DK2985_C000 1..28 - AlSharqia Echo Club

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9Global Ventricular Function and HemodynamicsANDRÉ Y. DENAULT, PIERRE COUTUREUniversity of Montreal, Montreal, CanadaJEAN BUITHIEUMcGill University, Montreal, CanadaI. Normal Right and LeftVentricular Morphology 186II. Normal Right and LeftVentricular Function 186A. Descent of the Base, SegmentalContraction, and Septal Curvature 186B. Pressure–Volume Relationship 1861. Preload 1872. Afterload 1903. Contractility and VentricularPerformance 191III. Abnormal Left Ventricular Function 192A. Acute vs Chronic Etiology 192B. Problems Confounding Diagnosis 193C. Transesophageal EchocardiographicEvaluation 193IV. Abnormal Right Ventricular Function 193A. Importance 193B. Transesophageal EchocardiographyFindings 194V. Abnormal Diastolic Function 198A. Left VentricularDiastolic Dysfunction 198B. Right VentricularDiastolic Dysfunction 200VI. Causes of Severe Hypotension and SpecificHemodynamic Derangements 201A. Myocardial Ischemia 204B. Left Ventricular OutflowTract Obstruction 204C. Right Ventricular OutflowTract Obstruction 206D. Mitral Valve Fluttering fromAortic Regurgitation 206E. Midsystolic Pulmonary Valve Closurein Pulmonary Hypertension 206VII. Pulmonary Thromboembolism 209VIII. Conclusion 211References 212Important roles of perioperative transesophageal echocardiography(TEE) include the determination of baselineventricular function before a surgical procedureand the identification of changes in ventricular functionduring cardiac and noncardiac procedures whichin some cases may lead to severe hemodynamicinstability which, when unresponsive to therapy, isconsidered a category 1 indication for the use ofTEE (1). In such cases TEE allows precise determinationof the mechanism of hemodynamic instabilitythrough evaluation of both left and right systolic anddiastolic function.185
186 Transesophageal EchocardiographyI. NORMAL RIGHT AND LEFTVENTRICULAR MORPHOLOGYThe normal ventricular morphology and quantitativeevaluation of ventricular size and function are describedin Chapters 4 and 5 and in the American Society ofEchocardiography (ASE) guidelines (2).II. NORMAL RIGHT AND LEFTVENTRICULAR FUNCTIONA. Descent of the Base, SegmentalContraction, and Septal CurvatureThere are several points which should be emphasized inthe evaluation of normal ventricular function. Normalleft ventricular function is associated with radial shorteningbut also longitudinal displacement of the basetowards the apex by 15–20 mm which can be quantifiedusing M-mode (3) or tissue Doppler imaging (4) andwhich correlates with ejection fraction (Fig. 9.1). ThereFigure 9.1 Relationship between ejection fraction (EF) andmitral annular motion (MAM) in 182 patients (A) and systolicmitral annular velocity (SMAV) by tissue Doppler in 60 patients(B). [Adapted with permission from Emilson et al. (3) and Alamet al. (4).]are normal regional variations in the thickening of ventricularsegments with increasing contractility from the baseto the apex. There is also rightward ventricular septalcurvature because normal left ventricular pressure is generallysuperior to right ventricular pressure.B. Pressure–Volume RelationshipThe determination of the relationship between ventricularfunction and hemodynamics is best described using thepressure–volume curves which allow graphical descriptionof ventricular function by displaying a singlecardiac cycle volume against pressure–time relationship(Fig. 9.2). This includes seven time-related events. Diastolestarts with isovolemic relaxation (phase 4), continueswith the opening of the mitral valve (MV) and earlyleft ventricular filling, diastasis and atrial systole (phases5–7) and ends with MV closure prior to isovolumiccontraction (phase 1). Systole begins with the isovolumiccontraction (phase 1), proceeds with the opening of theaortic valve (AoV) and ejection of the stroke volume (SV)(phases 2 and 3). The pressure–volume diagram can beobtained through continuous pressure and volume measurementbut is rarely done in clinical practice.Many determinants of the pressure–volume relationshipmay be obtained using TEE, a pulmonary artery catheter anda systemic arterial pressure catheter. Transesophageal echocardiographyallows estimation of the volume component(or abscissa). Pressure components of the ordinate axismay be estimated from the pulmonary artery catheter andfrom systemic arterial pressure (Fig. 9.3). The leftventricular end-diastolic pressure (LVEDP) will be estimatedby the pulmonary artery occlusion pressure (Paop)or wedge pressure at end-diastole, in the absence of anyobstruction between the pulmonary capillary bed and theleft ventricle (LV) such as mitral stenosis (MS). The leftventricular end-systolic pressure (LVESP) can be estimatedby the systolic arterial pressure (SAP) if aortic valvularobstruction is absent (5,6). The left ventricular end-systolicvolume (LVESV) and left ventricular end-diastolic volume(LVEDV) can be approximated by the left ventricular endsystolicarea (LVESA) and left ventricular end-diastolicarea (LVEDA) obtained from TEE short-axis transgastricviews. The SV is calculated from the ratio of the thermodilution-derivedcardiac output (CO) to the heart rate orthrough Doppler measurement (see Chapter 5). The areawithin the left ventricular pressure–volume curve is theleft ventricular stroke work [LVSW ¼ SV (meanarterial pressure or MAP 2 Paop) 0.0136] and thisvalue is obtained through automated calculation of thecardiopulmonary profile.Determinants of cardiac function, preload, afterloadand contractility are easily plotted on the left ventricularpressure–volume relationships (Fig. 9.4). Each change in
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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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Quantitative Echocardiography 115On
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Quantitative Echocardiography 117Ha
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Quantitative Echocardiography 119fl
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6Imaging Artifacts and PitfallsROBE
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Imaging Artifacts and Pitfalls 123F
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Imaging Artifacts and Pitfalls 125F
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Imaging Artifacts and Pitfalls 127(
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Page 244 and 245: 10CardiomyopathyVICKY SOULIÈRE, PH
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Page 254 and 255: Cardiomyopathy 225Figure 10.10 Flow
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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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