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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  REVIEW ARTICLE
Echocardiographic Assessment of Mitral Stenosis: Key Learning Points for Fellows/Residents in Training
Ravi Raj
[Year:2015] [Month:January-June] [Volume:3 ] [Number:1] [Pages:38] [Pages No:17-24] [No of Hits : 948]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1030 | FREE

ABSTRACT

Mitral stenosis is most commonly due to rheumatic heart disease, even in western countries. Transthoracic echocardiography is the modality of choice for establishing diagnosis, underlying cause, assessment of severity, staging of disease, valve morphology and other associated lesions. Transesophageal echocardiography is recommended in patients considered for percutaneous balloon mitral valvotomy to rule out LA clot, significant MR and to better assess mitral valve morphology. Three-dimensional echocardiography is now increasingly used for estimating mitral valve area and suitability for percutaneous balloon mitral valvotomy. We provide a brief discussion on echocardiographic assessment of mitral stenosis.

Keywords: Rheumatic mitral stenosis, Transthoracic echocardiography, Transesophageal echocardiography, Threedimensional echocardiography, Mitral valve.

How to cite this article: Raj R. Echocardiographic Assessment of Mitral Stenosis: Key Learning Points for Fellows/Residents in Training. J Perioper Echocardiogr 2015;3(1):17-24.

Source of support: Nil

Conflict of interest: None

 
2.  REVIEW ARTICLE
Role of Perioperative Echocardiography Leadership in a Tertiary University Hospital
Kathirvel Subramaniam, Balachundhur Subramaniam
[Year:2015] [Month:January-June] [Volume:3 ] [Number:1] [Pages:38] [Pages No:4-16] [No of Hits : 606]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1029 | FREE

ABSTRACT

Echocardiography has been shown to improve the perioperative outcomes of surgical and critically ill patients. Several modalities of echocardiography (transthoracic, transesophageal, epicardial and epiaortic) are being utilized clinically for the hemodynamic management of surgical patients. They can be collectively described as perioperative echocardiography (PEC). Because of such a wider scope of practice in perioperative echocardiography, there is a need for leadership to maintain equipment, good clinical practice, education, research, quality, documentation, billing and reimbursement. American Society of Echocardiography (ASE) and Society of Cardiovascular Anesthesiologists (SCA) published guidelines for performance, reporting, education and quality improvement in PEC. The major role of echocardiography leadership is to ensure PEC team follows the guidelines published by ASE/SCA in their practice and utilize the potential of the various modalities to the benefit and safety of their patients. This article explores the key roles of the director for perioperative echocardiography service at a tertiary university hospital.

Keywords: Perioperative echocardiography, Leadership role, University hospital.

How to cite this article: Subramaniam K, Subramaniam B. Role of Perioperative Echocardiography Leadership in a Tertiary University Hospital. J Perioper Echocardiogr 2015;3(1):4-16.

Source of support: Nil

Conflict of interest: None declared

 
3.  CASE REPORT
Hypertrophied Papillary Muscle causing Mid Cavity Left Ventricular Obstruction after Cardiac Surgery
Vikas Dutta, Ravi Raj, Ajay Bahl, Shyam Singh Thingnum, Goverdhan Dutt Puri
[Year:2015] [Month:January-June] [Volume:3 ] [Number:1] [Pages:38] [Pages No:32-34] [No of Hits : 557]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1033 | FREE

ABSTRACT

A rare cause of mid cavity left ventricular obstruction can be a hypertrophied and/or a malformed papillary muscle. Hypertrophy of papillary muscle can be atypical presentation of hypertrophic obstructive cardiomyopathy. Most of these patients do not have a resting gradient, but a dynamic gradient can occur in hypovolumia or increased contractile state. We present a case of elderly patient who had a hypertrophied anterolateral papillary muscle and developed mid left ventricular obstruction after weaning the patient from cardiopulmonary bypass.

Keywords: Papillary muscle hypertrophy, Cardiac surgery, Mid left ventricular gradient.

How to cite this article: Dutta V, Raj R, Bahl A, Thingnum SS, Puri GD. Hypertrophied Papillary Muscle causing Mid Cavity Left Ventricular Obstruction after Cardiac Surgery. J Perioper Echocardiogr 2015;3(1):32-34.

Source of support: Nil

Conflict of interest: None

 
4.  REVIEW ARTICLE
Imaging Congenital Heart Disease in the Perioperative Period using Transesophageal Echocardiography
Manchula Navaratham, Rajesh Punn, Theresa A Tacy
[Year:2014] [Month:January-June] [Volume:2 ] [Number:1] [Pages:48] [Pages No:10-28] [No of Hits : 2324]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1015 | FREE

ABSTRACT

Intraoperative transesophageal echocardiography (TEE) for pediatric congenital heart disease has become a standard of care in most institutions in the USA and across Europe. Advances in technology have facilitated the safe use of this tool in patients as small as 2.5 kg and have proved invaluable in guiding surgical repair of congenital cardiac lesions as well as guiding anesthesia management for cardiac and noncardiac procedures. This article describes a systematic approach to image acquisition in children with congenital heart disease (CHD). Specific congenital heart lesions are also described with an emphasis on intraoperative TEE data acquisition and analysis.

Keywords: Transesophageal, Echocardiography, Congenital heart disease.

How to cite the article: Navaratham M, Punn R, Tacy TA. Imaging Congenital Heart Disease in the Perioperative Period using Transesophageal Echocardiography. J Perioper Echocardiogr 2014;2(1):10-28.

Source of support: Nil

Conflict of interest: None

 
5.  REVIEW ARTICLE
Transesophageal Echocardiography for Tetralogy of Fallot Repair: What a Perioperative Physician need to know?
Goverdhan Dutt Puri, Ravi Raj, Theresa A Tacy
[Year:2014] [Month:July-December] [Volume:2 ] [Number:2] [Pages:31] [Pages No:51-57] [No of Hits : 1961]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1021 | FREE

ABSTRACT

Transesophageal echocardiography (TEE) is now an integral part of intraoperative management of TOF patients undergoing intracardiac repair. With the availability of micro TEE probes, intraoperative TEE care can now be provided to even the smallest of patients. It provides live images of the anatomical and pathophysiological state of the heart and allows perioperative physicians to modify surgical and medical treatment perioperatively.
During pre-bypass period, TEE confirms preoperative diagnosis and can provide additional information which might be missed on transthoracic echocardiography (TTE). It also helps in modifying intraoperative surgical plan if new findings are detected intraoperatively. In addition, real time information on volume status and inotropy helps in management of hemodynamics and preventing hypercyanotic spells in prebypass period.
Adequacy of surgical repair can be assessed in immediate post-bypass period and any residual defect can be corrected before patient leaves the operating room. Post repair information on anatomical and pathophysiologic status helps guiding management in intensive care unit.

Keywords: Perioperative, Transesophageal echocardiography, Tetralogy of fallot, Intracardiac repair.

How to cite this article: Puri GD, Raj R, Tacy TA. Transesophageal Echocardiography for Tetralogy of Fallot Repair: What a Perioperative Physician need to know?. J Perioper Echocardiogr 2014;2(2):51-57.

Source of support: Nil

Conflict of interest: None

 
6.  ORIGINAL ARTICLE
Impact and Cost Effectiveness of Routine Intraoperative Transthoracic and Transesophageal Echocardiography on Surgical Decision Making in Pediatric Cardiac Surgery
Abhi Mishra, J Sethu Madhavan, BPS Ghuman, Ravi Raj, Ajay Kumar, Vikas Dutta, Sunder Negi, Yamini Tandon, Amit Kumar, VK Arya, Bhupesh Kumar, Aveek Jayant, Goverdhan Dutt Puri
[Year:2014] [Month:January-June] [Volume:2 ] [Number:1] [Pages:48] [Pages No:3-9] [No of Hits : 1930]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1014 | FREE

ABSTRACT

Introduction: Congenital heart diseases (CHD) present with wide spectrum of lesions leading to diagnostic dilemmas and it is quite possible to miss correct diagnosis during preoperative transthoracic echocardiography (TTE) in an inadequately sedated child, especially in a busy outpatient setting. It is a routine practice in our center to do baseline TTE after induction of anesthesia followed by pre and postcardiopulmonary bypass (CPB) transesophageal echocardiography (TEE) in all CHD patients thus helping us review our surgical plan.

Materials and methods: All pediatric patients <18 years undergoing cardiac surgery from January 2013 to December 2013 at our tertiary care center in whom perioperative echocardiograhy was done were included. Appropriate sized TTE and TEE probes were used with the Philips iE33 echocardiography platform (Philips, Andover, MA) .

Results: Out of total 352 pediatric cardiac surgical patients, perioperative echocardiography was done in 347(98.5%) patients. Baseline TTE showed new findings leading to change in surgical plan in 11 (3.1%) patients while additional new findings in baseline TEE were seen in 9 (2.6%). Post bypass TEE showed residual lesions requiring a CPB rerun in 19 (5.5%) patients. Intraoperative echocardiography was found to be cost effective with an estimated savings per patient of ` 3950 to 5373($61 - 83).

Conclusion: Intraoperative echocardiography is an important tool in armamentarium of perioperative physician which can be used to review diagnosis and help to formulate an informed surgical plan. Post-bypass transesophageal echocardiography is also useful as it identifies the residual lesions and establishes anatomical correction, which ultimately translates to lesser redo surgeries and a better postoperative outcome.

Keywords: Intraoperative echocardiography, Pediatric cardiac surgery, Congenital heart diseases, Transesophageal echocardiography.

How to cite the article: Mishra A, Madhavan JS, Ghuman BPS, Raj R, Kumar A, Dutta V, Negi S, Tandon Y, Kumar A, Arya VK, Kumar B, Jayant A, Puri GD. Impact and Cost Effectiveness of Routine Intraoperative Transthoracic and Transesophageal Echocardiography on Surgical Decision Making in Pediatric Cardiac Surgery. J Perioper Echocardiogr 2014;2(1):3-9.

Source of support: Nil

Conflict of interest: None

 
7.  CASE REPORT
Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle
Prashanth Panduranga
[Year:2014] [Month:January-June] [Volume:2 ] [Number:1] [Pages:48] [Pages No:29-31] [No of Hits : 1832]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1016 | FREE

ABSTRACT

Acute ischemic mitral regurgitation is due to complete or partial rupture of either anterolateral or posteriomedial papillary muscles occurring within a week of acute myocardial infarction. Chronic ischemic mitral regurgitation is due to postinfarct remodeling leading to imbalance between tethering and closing forces of mitral valve apparatus. We present a 64-year-old male, presenting with acute pulmonary edema secondary to severe mitral regurgitation, a week after his myocardial infarction. Transthoracic echocardiogram detected a mobile intracardiac mass near anterior mitral leaflet with no clear-cut intracardiac origin of this mass. Perioperative transesophageal echocardiography detected rupture of one of the heads of posteriomedial papillary muscle. This case illustrates a rare presentation of postinfarct rupture of one of the heads of posteriomedial papillary muscle occurring late after infarction presenting as an intracardiac mass, which can have surgical implications.

Keywords: Mitral regurgitation, Intracardiac mass, Papillary muscle rupture, Transesophageal echocardiography.

How to cite the article: Panduranga P. Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle. J Perioper Echocardiogr 2014;2(1)29-31.

Source of support: Nil

Conflict of interest: None

 
8.  CASE REPORT
TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy
Andrew W Murray, Stephen M McHugh
[Year:2014] [Month:January-June] [Volume:2 ] [Number:1] [Pages:48] [Pages No:34-37] [No of Hits : 1679]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1018 | FREE

ABSTRACT

Thymectomies have traditionally been performed via a midline sternotomy but are now increasingly being conducted via a thoracoscopic approach. Insufflation of CO2 into the hemithorax during this procedure can create severe compression of the right atrium and ventricle with resultant hemodynamic instability as well as lead to hypercapnia with possible pulmonary vasoconstriction and right heart strain. Transesophageal echocardiography allows monitoring of both the effects of CO2 insufflation on the heart and the efficacy of interventions to restore hemodynamic stability.

Keywords: Transesophageal echocardiography, Video-assisted thoracoscopic surgery, Video-assisted thoracoscopic surgery, Thymectomy, Pneumothorax.

How to cite the article: Murray AW, McHugh SM. TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy. J Perioper Echocardiogr 2014;2(1):34-37.

Source of support: Nil

Conflict of interest: None

 
9.  CASE REPORT
Iatrogenic Mitral Valve Perforation following CABG and Aortic Valve Replacement: A Rare Complication detected by Post-bypass Transesophageal Echocardiography
Ravi Raj, Sarin Mathew, Goverdhan Dutt Puri
[Year:2014] [Month:July-December] [Volume:2 ] [Number:2] [Pages:31] [Pages No:75-76] [No of Hits : 1378]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1027 | FREE

ABSTRACT

Iatrogenic mitral valve perforation following aortic valve replacement is a rare complication. We present a case of anterior mitral leaflet perforation following coronary artery bypass grafting (CABG) and aortic valve replacement detected by intraoperative transesophageal echocardiography (TEE). A 57-year-old male patient with preoperative diagnosis of coronary artery disease, sclerodegenerative aortic valve with severe aortic stenosis and mild central mitral regurgitation (MR) underwent CABG and aortic valve replacement. A post bypass TEE in midesophageal long axis view showed an additional MR jet across the body of the anterior mitral leaflet. We present intraoperative TEE images with a discussion on role of TEE in detection of mitral valve perforation and surgical decision making.

Keywords: Iatrogenic, Mitral valve perforation, Aortic valve replacement, Coronary artery bypass grafting, Transesophageal echocardiography.

Abbreviations: AVR: Aortic valve replacement; CABG: Coronary artery bypass grafting; 2D: Two-dimensional; MR: Mitral regurgitation; TEE: Transesophageal echocardiography; TTE: Transthoracic echocardiography.

How to cite this article: Raj R, Mathew S, Puri GD. Iatrogenic Mitral Valve Perforation following CABG and Aortic Valve Replacement: A Rare Complication detected by Post-bypass Transesophageal Echocardiography. J Perioper Echocardiogr 2014;2(2):75-76.

Source of support: Nil

Conflict of interest: None declared

 
10.  CASE REPORT
Midventricular Hypertrophic Obstructive Cardiomyopathy with Left Ventricular Aneurysm and Clot: The Role of Transesophageal Echocardiogram in Assessment and Management of Myomectomy
Vikas Dutta, Ravi Raj, Bhupesh Kumar, Ajay Bahl, Shyam KS Thingam, Sunder Lal Negi, Goverdhan Dutt Puri
[Year:2014] [Month:July-December] [Volume:2 ] [Number:2] [Pages:31] [Pages No:58-60] [No of Hits : 1358]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1022 | FREE

ABSTRACT

Hypertrophic obstructive cardiomyopathy (HOCM) with mid ventricular obstruction leading to apical aneurysm and clot is very rare. Intraoperative transesophageal echocardiogram (TEE) can be used to know the maximum thickness of the septum, its distance from the aortic annulus and the apical extent of septal bulge. Postresection TEE can provide information about residual obstruction or any complications. We present a case of 65-year-old male patient who underwent CABG, septal myectomy, Dor’s procedure for aneurysm and clot removal. Septal resection was done under TEE guidance.

Keywords: Hypertrophic cardiomyopathy, Midventricular obstruction, Transesophageal echocardiography.

How to cite this article: Dutta V, Raj R, Kumar B, Bahl A, Thingam SKS, Negi SL, Puri GD. Midventricular Hypertrophic Obstructive Cardiomyopathy with Left Ventricular Aneurysm and Clot: The Role of Transesophageal Echocardiogram in Assessment and Management of Myomectomy. J Perioper Echocardiogr 2014;2(2):58-60.

Source of support: Nil

Conflict of interest: None

 
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