE) helps improving efficacy and safety by capacitating the operators to perform the procedure, guiding them to better plans and to rapidly recognize and manage relative complications. Case presentation : We report four cases of CIED infections from single-centre, who were extracted endocardial leads with intra-op TEE monitoring and guidance. Three of them had three fatal complications as pulmonary embolism, pericardial tamponade and tricuspid trauma. The other one was found a massive vegetation detected by TEE not by pre-op TTE, which avoided intra-op embolism. Conclusions Continuously intra-op TEE should be one of the routine monitoring methods in these high-risk endocardial leads extraction procedures.

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Dynamic right-to-left interatrial shunt may complicate severe COVID-19

BMJ Case Reports ◽

10.1136/bcr-2021-245301 ◽

2021 ◽

Vol 14 (10) ◽

pp. e245301

Author(s):

Rajkumar Rajendram ◽

Arif Hussain ◽

Naveed Mahmood ◽

Gabriele Via

Keyword(s):

Transoesophageal Echocardiography ◽

Haemodynamic Instability ◽

Invasive Ventilation ◽

Serial Imaging ◽

Non Invasive Ventilation ◽

Bedside Echocardiography ◽

Contrast Enhanced ◽

Bedside Test ◽

Maximal Medical Therapy ◽

Interatrial Shunt

Right-to-left (RTL) interatrial shunt (IAS) may complicate select cases of COVID-19 pneumonia. We describe the use of serial imaging to monitor shunt in critically ill patients. A 52-year-old man presented with COVID-19 pneumonia. Hypoxia worsened despite maximal medical therapy and non-invasive ventilation. On day 8, saline microbubble contrast-enhanced transthoracic echocardiography revealed a patent foramen ovale (PFO) with RTLIAS. Invasive ventilation was initiated the next day. The course was complicated by intermittent severe desaturation without worsening aeration or haemodynamic instability, so PFO closure was considered. However, on day 12, saline microbubble contrast-enhanced transoesophageal echocardiography excluded RTLIAS. The patient was extubated on day 27 and discharged home 12 days later. Thus, RTLIAS may be dynamic and changes can be detected and monitored by serial imaging. Bedside echocardiography with saline microbubble contrast, a simple, minimally invasive bedside test, may be useful in the management of patients with severe hypoxia.

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Transoesophageal echocardiography: What a neuroanaesthesiologist should know?

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.148377 ◽

2015 ◽

Vol 02 (01) ◽

pp. 003-014 ◽

Cited By ~ 1

Author(s):

Minati Choudhury

Keyword(s):

Surgical Procedures ◽

Imaging Modality ◽

Air Embolism ◽

Transoesophageal Echocardiography ◽

Haemodynamic Instability ◽

Anaesthetic Care ◽

New Information ◽

Neurosurgical Patients ◽

Echocardiographic Examination ◽

And Function

AbstractTransoesophageal echocardiography (TEE) is a semi invasive imaging modality rapidly gained credence and popularity in the cardiothoracic centers worldwide by mid 1990s. It has also been found to be useful in some noncardiac surgical procedures, in particular in the management of neurosurgical patients and haemodynamically unstable patients in intensive care units (ICUs). The principal goal of basic transoesophageal echocardiographic examination encompass a broad range of anatomic imaging including the diagnosis of air embolism, causes of haemodynamic instability, ventricular size and function, volume status, and complications from invasive procedures, as well as the clinical impact or etiology of pulmonary dysfunction in ICU. TEE is relatively cheap and semi-invasive, but it should not be used as a stand-alone device but as a tool which provides data in addition to the data acquired from other forms of monitoring. The establishment of TEE in perioperative neuro anaesthetic care though recent, may result in a significant change in the role of the anaesthetsiologist who, using TEE can provide new information which may change the course and the outcome of surgical procedures.

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