DK2985_C000 1..28 - AlSharqia Echo Club

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Lung Transplantation 487(A)EKG 121Pa 103/62[78]Ppa 29/19[23]CO2 26Sat 99Resp 370(B)EKG 121Pa 103/61[77]Paop [13]CO2 25Sat 99Resp 370(C)(D)LVESCOFigure 21.9 Hemodynamic instability following single lung transplantation in a 53-year-old woman with end-stage emphysema.(A, B) Invasive hemodynamic monitoring shows a heart rate of 121 beats/min, an arterial blood pressure (Pa) of 103/62 mmHg, a pulmonaryartery pressure (Ppa) of 29/19 mmHg with a pulmonary artery occluded (wedge) pressure (Paop) of 13 mmHg. The centralvenous pressure was 14 mmHg (not shown). The capnographic waveform (CO 2 ) is typical of a single lung transplant with the initialnormal waveform from the transplanted lung followed by the ascending phase III typical of obstructive disease. Respiratory variationof the saturation (Sat) signal from the pulse oximeter is seen. (C, D) Despite relatively normal filling pressures, left ventricular endsystoliccavity obliteration (LVESCO) is found on the transgastric mid-papillary view at 08. The patient improved with intravenousfluid administration (EKG, electrocardiogram; Resp, respiration).postoperatively. We believe that careful tailoring of the vascularstructures on both the recipient and donor side as wellas a meticulous surgical technique with the use of intraoperativeTEE may account for these excellent results.IV.ROLE OF TEE AFTER LUNG TRANSPLANTIN THE INTENSIVE CARE UNITTransesophageal echocardiography also plays an essentialrole in the postoperative care of lung transplant recipientsin the ICU. The early post-operative course of thesepatients is frequently characterized by hemodynamic,radiographic and gas exchange abnormalities. Despiteimproved preservation techniques in recent years, severeischemia–reperfusion injury (IRI) is still prevalent in10% of patients following transplantation (Fig. 21.8).This injury is usually associated with abundant frothysputum from the endotracheal tube, a PaO 2 /FiO 2ratio , 100, diffuse alveolar infiltrates on the side of thegraft and hemodynamic instability. The differential diagnosisincludes acute allograft rejection, cardiogenic pulmonaryedema, noncardiogenic pulmonary edema otherthan IRI, sepsis and vascular anastomotic complications.Transesophageal echocardiography in this setting isuseful in excluding the etiologies listed earlier and inconfirming the diagnosis of IRI suggested by the clinicalhistory and the hemodynamic profile obtained from a PAcatheter. More interestingly, continuous TEE monitoringhelps to assess the response to therapy (Fig. 21.9) anddetermine the need for more invasive support such asextra-corporeal membrane oxygenation (ECMO).During ECMO, based on the American Society ofAnesthesiology–Society of Cardiovascular Anesthesiology(ASA–SCA) guidelines (1), TEE is considered a categoryI indication (see Chapter 14). Transesophagealechocardiography can help to evaluate ventricular recovery,assist in cannula positioning and exclude the presenceof intracardiac clot before initiating the weaning processEKG 111Pa 105/60[69]Ppa 45/26 [35]CO 2 28Sat 90Figure 21.10 Hemodynamic instability in a 65-year-old womanfollowing single lung transplantation. Fluctuation of the arterialpressure (Pa) or pulsus paradoxus coincident with the pulseoximetry signal (Sat), followed later by the pulmonary artery(Ppa) signal suggests tamponade. (CO 2 , end-tidal CO 2 ;EKG,electrocardiogram).[With permission of Denault et al. (25).]
488 Transesophageal <strong>Echo</strong>cardiographyPOSITIVE-PRESSURE EXPIRATION(A)(B)LAPEAoVRALUNGRVPEPOSITIVE-PRESSURE INSPIRATION(C)(D)RAPELAAoVLUNGRVPEFigure 21.11 (A, B) Truncated mid-esophageal four-chamber view during positive-pressure expiration: the right atrial cavity is seen withtwo small pericardial effusions. (C, D) During positive-pressure inspiration, collapse of the right atrial cavity is seen. (AoV, aortic valve; LA,left atrium; PE, pericardial effusion; RA, right atrium; RV, right ventricle). [Adapted with permission from Denault et al. (25).]POSITIVE-PRESSURE EXPIRATION(A)(B)PERVLVLUNGPOSITIVE-PRESSURE INSPIRATION(C)(D)RVPELVLUNGRVFigure 21.12 (A, B) Transgastric right ventricular outflow tract (RVOT) view at 558 during positive-pressure expiration. (C, D)During positive-pressure inspiration, collapse of the RVOT is observed with a small pericardial effusion (PE) (LV, left ventricle;RV, right ventricle). [Adapted with permission from Denault et al. (25).]
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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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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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Page 526 and 527: 23Intracavitary ContentsMARIA DI LO
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Page 532 and 533: Intracavitary Contents 503artery ca
Page 534 and 535: Intracavitary Contents 505(A)(B)MYX
Page 536 and 537: Intracavitary Contents 507(A)(B)LVL
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Page 540 and 541: Intracavitary Contents 511wall clos
Page 542 and 543: Intracavitary Contents 513(A)(B)LAR
Page 544 and 545: Intracavitary Contents 515(A)(B)PER
Page 546 and 547: Intracavitary Contents 517dysfuncti
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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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