DK2985_C000 1..28 - AlSharqia Echo Club

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Segmental Ventricular Function and Ischemia 1611. Basal anterior2. Basal anteroseptal3. Basal inferoseptal4. Basal inferior5. Basal inferolateral6. Basal anterolateralLADRCALCX3 69 1214 16177. Mid anterior8. Mid anteroseptal9. Mid inferoseptal10. Mid inferior11. Mid inferolateral12. Mid anterolateral0°394101514 17 1613. Apical anterior14. Apical septal15. Apical inferior16. Apical lateral17. Apex2 813 12 67190°115120°Figure 8.4 Coronary distribution from a transesophageal echocardiographic point of view (LAD, left anterior descending; LCX, leftcircumflex artery; RCA, right coronary artery). [Adapted from Cerqueira et al. (2).]in this view (5,6). A complete analysis of all 17 ventricularsegments, as described earlier, should be carried out.Both animal and clinical studies have documented thatwall motion is rapidly altered after coronary arteryocclusion. The first detectable abnormalities are cellularbiochemical changes and a perfusion defect (detected byradionuclide techniques), followed by delayed myocardialrelaxation and/or decreased compliance, and withinminutes, reduced systolic wall thickening and endocardialmotion. The electrocardiographic ST–T changes and1. Basal anterior2. Basal anteroseptal3. Basal inferoseptal4. Basal inferior5. Basal inferolateral6. Basal anterolateral7. Mid anterior8. Mid anteroseptal9. Mid inferoseptal10. Mid inferior11. Mid inferolateral12. Mid anterolateral13. Apical anterior14. Apical septal15. Apical inferior16. Apical lateral17. ApexLADRCALCXApex1514 1613BasalMid4109 113 58 12 2 671SHORT AXIS15 10 4171371LONG AXISFigure 8.5 Coronary distribution from a transgastric echocardiographic point of view (LAD, left anterior descending; LCX, leftcircumflex artery; RCA, right coronary artery). [Adapted from Cerqueira et al. (2).]
162 Transesophageal <strong>Echo</strong>cardiographyclinical symptoms of angina, if they appear, are latemanifestations of ischemia.III.12332 3Figure 8.6 Septal branches of the left anterior descendingartery (1, myocardium; 2, left anterior descending; 3, septalbranches; 4, epicardial fat). (Courtesy of Nicolas Dürrleman.)GLOBAL SYSTOLIC FUNCTION CHANGESWhen transthoracic images are suboptimal (e.g. patientswho are obese, have chronic obstructive lung disease, orare in a postoperative state), in critically ill patient settingsor when assessing patients undergoing cardiac or noncardiacsurgery, it is often useful to evaluate global andregional ventricular function from the transesophagealapproach. This technique provides immediate dataregarding segmental wall motion abnormalities, globalventricular function, volume status, and the presence oftamponade. In particular, TEE provides very importantdata on ventricular function in the hypotensive patientand allows the detection of ventricular or atrial compressionfrom severe tamponade. The severely hypovolemicpatient will most often have a normal orhyperkinetic ventricular function and obliteration of theleft ventricular cavity in systole (7). Although acute ischemiais usually manifested echocardiographically as aregional wall motion abnormality, global ventricular dysfunctionmay result from high-grade obstruction of oneor more arteries perfusing a large area, the acute obstructionof one artery in the setting of previous infarction inother areas or the presence of an ischemic mechanicalcomplications such as papillary muscle rupture.4Global left ventricular systolic function can be evaluatedeither qualitatively or quantitatively. Global systolicfunction can be qualitatively classified as normal, mildly,moderately or severely reduced, but this information isconsidered incomplete by most clinicians. In contrast,determination of the left ventricular ejection fraction hasmajor prognostic significance in patients with coronaryartery disease (CAD). In the clinical setting, visual estimationof the left ventricular ejection fraction hasbecome common practice. The correlation between thevisual echocardiographic estimation (eye balling) and theradionuclide determination is surprisingly good, especiallyin patients with impaired ejection fraction. This method,however, requires experience and clinicians should validatetheir own performance with quantitative methods.All echocardiographic approaches for the assessment ofregional and global ventricular function need to take intoaccount the quality of endocardial border definition, theasynchronous contraction patterns observed with ventricularpacing or in the presence of conduction defects, the heterogeneityof normal ventricular function and the observedabnormality in septal wall motion frequent in the postoperativeperiod.The motion of the mitral annulus towards the apex canalso be used as an indirect measure of left ventricularsystolic function. It is usually measured in the apicalfour-chamber view, where the movement of the mitralannulus is parallel to the ultrasound beam and is normally12 + 2 mm. A motion of ,8 mm has been reported tohave a sensitivity of 98% and a specificity of 82% in theidentification of an ejection fraction less than 50% (8).Pai et al. (9) examined the mitral annular systolic excursionin 57 patients with a wide range of LV ejection fraction(13–84%) and found a good correlation (r ¼ 0.95,p , 0.001) between the mitral annulus motion and theejection fraction as measured by the radionuclide approach(Fig. 8.10).The quantitative assessment of global systolic functionrequires the determination of the left ventricular cavitydimensions on high-quality images. Volume estimationsare based on geometric assumptions about ventricularshape which range from a simple ellipsoid to a complexhemicylindrical hemiellipsoid shape. A description ofeach geometric shape, the corresponding formula andrequirements is beyond the scope of this chapter(Chapter 5). Nevertheless, the biplane modified Simpson’sformula, which divides the ventricular cavity into multiplecylindrical slices of known volume with the sum representingleft ventricular volume, is the most commonlyused approach in clinical practice to assess left ventricularvolume and global function. This involves tracing of theendocardial borders at end-systole and end-diastole inthe mid-esophageal four- and two-chamber views (transducerat 08 and 908, respectively). The left ventricular
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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 101Fi
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Quantitative Echocardiography 105in
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Global Ventricular Function and Hem
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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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