DK2985_C000 1..28 - AlSharqia Echo Club

Pulmonic and Tricuspid Valves 467Table 19.7 Summary of the Role of TEE in Patients UndergoingTricuspid Valve SurgeryBefore the procedureSee Table 13.1 forthe role of TEE incardiac surgeryEvaluate right atrialdimensionEvaluation of the severityof pulmonary hypertensionand tricuspid regurgitationDuring CPBSee Table 13.1After CPBSee Table 13.1Evaluate result of repairor replacementDetect abnormal motionof PA catheterIn the intensive care unitSee Table 13.1ImportanceAnticipation of difficultvalve repair withpossible modificationof the surgical approachAnticipate difficultseparation from CPBEarly detection and correctionof prostheticdysfunction or suboptimalrepairThe PA catheter could beaccidentallyentrapped during closureof the RANote: CPB, cardiopulmonary bypass; PA, pulmonary artery; RA, rightatrium; TEE, transesophageal echocardiography.prosthesis can be shown with relative ease at 30–1208 in themid-esophageal and in the transitional gastroesophagealviews. The transgastric views at 60–1208 can also beused to inspect the diaphragmatic aspect of the TV. Thenormal tricuspid bioprosthesis has thin leaflets (2–4 mm)attached to three struts which protrude into the RV. Theirappearance and movement resemble those of native leaflets.Mechanical bileaflet valve hemidiscs have a morelinear aspect and produce characteristic linear acousticreverberations pivoting within the annulus (Fig. 19.24). Inthe open position, the two hemidisks appear as two parallellines, while in the closed position, they assume a wide-openV-shape against the prosthetic annulus.Mechanical TV thrombosis should be ruled out whenfull range excursion of both hemidisks cannot be demonstrated(47). Even by TEE, thrombus within the prosthesisassociated with decreased mobility of the occluder issometimes difficult to establish. A search for perivalvularregurgitation should be done by color flow imaging inmultiple imaging planes to describe the sector, site andwidth of the leak.As for its native counterpart, the assessment of the pulmonaryvalve prosthesis suffers from the distance betweenthe TEE in the esophagus and the anterior position of thepulmonary valve. In the absence of shadowing fromthe AoV, the pulmonary valve can be seen in the midesophagealshort-axis view at 30–808 and sometimes inthe sagittal transgastric view.In conclusion, TEE is a useful modality in the evaluationand quantification of the tricuspid and pulmonicvalves, and prosthetic dysfunction (Table 19.7). Its intraoperativeuse complements hemodynamic data from thepulmonary artery catheter and is likely to become anessential part of the postoperative evaluation of tricuspidand PV surgery.REFERENCES1. Chaliki HP, Click RL, Abel MD. Comparison of intraoperativetransesophageal echocardiographic examinationswith the operative findings: prospective review of 1918cases. J Am Soc Echocardiogr 1999; 12(4):237–240.2. King RM, Schaff HV, Danielson GK, Gersh BJ, OrszulakTA, Piehler JM et al. Surgery for tricuspid regurgitationlate after mitral valve replacement. Circulation 1984;70(3 Pt 2):I193–I197.3. Bajzer CT, Stewart WJ, Cosgrove DM, Azzam SJ,Arheart KL, Klein AL. Tricuspid valve surgery and intraoperativeechocardiography: factors affecting survival, clinicaloutcome, and echocardiographic success. J Am CollCardiol 1998; 32(4):1023–1031.4. Roguin A, Rinkevich D, Milo S, Markiewicz W,Reisner SA. Long-term follow-up of patients with severerheumatic tricuspid stenosis. Am Heart J 1998;136(1):103–108.5. Ammash NM, Warnes CA, Connolly HM, Danielson GK,Seward JB. Mimics of Ebstein’s anomaly. Am Heart J1997; 134(3):508–513.6. Shanewise JS, Cheung AT, Aronson S, Stewart WJ,Weiss RL, Mark JB et al. ASE/SCA guidelines forperforming a comprehensive intraoperative multiplanetransesophageal echocardiography examination: recommendationsof the American Society of EchocardiographyCouncil for Intraoperative Echocardiography and theSociety of Cardiovascular Anesthesiologists Task Forcefor Certification in Perioperative Transesophageal Echocardiography.J Am Soc Echocardiogr 1999; 12(10):884–900.7. Cohen GI, White M, Sochowski RA, Klein AL, Bridge PD,Stewart WJ et al. Reference values for normal adulttransesophageal echocardiographic measurements. J AmSoc Echocardiogr 1995; 8(3):221–230.8. Netter FH, Yonkman FF, Ciba Pharmaceutical Company.Heart: a compilation of paintings on the normal and pathologicanatomy and physiology, embryology, and diseases.Summit, N. J: CIBA Pharmaceutical Company, 1978.9. Hauck AJ, Freeman DP, Ackermann DM, Danielson GK,Edwards WD. Surgical pathology of the tricuspid valve: astudy of 363 cases spanning 25 years. Mayo Clin Proc1988; 63(9):851–863.