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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 : 1058]
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 : 675]
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 : 622]
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
Real-time Ultrasound-guided Axillary Vein Cannulation
Bahareh Khatibi, Nav Parkash Sandhu
[Year:2015] [Month:July-December] [Volume:3 ] [Number:2] [Pages:28] [Pages No:42-47] [No of Hits : 525]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1036 | FREE

ABSTRACT

The axillary vein has been shown to be a safe and effective cannulation site for patients requiring central venous access. Compared to subclavian vein cannulation, axillary vein cannulation may reduce the rate of pneumothorax and hemothorax. Long-term complications, including the rate of infection or deep vein thrombosis, are comparable to internal jugular vein cannulation. The use of ultrasound for cannulation at traditional central vein sites, such as the internal jugular and femoral veins has been shown to aid in successful cannulation and potentially reduce complications. For axillary vein cannulation, however, when ultrasound is used only for localization of the axillary vein precannulation, it has not been shown to improve successful cannulation or decrease the rate of arterial puncture.
Real-time ultrasound-guided axillary vein cannulation has been described and may increase the rate of successful cannulation and decrease complications. Various techniques of real-time ultrasound-guided axillary vein cannulation have been studied over the past decade. They differ in various characteristics including technique for needle imaging (in-plane vs out-of-plane) and upper extremity positioning (neutral vs abducted). The in-plane technique, which images the axillary vein in longitudinal view and allows the needle to be visualized at all times, has been found to result in greater first-attempt success and easier overall placement than the transverse view technique. As for upper extremity positioning, 90° abduction may result a decreased risk of catheter misplacement after proximal axillary vein cannulation.
Ultrasound-guided axillary vein cannulation has many emerging uses, including use in oncology, cardiology, and nephrology.

Keywords: Axillary vein, Central venous access, Ultrasound.

How to cite this article: Khatibi B, Sandhu NP. Real-time Ultrasound-guided Axillary Vein Cannulation. J Perioper Echocardiogr 2015;3(2):42-47.

Source of support: Nil

Conflict of interest: None

 
5.  CASE REPORT
Unanticipated Ruptured Sinus of Valsalva Aneurysm in a Patient with Subpulmonic Ventricular Septum Defect: Suspected by Intraoperative Transthoracic Echo; Confirmed by Intraoperative Transesophageal Echo
Imran Hussain Bhat, Ravi Raj, Goverdhan Dutt Puri
[Year:2015] [Month:January-June] [Volume:3 ] [Number:1] [Pages:38] [Pages No:25-28] [No of Hits : 502]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10034-1031 | FREE

ABSTRACT

A sinus of valsalva (SOV) aneurysm is a rare cardiac anomaly that may be congenital or acquired and may be associated with other cardiac lesions. If the aneurysm ruptures, it causes acute symptoms of dyspnea. Echocardiography is a useful diagnostic tool that can guide in proper management of these patients. We present a case of subpulmonic ventricular septal defect (VSD) in which ruptured SOV was detected by intraoperative transthoracic echocardiography and confirmed by transesophageal echocardiography (TEE) which helped in adequate surgical repair and good outcome for the patient. This case report emphasizes the importance of routine transthoracic and TEE in operating room by cardiac anesthesiologist to confirm the original diagnosis and look for new unanticipated findings, especially in a patient with strong clinical suspicion.

Keywords: Ruptured sinus of valsalva aneurysm, Subpulmonic ventricular septum defect, Transesophageal echocardiography, Transthoracic echocardiography.

How to cite this article: Bhat IH, Raj R, Puri GD. Unanticipated Ruptured Sinus of Valsalva Aneurysm in a Patient with Subpulmonic Ventricular Septum Defect: Suspected by Intraoperative Transthoracic Echo; Confirmed by Intraoperative Transesophageal Echo. J Perioper Echocardiogr 2015;3(1): 25-28.

Source of support: Nil

Conflict of interest: None

 
6.  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 : 2370]
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

 
7.  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 : 2091]
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

 
8.  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 : 1975]
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

 
9.  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 : 1909]
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

 
10.  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 : 1763]
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

 
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