DK2985_C000 1..28 - AlSharqia Echo Club

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Pulmonic and Tricuspid Valves 461(A)(B)LCAoVMPARVOTAC(C)LCACFigure 19.18 Bicuspid stenotic pulmonic valve in a 29-year-old man before open commisurotomy. (A, B) Mid-esophageal view at858. (C) Intraoperative findings (AoV, aortic valve; AC, anterior cusp; LC, left cusp; MPA, main pulmonary artery; RVOT, rightventricular outflow tract).(A)(B)AoVLAPATVRAPVRVCATHETER(C)(D) PVAoVEKG200100PpaPaPrv0mmHgPraFigure 19.19 Bicuspid stenotic pulmonic valve (PV) in a 29-year-old man before open commisurotomy. (A, B) Mid-esophageal rightventricular inflow–outflow view showing with PV regurgitation. (C) The degree of PV stenosis is easily appreciated on the pulmonaryartery catheter pressure tracing, note the gradient between the pulmonary artery pressure (Ppa) and the right ventricular pressure (Prv).The Prv was obtained through the paceport of the pulmonary artery (PA) catheter. (D) Three-dimensional echocardiogram of PV stenosis(AoV, aortic valve; EKG, electrocardiogram; LA, left atrium; Pa, arterial pressure; Pra, right atrial pressure; RA, right atrium; RV, rightventricle; TV, tricuspid valve). (Photo D courtesy of Philips.)
462 Transesophageal EchocardiographyTable 19.4 Echocardiographic and Doppler Parameters Used in the Evaluation of Pulmonary Regurgitation Severity: Utility, Advantages,and LimitationsParameter Utility/advantages DisadvantagesRV sizeRV enlargement sensitive for chronic Enlargement seen in other conditionssignificant PRNormal size virtually excludessignificant PRParadoxical septal motion Simple sign of severe PRNot specific for PR(volume overload pattern)Jet length—color flow Simple Poor correlation with severity of PRVena contracta widthSimple quantitative method thatworks well for other valvesMore difficult to perform; requires good images ofpulmonary valve; lacks published validationJet deceleration rate—CWD Simple Steep deceleration not specific for severe PRFlow quantitation—PWD Quantitates regurgitant flowand fractionSubject to significant errors due to difficulties ofmeasurement of pulmonic annulus and a dynamicRVOT; not well validatedNote: CWD, Continuous-wave Doppler; PWD, pulsed-wave Doppler; RV, right ventricle; PR, pulmonary regurgitation; RVOT, right ventricularoutflow tract. [With permission of Zoghbi WA (20).]intraoperative TEE has a controversial ability in predictinglong-term mortality following valve surgery but predicts atleast a reduced event-free survival (2,3).A. Suture Annuloplasty, Complications,Failed RepairThe TV suture annuloplasty by the technique of DeVegais done with a 2.0 propylene suture button stressed withTeflon. A first suture line is started at the anteroseptalcommissure and proceeds clockwise to a point justbeyond the posteroseptal commissure (Fig. 19.20) (38).A second suture line is similarly run 2–3 mm above thefirst one. The sutures are then tied with Teflon over a 27valve sizer in the annulus to prevent valvular stenosis(39). Significant residual TR following repair usuallybecomes clinically evident with symptoms of fatigue andsigns of right-sided heart failure on long-term follow-up.Perioperative TEE may be useful in detecting residualproblems following cardiac surgery. Indeed, right ventriculardimensions and systolic function remain importantpredictors of long-term success as the annuloplastyrepair alone may not correct incomplete tricuspid leafletclosure in the setting of chronic right ventricularTable 19.5Echocardiographic and Doppler Parameters Used in Grading Pulmonary Regurgitation SeverityParameter Mild Moderate SeverePulmonic valve Normal Normal or abnormal AbnormalRV size Normal a Normal or dilated Dilated bJet size by color Doppler c Thin (usually ,10 mm in length)with a narrow originIntermediateUsually large, with a wide origin;may be brief in durationJet density and decelerationrate CWD d Soft; slow deceleration Dense; variabledecelerationDense; steep deceleration earlytermination of diastolic flowPulmonary systolicflow compared tosystemic flow—PWD e Slightly increased Intermediate Greatly increaseda Unless there are other reasons for RV enlargement. Normal 2D measurements from the apical four-chamber view; RV mediolateral end-diastolicdimension ,4.3 cm, RV end-diastolic area ,35.5 cm 2 .b Exception: acute PR.c At a Nyquist limit of 50–60 cm/sec.d Steep deceleration is not specific for severe PR.e Cut-off values for regurgitant volume and fraction are not well validated.Note: CWD, continuous-wave Doppler; PR, pulmonary regurgitation; PWD, pulsed-wave Doppler; RA, right atrium; RF, regurgitant fraction; RV, rightventricle. [With permission of Zoghbi WA (20).]
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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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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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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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Page 526 and 527: 23Intracavitary ContentsMARIA DI LO
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Page 532 and 533: Intracavitary Contents 503artery ca
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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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