DK2985_C000 1..28 - AlSharqia Echo Club

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Equipment, Complications, Infection Control, and Safety 147Table 7.6Prophylaxis is optional for the high-risk patient whenundergoing TEE as recommended by the AmericanHeart Association (AHA) (Table 7.6) (10). High-risk categoriesinclude: prosthetic valves, previous endocarditis,complex cyanotic congenital heart disease, and surgicallyconstructed systemic pulmonary shunts or conduits. Highriskpatients with poor oral and dental hygiene or preexistingesophageal disease, may also benefit from antibioticprophylaxis (10).VI.Antibioprophylaxis for TEEStandard regimenAmpicilline 2.0 g IV or IM and gentamycin 1.5 mg/kg IV orIM (not to exceed 80 mg) within 30 min before procedureAmoxicillin 1.5 g PO 6 h after the initial doseAlternatively, the parenteral regimen may be repeated once 8 hafter the initial doseRegimen for penicillin-allergic patientsVancomycin 1.0 g IV over 1 h and gentamycin 1.5 mg/kg IVor IM (not to exceed 80 mg) within 30 min of starting theprocedureMay be repeated once 8 h after the initial doseMONITORING AND PATIENT POSITIONDURING TEE EXAMINATIONWhen performing a TEE examination, basic monitoring ofthe patient is essential. In the operating room at our institution,a satellite TEE display is positioned close to thehemodynamic monitor so that both are in the samevisual field (Fig. 7.4). Pulse oxymetry, blood pressure,and electrocardiogram (EKG) must be monitored. Baselinevital signs should be recorded before the beginningof the procedure. A reliable intravenous access must besecured for administration of sedation, anesthesia, orresuscitation drugs. Suctioning devices, supplementaryoxygen, and resuscitation equipment should be readilyavailable, as well as trained personnel to assist the procedureand help to monitor the patient.The performance of TEE under conscious sedationrequires adequate knowledge of the pharmacodynamicand pharmacokinetic properties of sedative and narcoticagents. Guidelines on their utilization should be reviewed,particularly if given by non-anesthesiologists unfamiliarwith them. Their dosage, utilization, and combinationare beyond the scope of this chapter but there have beenseveral reviews on this subject (11–13). It has to be keptin mind that dosage should be adjusted in the elderly ordebilitated patient with reduced renal or liver function,and adverse reactions should be anticipated. The dosage ofsedation is a delicate balance and both reduced and excessivesedation can be associated with undesirable side effects(Fig. 7.5). Reversal agents for benzodiazepine and narcoticoverdose such as flumazenil and naloxone respectivelyshould be readily available.Oropharyngeal anesthesia with local anesthetic alone, orcombined with sedation, improves patient tolerance to theprocedure. It reduces the hemodynamic effects associatedwith esophageal intubation and probe manipulation.Additional superior laryngeal block can be performed ifadequate local anesthesia and suppression of the gagreflex cannot be obtained. However, local anestheticagents also have specific toxic dosages. Careful managementof local anesthetic administration is important andmany intoxication cases have been reported in the literaturewith TEE and upper gastrointestinal endoscopy dueto inadequate administration of local anesthesia (14).VII.SATELLITE TEE MONITORANESTHESIA MACHINETEE PROBE INSPECTIONHEMODYNAMICMONITORINGOXYGENATION,CAPNOGRAPHYAND GAS ANALYZERFigure 7.4 Intraoperative monitoring during TEE examination.The use of a satellite TEE monitor helps to maintainvigilance with both hemodynamic and echocardiographicmonitoring.The TEE probe consists of an ultrasound transducerinstalled at the distal extremity of a flexible endoscope.The maximal adult probe diameter is 0.9–1.6 cm and forthe pediatric patient 0.5–0.6 cm. The probe total lengthvaries between 70 and 120 cm. Two proximal controlknobs permit anteroposterior and lateral motion of thehead of the probe, of about 908 and 708 respectively.
148 Transesophageal <strong>Echo</strong>cardiographyInsufficient orno sedation• Hypertension• Anxiety• Retching + Valsalvamaneuver• Intrathoracic pressure• Central venous pressure• Pulmonary pressure• Arrhythmia• Ischemic eventAwake sedationCollaboration• Reduced sympathetic response• Reduce vagal reactionExcessive sedation• Respiratory depression• Desaturation• Hypoxemia• Gastric aspiration• Ischemic event• CardiodepressionFigure 7.5 The sedative agents have to be titrated for adequate performance of TEE and this titration is a delicate balance betweenno sedation and excessive sedation. Insufficient or absent sedation will lead primarily to cardiac symptoms such as tachycardia andhypertension. On the other hand, excessive sedation can lead to pulmonary symptoms such as respiratory depression and hypoxia.Figure 7.6(A) Linear fissure in the distal tip of the TEE probe (arrow). (B) Broken connector plate (arrow). (C, D) Broken casing.
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TransesophagealEchocardiographyMult
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Published in 2005 byTaylor & Franci
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ForewordThe use of transesophageal
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xPrefaceThere are several other ind
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ContentsForeword Jean-Francois Hard
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ContributorsRobert Amyot, MD, FRCPC
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ContributorsxviiFrançois Marcotte,
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xxAbbreviationsCNS central nervous
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xxiiAbbreviationsPMLPpaPPHPPHTNPraP
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How to Use the Transesophageal Echo
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1Principles of UltrasoundALAIN GAUV
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Principles of Ultrasound 3Table 1.1
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Principles of Ultrasound 5the ratio
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Principles of Ultrasound 7transduce
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Principles of Ultrasound 9(A)(B)Fig
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Principles of Ultrasound 11certain
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Principles of Ultrasound 13PULSERBE
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Principles of Ultrasound 152. Trans
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Principles of Ultrasound 17(A)(B)TV
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Principles of Ultrasound 19(A)(B)(E
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Principles of Ultrasound 21to the i
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24 Transesophageal Echocardiography
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3TransducersFRANÇOIS HADDADUnivers
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Transducers 43(A)(C)(B)Figure 3.3 (
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Transducers 45more frequencies than
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Transducers 47Figure 3.10 Beam focu
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Transducers 49sound that propagate
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Transducers 51(A)(B)(C)Figure 3.15
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5Quantitative EchocardiographyJEAN
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Quantitative Echocardiography 91dim
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Quantitative Echocardiography 93Fig
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Quantitative Echocardiography 95Fig
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Page 150 and 151: 6Imaging Artifacts and PitfallsROBE
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Page 214 and 215: 9Global Ventricular Function and He
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Global Ventricular Function and Hem
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10CardiomyopathyVICKY SOULIÈRE, PH
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Cardiomyopathy 217Figure 10.1 (A, B
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Cardiomyopathy 219Figure 10.4 Systo
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Cardiomyopathy 221RVOT must also be
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Cardiomyopathy 223either by reduced
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Cardiomyopathy 225Figure 10.10 Flow
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Cardiomyopathy 227On the other hand
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Cardiomyopathy 229volumes are both
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Cardiomyopathy 231(A)TMFAE(B)PVFDMe
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Cardiomyopathy 233(A)(B)LUPVLAAoLAA
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Cardiomyopathy 235(A)(B)LALV(C)Figu
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Cardiomyopathy 237than moderate MR
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Cardiomyopathy 23920. Yu EH, Omran
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242 Transesophageal Echocardiograph
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12AortaIVAN IGLESIAS, DANIEL BAINBR
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Aorta 263GRADE 1:NORMALAoGRADE 2:IN
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Aorta 265(A)(B)LALMCARAAoRVRCAFigur
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Aorta 267Figure 12.9Short- (A, B) a
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Aorta 269(A)(B)AORTAMOBILEATHEROMA(
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Aorta 271diameter (22). Aneurysms o
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Aorta 273(A)(B)NCCRALARCCMPALCCANEU
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Aorta 275(A)(B)LAARTEFACT(C)AoARTEF
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Aorta 277(A)(B)AoLATVRAFL TLPVRV(C)
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Aorta 279(A)(B)AORTICHEMATOMAAo(C)A
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Aorta 281(A)(B)FLTLAo(C)(D)INTRALUM
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Aorta 28331. Bansal RC, Chandraseka
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14Perioperative Role of TEE in Mech
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TEE in Mechanical Circulatory Assis
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15Native Aortic ValveFRANÇOIS A. B
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Native Aortic Valve 331Figure 15.2
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Native Aortic Valve 333(A)(B)ARANTI
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Native Aortic Valve 335(A) (B) (C)
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Native Aortic Valve 337(A)(B)LAAoLV
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Native Aortic Valve 339(A)(B)MVAoVL
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Native Aortic Valve 341(A)(B)LAAoVL
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Native Aortic Valve 343(A)(B)SAMLAI
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Native Aortic Valve 345(A)(B)AoVLAT
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Native Aortic Valve 347Although the
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Native Aortic Valve 349substitution
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Native Aortic Valve 351(A)(B)AoVLVO
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Native Aortic Valve 353(A)(B)LARPAL
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Native Aortic Valve 355(A)(B)LAAoVR
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Native Aortic Valve 357In those pat
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Native Aortic Valve 359Table 15.4 E
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Native Aortic Valve 36111. Levine R
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17Mitral ValveANDRÉ SAINT-PIERRELa
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Mitral Valve 385(A)SCHEMATIC VIEW(B
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Mitral Valve 387Figure 17.5 Echocar
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Mitral Valve 389(A)(B)LVP3A2LAAA1Fi
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Mitral Valve 391(A)(B)(C)(D)A1LAP1L
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Mitral Valve 393(A)(B)LARALVRV(C)(D
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Mitral Valve 395(A)(B)AoVFLAIL P1LA
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Mitral Valve 397(A)(B)P3LALVLAAA1(C
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Mitral Valve 399(A)(B)LALAALV(C)(D)
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Mitral Valve 401Table 17.3Mitral Re
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Mitral Valve 403(A)(B)MITRAL VALVEV
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Mitral Valve 405(A)EKG(B)PVFPaSDRES
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Mitral Valve 407Table 17.4BVR Echoc
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Mitral Valve 409Left ventricular sy
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Mitral Valve 411(A)(B)LALVAoRV(C)TM
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Mitral Valve 413Table 17.8StenosisT
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Mitral Valve 415identification of a
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19Pulmonic and Tricuspid ValvesFRAN
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Pulmonic and Tricuspid Valves 449Ta
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Pulmonic and Tricuspid Valves 451(A
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Pulmonic and Tricuspid Valves 459ti
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Pulmonic and Tricuspid Valves 463AN
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Pulmonic and Tricuspid Valves 46939
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23Intracavitary ContentsMARIA DI LO
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Intracavitary Contents 499(A)(B)PFO
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Intracavitary Contents 501(A)(B)LAL
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Intracavitary Contents 503artery ca
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Intracavitary Contents 505(A)(B)MYX
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Intracavitary Contents 507(A)(B)LVL
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Intracavitary Contents 509(A)(B)THY
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Intracavitary Contents 511wall clos
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Intracavitary Contents 513(A)(B)LAR
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Intracavitary Contents 515(A)(B)PER
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Intracavitary Contents 517dysfuncti
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Intracavitary Contents 519endocardi
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Intracavitary Contents 521and angle
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Intracavitary Contents 52317. Lando
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25Indications for Perioperative Tra
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Indications for Perioperative TEE 5
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570 IndexAortic aneurysmclassificat
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572 IndexColor jet area, 402Commiss
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574 IndexHypotension, 491Hypothermi
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576 IndexMitral valve repair, 394,
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578 IndexRight atrial thrombus, 517
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580 IndexTricuspid leafletsanterior
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DK2985_C000 1..28 - AlSharqia Echo Club

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