Journal of Perioperative Echocardiography

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Volume 9, Number 2, July-December 2021
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EDITORIAL

Rajarajan Ganesan

Ultrafast Ultrasound: Potential Applications in Cardiac Anesthesia and Intensive Care

[Year:2021] [Month:July-December] [Volume:9] [Number:2] [Pages:2] [Pages No:27 - 28]

   DOI: 10.5005/jp-journals-10034-1136  |  Open Access |  How to cite  | 

159

REVIEW ARTICLE

Minati Choudhury

Role of Artificial Intelligence in Echocardiography: A Narrative Review

[Year:2021] [Month:July-December] [Volume:9] [Number:2] [Pages:4] [Pages No:29 - 32]

Keywords: Artificial intelligence, Cardiovascular disease, Echocardiography

   DOI: 10.5005/jp-journals-10034-1131  |  Open Access |  How to cite  | 

Abstract

Echocardiography has been in wide use over the past decade in most cardiac diseases for both diagnostic and prognostic purposes. This is because of its portability, high temporal resolution, absence of radiation, and low costs. It is also true that image analysis, including quantification and reporting, has become extensively resource-sensitive and time-consuming. The recent advent of artificial intelligence (AI) technology has created an environment in which AI confers the ability for automation, image acquisition, analysis, and interpretation in a more predictive manner. In spite of a few challenges that are yet to be overcome, AI in echocardiography seems to be promising because of its benefits obtained from automated analysis and interpretation.

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CASE REPORT

Vanni S Jhawar, Rajarajan Ganesan, Poornima Reddy, Sheenam Walia, Harkant Singh, Tsering Sandup

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

[Year:2021] [Month:July-December] [Volume:9] [Number:2] [Pages:4] [Pages No:33 - 36]

Keywords: Case report, Left atrial dissection, Mitral valve surgery, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1130  |  Open Access |  How to cite  | 

Abstract

Background: Left atrial dissection presents as a rare complication post-mitral valve surgery. Its presentation can be varied, from asymptomatic to severe hemodynamic instability, which needs a prompt diagnosis. Case presentation: Here we present a case of left atrial dissection late after aortic and mitral valve replacement, identified on preoperative transesophageal echocardiography which facilitated proper diagnosis and management..

122

CASE REPORT

Diana Thomas, Kartheek Hanumansetty, Azeez Aspari, Bineesh Radhakrishnan, Unnikrishnan P Koniparambil

Mitral Valve Repair Surgery—When the Right Ventricle is Not Just an Innocent Bystander: A Case Report

[Year:2021] [Month:July-December] [Volume:9] [Number:2] [Pages:4] [Pages No:37 - 40]

Keywords: Case report, Intraoperative echo, Mitral valve repair, Mitral valve surgery, Right ventricle dysfunction, Systolic anterior motion, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1133  |  Open Access |  How to cite  | 

Abstract

Aim: To assess rare causes of systolic anterior motion (SAM) of the mitral valve (MV) after MV repair. Background: A preoperative assessment of the MV apparatus is done to predict postoperative SAM in all patients undergoing MV surgery. These parameters include the lengths of MV leaflets and the ratio between them, the aortomitral angle, the distance between the coaptation point and septum, and septal thickness. When predicted, surgical repair is planned with the goal of avoiding the occurrence of SAM. Case description: A 45-year-old man with MV prolapse and severe mitral regurgitation (MR) underwent MV repair after intraoperative transesophageal echocardiography (TEE) assisted confirmation of feasibility. The postoperative risk of SAM was ruled out. Although there was no SAM in the immediate postrepair TEE, he developed hemodynamic instability, which, on reevaluation, was found to be due to new onset SAM. Transgastric imaging revealed inferior wall hypokinesia and right ventricle (RV) dysfunction, which infrequently causes SAM. Medical management was sufficient to address this manifestation. Conclusion: Systolic anterior motion (SAM) may be caused by right ventricular dysfunction even in the absence of other TEE-described predictors. Clinical significance: It is important to identify medically reversible causes of SAM so as to avoid a redo of surgical intervention with a return to cardiopulmonary bypass, especially in the absence of preoperative predictors.

149

CASE REPORT

Tanya Mital, Jijo Francis, Suruchi Hasija, Pradeep R Reddy

Role of Transesophageal Echocardiography in “Off-pump” Inferior Vena Cava Thrombectomy Associated with Renal Cell Carcinoma: A Case Report

[Year:2021] [Month:July-December] [Volume:9] [Number:2] [Pages:4] [Pages No:41 - 44]

Keywords: Cardiopulmonary bypass, Case report, Renal cell carcinoma, Transesophageal echocardiography, Tumor thrombus

   DOI: 10.5005/jp-journals-10034-1134  |  Open Access |  How to cite  | 

Abstract

The treatment for renal cell carcinoma (RCC), with tumor thrombus extending into the supradiaphragmatic inferior vena cava (IVC) and right atrium (RA), is IVC thrombectomy with radical nephrectomy. Intraoperative transesophageal echocardiography (TEE) plays a vital role in such cases and is essential for accurate surgical planning. TEE aids in defining tumor mobility, adherence, and fragility, assessing adequacy of tumor removal, placement of central venous catheter (CVC), and continuous hemodynamic monitoring. We present a case of RCC with supradiaphragmatic extension of IVC thrombus where real-time TEE imaging was pivotal in changing the operative approach to the tumor thrombus and averting cardiopulmonary bypass (CPB) and its antecedent complications.

128

CASE REPORT

Alok Kumar, Ankur Joshi, Bhargava V Devarakonda, Gurpinder S Ghotra

Intraoperative Transesophageal Echocardiography Diagnosis of a Left Ventricular False Tendon Mimicking a Left Ventricular Mass: A Case Report

[Year:2021] [Month:July-December] [Volume:9] [Number:2] [Pages:3] [Pages No:45 - 47]

Keywords: Cardiac mass, Case report, Left ventricular false tendon, Transesophageal echocardiography, Transthoracic echocardiography

   DOI: 10.5005/jp-journals-10034-1135  |  Open Access |  How to cite  | 

Abstract

Background: Left ventricle false tendons (LVFTs) are discrete and relatively rare, fibromuscular structures of varying length and thickness that traverse the left ventricle (LV) cavity. Routine transthoracic echocardiography (TTE) is the commonly used diagnostic technique to diagnose and evaluate LVFT. Case description: Thickened LVFT not oriented in either longitudinal or transverse fashion was misdiagnosed as a case of LV mass on two-dimensional (2D) echo and cardiac magnetic resonance index (MRI) in a young patient. He was listed for excisional surgery. Preoperative transesophageal echocardiography (TEE) revealed it to be LVFT and the surgery could be averted. Conclusion: Though TTE and cardiac MRI are the commonly used diagnostic techniques to diagnose and evaluate cardiac masses, TEE provides superior image resolution and better visualization of cardiac masses.

136

CLINICAL TECHNIQUE

Kedar Bangal

A Novel View for Performing Left Atrial Strain Analysis by Transesophageal Echocardiography

[Year:2021] [Month:July-December] [Volume:9] [Number:2] [Pages:3] [Pages No:48 - 50]

Keywords: Echocardiography, Perioperative transesophageal echocardiography, Speckle tracking echocardiography, Transesophageal echocardiography, Transthoracic echocardiography

   DOI: 10.5005/jp-journals-10034-1132  |  Open Access |  How to cite  | 

Abstract

Aim: To devise a technique for producing a view that can be utilized to perform strain analysis of the left atrium (LA) by transesophageal echocardiography (TEE). Background: Advancement in the field of echocardiography has led to the development of strain and speckle tracking. The magnitude of LA deformation is utilized to determine the diastolic function by means of strain rate imaging. It is difficult to accommodate all the borders of LA in an image by TEE. Technique: Hereby, I would like to present a TEE view that is identical to the subcostal view of transthoracic echocardiography (TTE). This may be named as “deep transgastric four-chamber view” (deep TG-4C), and it is unique compared to the 28 TEE views. I have devised a technique for producing this view on TEE, and I have used it to analyze LA strain intraoperatively for 50 cases. Echocardiography was performed using a CVx TEE probe (Philips Healthcare, Andover, Massachusetts) and strain analysis was performed by Tomtec Autostrain software. The exact maneuvers to produce this view are also devised by me. Conclusion: The deep TG-4C view is helpful in performing LA strain analysis by TEE. Clinical significance: The deep TG-4C view of TEE accommodates all the borders of the LA and is helpful in performing LA strain analysis.

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journal videos

Apical four-chamber viewing showing the prosthetic mitral valve prolapsed into the left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 369 KB

Parasternal long-axis view showing the displaced prosthetic mitral valve; LA, left atrium; LV, left ventricle; RV, right ventricle

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 324 KB

Midesophageal four-chamber view showing the displaced prosthetic mitral valve; LA, left atrium; LV, left ventricle; RV, right ventricle

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 436 KB

Midesophageal two-chamber view showing the displaced prosthetic mitral valve with tissue accompanying the displaced prosthesis; LA, left atrium; LV, left ventricle

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 319 KB

Midesophageal aortic valve long-axis view showing the left atrial dissection; LA, left atrium

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 584 KB

Midesophageal aortic valve long-axis view showing better delineation of the dissection; LA, left atrium

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 348 KB

Surgical view of the displaced prosthetic mitral valve approached through the interatrial septum; RA, right atrium

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 179 KB

Surgical view after explanation of the displaced prosthetic valve showing the edge of the dissection

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 113 KB

Post-cardiopulmonary bypass midesophageal long-axis view showing the normally functioning new mitral valve prosthesis; LA, left atrium

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 289 KB

Three-dimensional zoom view of the normally functioning new mitral valve prosthesis

Prosthetic Mitral Valve Prolapsing into the Left Atrium: Identifying the Pathology with Transesophageal Echocardiography: A Case Report

Size: 306 KB

Mid-esophageal (ME) LV long axis view showing laminar flow across the LVOT, implying the absence of SAM of the MV

Mitral Valve Repair Surgery—When the Right Ventricle is Not Just an Innocent Bystander: A Case Report

Size: 386 KB

Focused view of the LVOT from ME five-chamber view (ME-5C) showing significant MR and turbulent flow across LVOT

Mitral Valve Repair Surgery—When the Right Ventricle is Not Just an Innocent Bystander: A Case Report

Size: 1 MB

Transgastric mid-papillary short axis view showing inferior wall hypokinesia

Mitral Valve Repair Surgery—When the Right Ventricle is Not Just an Innocent Bystander: A Case Report

Size: 983 KB

Mid-esophageal 5C (ME-5C) depicting dysfunctional left and RVs

Mitral Valve Repair Surgery—When the Right Ventricle is Not Just an Innocent Bystander: A Case Report

Size: 890 KB

The origin and the insertion of this band-like structure were found to be continuous with the LV wall without any evidence of wall motion abnormality

Intraoperative Transesophageal Echocardiography Diagnosis of a Left Ventricular False Tendon Mimicking a Left Ventricular Mass: A Case Report

Size: 456 KB

The entire length of this structure, seen traversing the entire ventricular cavity, could not be imaged completely in any single conventional TEE view

Intraoperative Transesophageal Echocardiography Diagnosis of a Left Ventricular False Tendon Mimicking a Left Ventricular Mass: A Case Report

Size: 712 KB

This view may be named the “deep transgastric four-chamber view” (deep TG-4C)

A Novel View for Performing Left Atrial Strain Analysis by Transesophageal Echocardiography

Size: 361 KB

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