Perioperative echocardiography

2011 ◽  
Author(s):  
R. Feneck ◽  
F. Guarracino
Keyword(s):  
Cardiac Surgery ◽  
Preoperative Diagnosis ◽  
Soft Tissues ◽  
Myocardial Function ◽  
Surgical Intervention ◽  
Intraoperative Imaging ◽  
Transoesophageal Echocardiography ◽  
Mitral Repair ◽  
Probe Insertion ◽  
Traumatic Damage

Perioperative echocardiography is one of the fastest growing areas of echocardiography. Although transthoracic imaging has a role, intraoperative imaging is mostly undertaken using transoesophageal echocardiography (TOE).The indications for perioperative echo have recently been re-evaluated, resulting in recognition of the ubiquitous benefit in patients undergoing cardiac surgery, and recognition of the value in non-cardiac surgery and critical care also.Although TOE is safe, it should be remembered that there may be a greater risk of traumatic damage to the soft tissues in anaesthetized patients who cannot complain of pain during probe insertion.Perioperative imaging should be used to confirm and refine the preoperative diagnosis, detect new or unsuspected pathology, adjust the anaesthetic and surgical plan, and assess the results of surgical intervention. Using imaging to optimize myocardial function is a constantly developing technique, and one which may ensure that patients leave the operating room in the best possible condition. The use of perioperative echo in some procedures, for example, in mitral repair, is now regarded as so valuable that it is arguable that perioperative TOE should be mandatory in these cases.

Perioperative echocardiography

2016 ◽  
Author(s):  
Patrick F. Wouters ◽  
Fabio Guarracino ◽  
Manfred Seeberger
Keyword(s):  
Cardiac Surgery ◽  
Preoperative Diagnosis ◽  
Soft Tissues ◽  
Myocardial Function ◽  
Surgical Intervention ◽  
Intraoperative Imaging ◽  
Transoesophageal Echocardiography ◽  
Primary Field ◽  
Probe Insertion ◽  
Traumatic Damage

Perioperative echocardiography is one of the fastest growing areas of echocardiography. Transthoracic imaging is increasingly being used in postoperative patients, in critical care settings, and in emergency medicine. Intraoperative imaging remains the exclusive domain of transoesophageal echocardiography (TOE) where cardiac surgery is the primary field of application. However, the use of intraoperative TOE is gradually expanding towards non-cardiac surgery. The indications for perioperative echo have recently been re-evaluated, resulting in recognition of the ubiquitous benefit in patients undergoing surgery. Although TOE is safe, there may be a greater risk of traumatic damage to the soft tissues in anaesthetized patients who cannot complain of pain nor resist during probe insertion. Perioperative imaging in cardiac surgery should be used to confirm and refine the preoperative diagnosis, detect new or unsuspected pathology, adjust the anaesthetic and surgical plan, and assess the results of surgical intervention. Using imaging to optimize myocardial function is a constantly developing technique to ensure that patients leave the operating room in the best possible condition.

The role of cardiac surgery in transvenous lead extraction (TLE) – experience from high volume center and 3207 procedures

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Tulecki ◽  
M Czajkowski ◽  
S Targonska ◽  
K Tomkow ◽  
D Nowosielecka ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Tricuspid Valve ◽  
Surgical Intervention ◽  
Clinical Success ◽  
Left Ventricular ◽  
Lead Extraction ◽  
Icd Leads ◽  
Ventricular Lead ◽  
Cardiac Surgeon

Abstract Background The guidelines suggest close co-operation between TLE operating team and cardiac surgery and its key role in the management of life-threatening complications remains unquestionable. But the role of cardiac surgeon seems to be much more extended. Purpose We have analysed the role of cardiac surgery in treatment of patients undergoing TLE procedures. Methods Using standard non-powered mechanical systems we have extracted ingrown PM/ICD leads from 3207 pts (38,7% female, average age 65,7-y) during the last 14 years. Non-infectious TLE indications were in 66,4% of patients. 46% had PM DDD system, 19% PM SSI, 22% ICD, 9% CRT, 4% other systems. In 12% of patients abandoned leads were found. 8% of patients had one lead, 54% - two, 15% - three and 4% - 4–6 leads in the heart. An average dwell time of all leads was 91,5 mth. The lead entry side was left in 96% of patients, right in 3% and both – 4%. Results Procedural success 96,1%, clinical success - 97,8%, procedure-related death 0,2%. Major complications appeared in 1,9% (cardiac tamponade 1,2%, haemothorax 0,2%, tricuspid valve damage 0,3%, stroke, pulmonary embolism <1%). Conclusions Rescue cardiac surgery (for severe haemorrhagic complications) is still the most frequent reason of surgical intervention (1,1%). The second area of co-operation includes supplementary cardiac surgery after (incomplete) TLE (0,8%). The third one is connected with reconstruction or replacement of tricuspid valve, which can be affected by ingrown lead or damaged during TLE procedure (0,5%). Implantation of the complete epicardial system during any surgical intervention (rescue or delayed) should be considered as a supplementation of the operation (0,65%). Some of patients after TLE need implantation of epicardial leads for permanent epicardial pacing (0,6%) and some only left ventricular lead to rebuild permanent cardiac resynchronisation (0,5%). The single experience of large TLE centre indicates the necessity of close co-operation with cardiac surgeon, whose role seems to be more comprehensive than a surgical stand-by itself. Table 1 Funding Acknowledgement Type of funding source: None

Advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma

2021 ◽  
pp. 32-42
Author(s):  
Igor Aleksandrovich Medyanik ◽  
Simon Quarteng Badu
Keyword(s):  
Neurological Disorders ◽  
Preoperative Diagnosis ◽  
Surgical Intervention ◽  
Complete Resection ◽  
Anaplastic Glioma ◽  
Neurological Deficits ◽  
Neural Pathways ◽  
Histological Subtype ◽  
Group A ◽  
Group B

The possibility of using only tractography as a preoperative diagnosis of anaplastic glioma is limited due to its inability to show the exact functional location of the tumor; therefore, the combination of tractography and fMRI seems to be a more promising complex diagnostic method. In neurooncology, complete resection without or with minimal neurological deficit is the goal of surgical intervention. The aim of the study was to investigate the advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma compared to standard CT or MRI. The study involved 48 patients who were divided into two groups based on the use of fMRI and tractography: group A (24 patients) and without it — group B (24 patients). The groups were compared in terms of age, sex, histological subtype of anaplastic glioma, degree of resection, postoperative complications, and dynamics of neurological disorders. The combination of fMRI and tractography is the best preoperative diagnosis, it is safe and allows localizing neural pathways, preserve them during surgery, and reduce postoperative neurological deficits.

INFORMATIVE VALUE OF SONOELASTOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF FOLLICULAR THYROID CANCER

2021 ◽  
pp. 73-78
Author(s):  
Lyubov A. Timofeeva ◽  
Tatiana N. Aleshina ◽  
Marina E. Baranova ◽  
Marina A. Yusova ◽  
Natalia N. Nikolaeva
Keyword(s):  
Thyroid Cancer ◽  
Preoperative Diagnosis ◽  
Surgical Intervention ◽  
Ultrasound Examination ◽  
Shear Wave Elastography ◽  
Diagnostic Methods ◽  
Follicular Thyroid Cancer ◽  
Leading Role ◽  
Quantitative Characteristics ◽  
Multiparametric Ultrasound

In recent years, the opportunities of radiation diagnostic methods have stepped far ahead and today they play a leading role at the stage of preoperative diagnosis of thyroid diseases. The most promising of them is multiparametric ultrasound examination, as well as sonoelastography associated with it. Strain elastography and shear wave elastography make it possible to determine the boundaries of pathological formation and quantitative characteristics of nodular stiffness, which is important when determining the boundaries of invasive tumor growth, primarily thyroid cancer, when planning an upcoming surgical intervention. The article describes a clinical case of radiation diagnosis made for follicular thyroid cancer; it shows the importance of multiparametric ultrasound, including sonoelastography, in the early detection of thyroid cancer. A timely diagnosis and a correct chosen tactics for treating follicular thyroid cancer resulted in a favorable disease outcome.

scholarly journals Implications of transoesophageal echocardiography in decision making during cardiac surgery

2015 ◽  
Vol 29 ◽  
pp. S77
Author(s):  
Muharrem Kocyigit ◽  
Sahin Senay ◽  
Ozgen Ilgaz Kocyigit ◽  
Ahmet Umit Gullu ◽  
Elif Akpek ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Transoesophageal Echocardiography

Transoesophageal echocardiography

ESC CardioMed ◽  
2018 ◽  
pp. 447-450
Author(s):  
Ruxandra Beyer ◽  
Frank A. Flachskampf
Keyword(s):  
Cardiac Surgery ◽  
Intraoperative Monitoring ◽  
Left Atrial ◽  
Aortic Valve Disease ◽  
Transoesophageal Echocardiography ◽  
Atrial Septum ◽  
Clinical Question ◽  
Aortic Diseases ◽  
Prosthetic Valves ◽  
Morphological Evaluation

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.

Surgical repair of the mitral valve

2018 ◽  
Author(s):  
David Sidebotham ◽  
Alan Merry ◽  
Malcolm Legget ◽  
Gavin Wright
Keyword(s):  
Mitral Regurgitation ◽  
Surgical Repair ◽  
Surgical Techniques ◽  
Transoesophageal Echocardiography ◽  
Degenerative Disease ◽  
Systolic Anterior Motion ◽  
Mitral Repair ◽  
Assessment And Treatment ◽  
Secondary Mitral Regurgitation ◽  
Characteristic Features

Chapter 9 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. In the first part of the chapter, the indications for MV repair are reviewed, and areas of controversy are highlighted. Next, the surgical techniques used for valve repair for different mitral pathologies are summarized, in particular the use of leaflet resection or neochordae for repair of degenerative disease. Considerations for minimally invasive mitral repair are briefly reviewed. The bulk of the chapter is given over to TOE assessment prior to, and following, surgical repair. Characteristic features of, and associated complications encountered with, different mitral pathologies are presented. In particular, the risk factors for post-operative systolic anterior motion (SAM) in patients with degenerative disease and failure of a reduction annuloplasty in patients with secondary mitral regurgitation are described. The final section of the chapter details the post-repair assessment, with an emphasis on the features of an optimal repair, quantifying residual mitral regurgitation, mechanisms of repair failure, and assessment and treatment of post-operative SAM.

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