scholarly journals Transesophageal Echocardiography in the Intensive Care Unit

2013 ◽  
Vol 1 (1) ◽  
pp. 4-15
Author(s):  
Sundar Krishnan ◽  
Dallen Mill
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Transesophageal Echocardiography ◽  
Diagnostic Technique ◽  
Ventricular Outflow Tract ◽  
Hemodynamic Instability ◽  
Pericardial Tamponade ◽  
Left Ventricular ◽  
Hemodynamic Assessment ◽  
Left Ventricular Outflow

ABSTRACT Management of shock in the intensive care unit involves advanced hemodynamic monitoring. Invasive monitoring with central venous lines and pulmonary artery catheters may be inadequate in guiding therapy and improving outcomes. Echocardiography is a reasonably-safe, minimally-invasive diagnostic technique that provides rapid bedside evaluation of ventricular filling and function. While transthoracic echocardiography is the method of choice initially, images can be suboptimal in up to a third of intensive care patients. Transesophageal echocardiography is then required to better evaluate the cause of hemodynamic instability. In addition, transesophageal echocardiography can be used to diagnose other causes of hemodynamic failure (for e.g., pericardial tamponade, pulmonary embolism and left ventricular outflow tract obstruction) and to diagnose intracardiac shunt. Echocardiography is also vital in diagnosing the cause and guiding management in patients with cardiac arrest. Specific training is required for physicians in order to achieve competence in probe insertion, completion of a comprehensive examination and interpretation of the images. In this article, we provide an overview of the indications and complications of the technique and training pathways for the intensivist, followed by transesophageal echocardiography-guided hemodynamic assessment and diagnosis of specific cardiac disorders commonly encountered in the intensive care unit. How to cite this article Krishnan S, Mill D. Transesophageal Echocardiography in the Intensive Care Unit. J Perioper Echocardiogr 2013;1(1):4-15.

scholarly journals Role of Perioperative TEE in Diagnosing and Management of a Case of Dynamic LVOT Obstruction/SAM

2015 ◽  
Vol 3 (2) ◽  
pp. 58-61
Author(s):  
GD Puri ◽  
V Rajkumar
Keyword(s):  
Transesophageal Echocardiography ◽  
Crucial Role ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Hemodynamic Instability ◽  
Left Ventricular ◽  
Systolic Anterior Motion ◽  
Left Ventricular Outflow ◽  
Perioperative Transesophageal Echocardiography

ABSTRACT Systolic anterior motion (SAM) of the mitral leaflets can lead to hemodynamic instability in post bypass period. Perioperative transesophageal echocardiography (TEE) plays a crucial role in the management of SAM. Perioperative echocardiography helps to (a) identify cause of left ventricular outflow tract obstruction, (b) assess SAM and diagnose severity and (c) management of SAM. A case is presented illustrating identification and management of SAM in post bypass period. How to cite this article Kumar A, Rajkumar V, Kumar A, Puri GD. Role of Perioperative TEE in Diagnosing and Management of a Case of Dynamic LVOT Obstruction/SAM. J Perioper Echocardiogr 2015;3(2):58-61.

scholarly journals Rapid Regression of Obstructive Cardiac Rhabdomyoma in a Preterm Neonate after Sirolimus Therapy

2017 ◽  
Vol 2 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Seung Jae Lee ◽  
Eun Song Song ◽  
Hwa Jin Cho ◽  
Young Youn Choi ◽  
Jae Sook Ma ◽  
...  
Keyword(s):  
Mtor Inhibitor ◽  
Mammalian Target Of Rapamycin ◽  
Mtor Inhibitors ◽  
Ventricular Outflow Tract ◽  
Hemodynamic Instability ◽  
Premature Neonate ◽  
Left Ventricular ◽  
Cardiac Rhabdomyoma ◽  
Left Ventricular Outflow ◽  
Rapid Regression

Cardiac rhabdomyoma can be subclinical or fatal depending on the onset age, involving site, and the size and degree of invasion. Although most rhabdomyomas become smaller with time, emergency intervention is indicated when severe obstruction induces hemodynamic instability. Mammalian target of rapamycin (mTOR) inhibitors have been used to treat neonates and children with hemodynamically obstructive cardiac rhabdomyoma. Herein, we report a premature neonate at the gestational age of 30 + 4 weeks with severe left ventricular outflow tract obstructive cardiac rhabdomyoma who was successfully treated with the mTOR inhibitor sirolimus. To the best of our knowledge, this is the first recorded case of a premature neonate with obstructive cardiac rhabdomyoma who was successfully treated with an mTOR inhibitor. Therefore, sirolimus could be considered as an alternative medical option for managing premature neonates with obstructive cardiac rhabdomyoma.

scholarly journals Left Ventricular Outflow Tract Area After Percutaneous Transseptal Transcatheter Mitral Valve Implantation; A Three-dimensional Transesophageal Echocardiography Study

2021 ◽  
Author(s):  
atsushi hayashi ◽  
hiroki ikenaga ◽  
takafumi nagaura ◽  
Jun Yoshida ◽  
Florian Rader ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Left Ventricular Outflow Tract ◽  
Strong Association ◽  
Multivariable Analysis ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Outflow ◽  
Valve Implantation

Background: Left ventricular (LV) outflow tract (LVOT) obstruction increases mortality in patients undergoing transcatheter mitral valve implantation (TMVI) in degenerated bioprostheses, annuloplasty rings, and native mitral valves. We aimed to evaluate the left ventricular outflow tract area after TMVI using 3-diensional (3D) transesophageal echocardiography (TEE) and to investigate the pre-procedural cardiac geometry affects the LVOT area after TMVI. Methods: We retrospectively reviewed echocardiography data in 43 patients who had TMVI. A change in pressure gradient across LVOT from before to after TMVI (∆PG) and post-procedure 3D cross sectional area (CSA) at the level of the most distal portion of the mitral valve stent that was closest to the LV apex were assessed as evidence of LVOT narrowing. Results: TMVI with the use of balloon-expandable valve system was performed for 24 bioprostheses, 7 annuloplasty rings, and 12 native valves. Compared to patients without increase in LVOT gradient (∆PG <10 mmHg; n=33), patients with increase in LVOT gradient (∆PG ≥10 mmHg; n=10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF) and smaller aorto-mitral (AM) angle. CSA at the valve stent distal edge showed strong association with ∆PG (r=-0.68, P<0.0001). Only small AM angle was associated with small CSA at the valve stent ventricular edge on multivariable analysis, independent of LVESV and LVEF. Conclusion: Pre-procedural AM angle as well as LVESV and LVEF were associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-in-ring, and valve-in-native valve implantation. These data may be useful for preprocedural planning.

Intraoperative Determination of Cardiac Output Using Multiplane Transesophageal Echocardiography 

1998 ◽  
Vol 89 (2) ◽  
pp. 350-357 ◽  
Author(s):  
Albert C. Perrino ◽  
Stephen N. Harris ◽  
Martha A. Luther
Keyword(s):  
Cardiac Output ◽  
Transesophageal Echocardiography ◽  
Continuous Wave ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Continuous Wave Doppler ◽  
Imaging Array ◽  
Left Ventricular Outflow

Background Limitations in the imaging views that can be obtained with transesophageal echocardiography (TEE) have hindered development of a widely adopted Doppler method for cardiac output (CO) monitoring. The authors evaluated a CO technique that combines steerable continuous-wave Doppler with the imaging capabilities of two-dimensional multiplane TEE. Methods From the transverse plane transgastric, short-axis view of the left ventricle, the imaging array was rotated to view the left ventricular outflow tract (LVOT) and ascending aorta. Steerable continuous-wave Doppler was subsequently used to measure aortic blood flow velocities. Aortic valve area was determined using a triangular orifice model. Matched thermodilution and Doppler CO measurements were obtained serially during surgery. Results The left ventricular outflow tract was imaged in 32 of 33 patients (97%). Data analysis reveal a mean difference between techniques of -0.01 l/min, and a standard deviation of the differences of 0.56 l/min. Multiple regression showed a correlation of r = 0.98 between intrasubject changes in CO. Multiplane TEE correctly tracked the direction of 37 of 38 serial changes in thermodilution CO but with a modest 14% underestimation of the magnitude of these changes. Conclusions These results indicate that multiplane TEE can provide an alternative method for the intraoperative measurement of CO. The ability of the rotatable imaging array to align with the left ventricular outflow tract and the need for only minimal adjustments in probe position advance the utility of intraoperative TEE.

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