Journal of Perioperative Echocardiography

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2018 | June | Volume 6 | Issue 1

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Shyam KS Thingnam

Assisting the Surgeon with Transesophageal Echocardiography

[Year:2018] [Month:June] [Volume:6] [Number:1] [Pages:2] [Pages No:1 - 2]

   DOI: 10.5005/jp-journals-10034-1077  |  Open Access |  How to cite  | 



Usha Kiran, Ira Balakrishnan, Ummed Singh

Role of Comprehensive Perioperative Transesophageal Echocardiography in Ebstein's Anomaly

[Year:2018] [Month:June] [Volume:6] [Number:1] [Pages:7] [Pages No:3 - 9]

Keywords: Ebstein's anomaly, Perioperative, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1078  |  Open Access |  How to cite  | 


Ebstein's anomaly (EA) is a complex congenital anomaly with a broad morphological spectrum. Although typically characterized by apical displacement of the septal tricuspid leaflet (STL) .8 mm/m2 body surface area (BSA), diagnostic categorization is confusing in cases with minor downward displacement of the leaflets. A comprehensive transesophageal echocardiography (TEE) has an integral role in the surgical decision-making and perioperative management of EA. Preoperative TEE aims to provide the morphological diagnosis, coexistent cardiac lesions most commonly, atrial septal defect (ASD), degree of atrialization of the right ventricle (RV), size of the functional RV, biventricular function, quantification of the resultant tricuspid regurgitation (TR), and the amenability of the leaflets to surgical repair. Postoperatively, TEE examination can elucidate valuable information about the competency of tricuspid apparatus, RV dysfunction, and any residual shunting across ASD. Threedimensional echocardiography has been especially employed to study the leaflet morphology and coaptation defects. The TEE is also indispensable in guiding the management of critically sick neonates with EA. The Great Ormond Street Echocardiography (GOSE) score predicts mortality in neonatal EA and has been proposed for risk stratification. The TEE is also helpful in identifying the cases which are not suitable for a biventricular repair and the ones which may require a valve replacement.



Vinay Badhwar, Diana S DeAndrade, Daniel Ford, Lawrence M Wei, Heather K Hayanga

Surgical Repair of an Isolated Parachute-like Asymmetric Mitral Valve Defect in an Adult

[Year:2018] [Month:June] [Volume:6] [Number:1] [Pages:4] [Pages No:10 - 13]

Keywords: Parachute-like asymmetric mitral valve, Parachute mitral valve, Severe mitral regurgitation

   DOI: 10.5005/jp-journals-10034-1079  |  Open Access |  How to cite  | 


Parachute mitral valve (PMV) is a congenital anomaly of the left ventricular papillary muscles. True PMV is characterized by the unifocal attachment of all chordae tendineae into a single papillary muscle group, while parachute-like asymmetric mitral valve (PLAMV) involves two papillary muscle groups with marked asymmetry in the distribution of chordae. Both defects often occur in association with other cardiac anomalies and, therefore, are typically diagnosed in early infancy or childhood. The diagnosis is rarely made in adults as only 1% of PMV is isolated. We report a case of isolated PLAMV in an adult in which more accurate preoperative diagnosis by echocardiography may have assisted with surgical planning.



S Subash, Placid Siroraj, Nandhakumar M Nandanam, Vijay T Cherian, Shaji Palangadan

Inversion of Left Atrial Appendage mistaken as Remnant of Left Atrial Myxoma: Role of Transesophageal Echocardiography

[Year:2018] [Month:June] [Volume:6] [Number:1] [Pages:2] [Pages No:14 - 15]

Keywords: Inversion of left atrial appendage, Left atrial myxoma, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1080  |  Open Access |  How to cite  | 


An inversion of left atrial appendage (LAA) is a rare finding. It can be confused as a left atrial (LA) mass, if not diagnosed correctly. We report a case of LA myxoma patient who had developed LAA inversion, following LA myxoma excision and its significance.



Shrinath Damodaran, KP Gaurav, Shyam Thingnam, Vipan Garg

Role of Transesophageal Echocardiography in Patient with Tetralogy of Fallot with Unilateral Absence of Pulmonary Artery undergoing Intracardiac Repair

[Year:2018] [Month:June] [Volume:6] [Number:1] [Pages:4] [Pages No:16 - 19]

Keywords: Absent left pulmonary artery, Tetralogy of Fallot, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1081  |  Open Access |  How to cite  | 


Unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly commonly associated with cardiovascular malformation. Tetralogy of Fallot (TOF) is the most frequent concomitant disorder for UAPA disease. Incidence of UAPA in TOF is 1 to 3%. The absent left pulmonary artery (LPA) is 5 to 8 times more frequent than the right pulmonary artery (RPA). In this case report, emphasis has been given to the role of transesophageal echocardiography (TEE) in patients with UAPA with TOF undergoing intracardiac repair.



Ganesh K Munirathinam, Imran H Bhat, Shyam KS Thingnam, Srinath Damodaran, Virendra K Arya

Role of Perioperative Transesophageal Echocardiography in Left Ventricular Apical Pseudoaneurysm Surgery

[Year:2018] [Month:June] [Volume:6] [Number:1] [Pages:5] [Pages No:20 - 24]

Keywords: Cardiopulmonary bypass, Left ventricular apical pseudoaneurysm, Myocardial infarction, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1082  |  Open Access |  How to cite  | 


Left ventricular apical pseudoaneurysm following myocardial infarction is a rare entity and often fatal due to rupture of free wall, thus warranting an urgent surgery. Although transthoracic echocardiography (TTE) plays a significant role in the diagnosis of pseudoaneurysm, transesophageal echocardiography (TEE) remains an indispensable tool during perioperative period. In this report, we are describing a case of left ventricular apical pseudoaneurysm planned for an urgent surgery.



BPS Ghuman, Alok Kumar, Saajan Joshi

Role of Transesophageal Echocardiography in Perventricular Closure of Muscular Ventricular Septal Defect

[Year:2018] [Month:June] [Volume:6] [Number:1] [Pages:4] [Pages No:25 - 28]

Keywords: Amplatzer septal occluder, Muscular ventricular septal defect, Perventricular closure

   DOI: 10.5005/jp-journals-10034-1083  |  Open Access |  How to cite  | 


Muscular ventricular septal defect (mVSD) transcatheter occlusion technique is an established and preferred treatment modality and has become an alternative to surgery under extracorporeal circulation. But in small infants with large size of delivery assembly vis-à-vis small size of vessel caliber, it becomes not only technically challenging, but also possesses serious procedure-related complications. Perventricular device closure of such VSD on beating heart is an alternative. In this study, we aimed to present the role of intraoperative transesophageal echocardiography (TEE) in successful perventricular closure of mVSD in a small infant.



Imran Bhat, Gurpinder S Ghotra, Srinath Damodaran, Sunderlal Negi

Detection of Right Coronary Artery Air Embolism by Transesophageal Echocardiography

[Year:2018] [Month:June] [Volume:6] [Number:1] [Pages:4] [Pages No:29 - 32]

Keywords: Intracoronary air embolism, Right ventricle dysfunction, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1084  |  Open Access |  How to cite  | 


Cardiac air embolism is common while undergoing cardiac surgeries as these require an opening of left-sided cardiac chambers, right-sided cardiac chambers, aorta or due to inadequate de-airing of a saphenous vein graft. Right coronary artery air embolism is one of the common cause of hemodynamic instability after coming off cardiopulmonary bypass. We discussed two cases in which the transesophageal echocardiography (TEE) helped in diagnosing right-coronary artery air embolism as the cause of sudden ST-segment elevation, hemodynamic instability, and right ventricular (RV) dysfunction.


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