Transoesophageal echocardiography in cardiac anaesthesia
Publication date: Available online 4 September 2015 Source:Anaesthesia & Intensive Care Medicine Author(s): Christine Herr, Andrew Roscoe Echocardiography is the most widely used minimally invasive investigation to diagnose heart disease. Transoesophageal echocardiography (TOE) was first introduced perioperatively in the 1980s and is now an important monitoring tool for patients undergoing cardiac surgery. Because of the close proximity of the oesophagus to the heart, TOE facilitates the acquisition of high-resolution images. The TOE probe is a multiplane transducer. This means that the image planes can be rotated from 0° to 180°, enabling three-dimensional (3D) assessment of the structure of interest. Intraoperative TOE has been shown to improve outcome in a variety of cardiac surgeries. The introduction of real-time 3D TOE has provided better diagnosis of the mechanism of certain valve pathologies. TOE has become an important investigation in the assessment of haemodynamic instability in the perioperative period because it allows rapid and accurate diagnosis.
PERCUTANEOUS REPAIR and replacement increasingly are being used to treat valvular heart disease. Adoption of these catheter-based techniques necessitates standardized methods for evaluating new or residual regurgitation after percutaneous valve repair or replacement. The American Society of Echocardiography guidelines document, “Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement,” addresses this need and provides a framework for evaluating regurgitation using echocardiography, invasive hemodynamic assessment, and cardiac magnetic resonance (CMR) imaging.
Echocardiography is an important diagnostic tool in modern-day cardiothoracic surgery. Its use is supported by guidelines published by the American Heart Association/American College of Cardiology in 2014, which make a class 1 recommendation for the use of transthoracic echocardiography (TTE) in the evaluation of suspected valvular heart disease and infective endocarditis, as well as for the use of transesophageal echocardiography (TEE) in patients whose TTE was nondiagnostic.1 This recommendation is consistent with the consensus that valvular lesions usually are visualized better on TEE, with the exception of the pulmonic...
Aortic stenosis (AS) is the most common form of valvular heart disease in the elderly. As this patient population continues to increase, anesthesiologists more often will encounter these patients in the perioperative setting for noncardiac surgical procedures. Cardiac risk during noncardiac surgery in the patient with AS appears to have decreased significantly compared with previous reports that shaped current practice guidelines for perioperative management. In addition, these guidelines preceded the publication of current data supporting the continually expanding role for transcatheter aortic valve replacement in the treatment of AS.
Vinodhadevi Vijayakumar, Thiruvarul Santhoshini, Dhanabagyam Govindarajulu, Shaik MushahidaSaudi Journal of Anaesthesia 2019 13(3):237-239 A 24-year-old primigravida with a history of rheumatic heart disease and prosthetic mitral valve on oral anticoagulation who was lost follow-up during the third trimester presented with premature rupture of membranes. On evaluation, she had new-onset complete heart block. She was temporarily paced but developed cardiac failure. Anesthetic challenges and management of this parturient with post mitral valve replacement, complete heart block, and warfarin-induced coagulopathy for emergenc...
Abstract Tricuspid regurgitation in carcinoid syndrome leads to significant morbidity and mortality that may warrant a tricuspid valve replacement. However, for patients with high serotonin levels and known hypercoagulable risks, the optimum timing for surgery and postoperative anticoagulation approaches remain unclear. High serotonin-triggered hypercoagulability makes prosthetic valves susceptible to thrombosis. Despite appropriate management with a somatostatin analog, some patients continue to have high markers of serotonin that causes platelet aggregation and rapid clot formation. In severely symptomatic patie...
Conclusion: Moderate and severe PAH does not affect short and long term outcomes of patients undergoing valve surgery for RHD. Patients with MS with severe PAH had higher mortality compared to those with no PAH.
PULMONARY HYPERTENSION (PH) is a major cause of mortality and morbidity in patients undergoing cardiac surgery. In the early days, mitral valve disease was the most common cause of PH in left heart disease,1 and rheumatic fever was the leading cause of valvular heart disease. The scenario has changed, and currently heart failure with preserved ejection fraction and heart failure with systolic dysfunction are the most common causes of PH in left heart disease.1 In developing countries, rheumatic valvular heart disease continues to be a major cause of secondary PH.
THE POPULATION of adult patients with congenital heart disease (CHD) is estimated to be over 1.3 million in the United States, and there is a growing need for a medical follow-up as age-related changes after the CHD repair may require additional procedures.1 Bloodless surgery for the Jehovah's Witness (JW) has been performed since late 1950s,2 but redo surgery poses increased risks for hemorrhage and transfusion owing to adhesions and distorted anatomy, especially in patients with CHD who have undergone previous surgery.
A 35-YEAR-OLD man presented to the authors ’ institution with a 2-year history of progressive dyspnea on exertion. Transthoracic echocardiography revealed mild mitral stenosis and severe aortic valve regurgitation resulting from rheumatic heart disease. The left ventricle (LV) was dilated; ejection fraction was 45% to 50%. The patient was taken to the operating room for aortic valve replacement. Catheters were placed in the right radial and left femoral arteries for continuous monitoring of arterial pressure.
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