DK2985_C000 1..28 - AlSharqia Echo Club

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13Echocardiography During Cardiac SurgeryPIERRE COUTURE, ANDRÉ Y. DENAULT, RAYMOND CARTIERUniversity of Montreal, Montreal, CanadaI. Introduction 285II. Devices Used During CardiopulmonaryBypass 286A. Central Venous andIntracardiac Catheters 286B. Mediastinal Catheter for PleuralFluid Drainage 287C. Vascular Clamp Placement andAortic Canulation 287D. Coronary Sinus Catheter 289E. Vents and Venous Canulation 291III. Cardiac Physiology and Procedures BeforeCardiopulmonary Bypass 291A. Controlled Ventilation 291B. Anesthestic Drugs 2951. Inhalation Agents 2962. Intravenous Anesthetic Agents onSystolic Function 2993. Effect of Intravenous AnestheticAgents on Diastolic Function 300C. Nonanesthetic Drugs Commonly UsedDuring Cardiac Surgery 3001. Positive Inotropic Drugs 3002. Synthetic Catecholamines 3013. Phosphodiesterase Inhibitors 302D. Internal Mammary Dissection 302E. Arterial Cannulation 302IV. Cardiac Physiology and Procedures DuringCardiopulmonary Bypass 304A. Hypothermia, Hemodilution, andNonpulsatile Flow 304B. Myocardial Perfusion andCardioplegia 304C. Spontaneous Echo Contrast 305V. Changes in Cardiac Physiology DuringWeaning from Cardiopulmonary Bypass 306A. Assessment of Regional LeftVentricular Function 306B. Assessment of Global LeftVentricular Function 306C. Preload Assessment 306D. Assessment of Right VentricularFunction 308E. Assessment of Diastolic Function 308F. Air Detection 308VI. Changes in Cardiac Physiology AfterCardiopulmonary Bypass 309A. Protamine 309B. Right and Left Ventricular ContractileFunction and Valve Function 309References 310I. INTRODUCTIONSeveral indications for perioperative transesophagealechocardiography (TEE) have become well establishedin cardiac surgery and include evaluation of mitral valverepairs, congenital heart repairs requiring cardiopulmonarybypass (CPB), and evaluation of life threatening conditions(1). These indications are considered Category 1285
286 Transesophageal Echocardiography(supported by strong evidence/expert opinion), as publishedin the American Society of Anesthesiologists(ASA) practice guidelines for perioperative TEE.However, many other indications for the use of TEEremain controversial. For example, routine use in patientsat risk for myocardial ischemia or infarction is considereda Category II indication (supported by fair/good evidence)while monitoring during cardioplegia administration orintra-aortic balloon pump insertion is considered a CategoryIII indication (no good supporting evidence). Asmore experience is acquired with the use of perioperativeTEE, we have documented, as other authors have done, thefavorable impact of routine use of TEE in cardiac surgery(2). The goal of the present chapter is to review some ofthe general applications of TEE during cardiac surgery.Monitoring of segmental and global myocardial function,assessment of valvular function and aortic pathology willalso be discussed although briefly, as they have beenreviewed in more detail in other chapters.II.DEVICES USED DURINGCARDIOPULMONARY BYPASSMany devices are used during CPB. Although it is considereda Category III indication by the ASA guidelines(1), TEE can be used to assist their insertion and toensure the proper functioning and location of the variouscatheters.A. Central Venous and Intracardiac CathetersThe use of surface ultrasound techniques to assist theinsertion of central venous catheters has been described(3). Although TEE is not helpful for this purpose, it hasbeen used to guide central venous catheter placement inchildren with congenital heart disease and also in adults.Correct placement of a catheter in the superior vena cava(SVC) [at 10 mm from the junction of the SVC with theright atrium (RA)] was achieved in 100% of casesguided by TEE compared with 86% in the control groupof patients with congenital heart disease (4). This maybe particularly useful in this population as external topographicallandmarks and withdrawn blood color are lessreliable to confirm proper vessel cannulation. Transesophagealechocardiography may also be helpful to confirmproper guidewire position prior to introduction of theintroducer sheath into the jugular vein, especially whendifficulty in passing the guidewire is encountered (5).This can be accomplished in the standard bicaval view atmid-esophageal level at 90–1308 (Fig. 13.1). Improperintra-arterial insertion of a central venous catheter can bedetected by TEE, particularly when the subclavian veinapproach is used (6). Other authors have suggested usingTEE during pulmonary artery catheter insertion after tricuspidvalve (TV) surgery to avoid damage to the tricuspidannuloplasty ring (7). Finally, in the course of difficult catheterinsertion, TEE may disclose a persistent left SVCknown to be present in 0.5% of adults and 1% ofchildren. This is usually connected to the RA via a dilatedcoronary sinus, but may sometimes open into the leftatrium (LA), resulting in a right-to-left shunt. The presenceof a persistent left SVC is suspected when a central catheterinserted through a left-sided access vein is seen lying verticallyin the left pulmonary field on the chest X-ray (CXR).Catheter placement in the persistent left SVC was reportedpotentially to lead to arrhythmiae or angina if the tip of thecatheter is in the coronary sinus (8). Its presence in the coronarysinus may also preclude the insertion of a retrogradecardioplegia catheter. The diagnosis of persistent left SVCis confirmed when ultrasound contrast injection through aleft-sided access vein appears in the (usually dilated)coronary sinus before the RA: this is easily visualized in amid-esophageal four-chamber view (Fig. 13.2).(A)(B)IVCLASVCGUIDE WIRERAFigure 13.1 Mid-esophageal bicaval view at 1158. The J-shaped guidewire is seen originating from the superior vena cava (SVC)(IVC, inferior vena cava; LA, left atrium; RA, right atrium).
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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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Imaging Artifacts and Pitfalls 1391
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142 Transesophageal Echocardiograph
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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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Page 292 and 293: Aorta 263GRADE 1:NORMALAoGRADE 2:IN
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Page 358 and 359: 15Native Aortic ValveFRANÇOIS A. B
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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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