Journal of Perioperative Echocardiography

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2019 | January-June | Volume 7 | Issue 1

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Shagun Sachdeva

Myriad Uses of Intraoperative Transesophageal Echocardiography

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:1] [Pages No:1 - 1]

   DOI: 10.5005/jp-journals-10034-1100  |  Open Access |  How to cite  | 



Ganesh K Munirathinam, Vamsi Dar

Role of Intraoperative Transesophageal Echocardiography in the Management of Renal Cell Carcinoma with Cavoatrial Extension

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:4] [Pages No:2 - 5]

Keywords: Cardiac extension, Renal cell carcinoma, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1099  |  Open Access |  How to cite  | 


In all, 4–10% of tumor thrombus in renal cell carcinoma (RCC) extends into the inferior vena cava (IVC). When the thrombus extends into the right atrium (RA), it becomes surgically challenging; and depending on its extension and adherence to the underlying structure, it may need cardiopulmonary bypass (CPB). The utility of transesophageal echocardiography (TEE) is reviewed for the management of RCC with cavoatrial extension. Intraoperative TEE is an essential modality in cases of RCC with level IV tumor thrombus, and in cases that require CPB with or without deep hypothermic circulatory arrest (DHCA). Intraoperative TEE provides us real-time information about thrombus staging in addition to the properties of the thrombus, such as adherence and fragility. Intraoperative TEE can also be used to assess cardiac function, fluid status, real-time monitoring of thrombus including embolization while manipulation and to ensure no residual thrombus. We therefore recommend the use of intraoperative TEE in RCC with level IV tumor thrombus. In the future, more research is needed to demonstrate the impact of intraoperative TEE on morbidity, mortality, and complication rate of the procedures.



Srinath Damodaran, Imran Bhat, Sunder Negi, Maramreddy Revanth, Vinay Upadhyay

Perioperative Concerns and Management of Patients with Right Atrial Thrombus in Chronic Constrictive Pericarditis Undergoing Pericardiectomy: A Case Series

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:6] [Pages No:6 - 11]

Keywords: Cardiopulmonary bypass, Constrictive pericarditis, Echocardiography, Right atrium thrombus

   DOI: 10.5005/jp-journals-10034-1094  |  Open Access |  How to cite  | 


Chronic constrictive pericarditis (CCP) is a condition in which thickened, noncompliant pericardium encases heart structures. Association of right atrial (RA) thrombus in CCP imparts some challenges during the perioperative period. Perioperative echocardiography plays a vital role in managing this group of patients. This case series highlights the importance of perioperative echocardiography in managing the patients who had CCP with RA thrombus.



Kamal Kajal, Imran Bhat, Srinath Damodaran

Left Atrial Myxoma Causing Mitral Valve Obstruction with Right Ventricular Dysfunction Complicated by Atrial Fibrillation

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:3] [Pages No:12 - 14]

Keywords: Atrial fibrillation, Left atrium myxoma, Right ventricular dysfunction

   DOI: 10.5005/jp-journals-10034-1093  |  Open Access |  How to cite  | 


Myxomas are the most common type of tumors of the heart and account for 83% of the primary tumors. The left atrium (LA) is the most common site for myxoma, followed by the right atrium. Obstructive symptoms of myxomas can mimic as mitral stenosis, and the severity increases due to an increase in heart rate such as the development of atrial fibrillation (AF). There is a high probability of developing pulmonary artery hypertension and right ventricular (RV) failure in patients with long-standing LA myxomas which can further be complicated by the development of AF. As the majority of patients with LA myxomas present late due to their nonspecific symptoms, a thorough assessment of pulmonary artery hypertension and RV function assessment should be done before surgical intervention.



Srinath Damodaran, Bhupesh Kumar

Indispensable Role of Transesophageal Echocardiography in Elucidating the Mechanism of Bioprosthetic Heart Valve Dysfunction Causing Severe Regurgitation: A Case Report

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:3] [Pages No:15 - 17]

Keywords: Bioprosthetic heart valves, Flail leaflet, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1098  |  Open Access |  How to cite  | 


Transesophageal echocardiography (TEE) is invaluable in identifying the exact mechanism of prosthetic valve dysfunction (PVD), which may help in the proper management of patient. Here, we report a case of severe mitral regurgitation due to flail mitral valve leaflet resulting from torn bioprosthetic cusp where TEE was instrumental in demonstrating the exact mechanism of valve dysfunction.



Mandeep Kumar, Alok Kumar, Anand K Mishra

Transesophageal Echocardiographic Identification of Anomalous Course of the Left Atrial Appendage

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:4] [Pages No:18 - 21]

Keywords: Juxtaposition, Left atrial appendage, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1096  |  Open Access |  How to cite  | 


The left atrial appendage (LAA) considerably varies in morphology and position. In rare cases, it can be juxtaposed on the right side. Here, we present the transesophageal echocardiography (TEE) images and surgical findings of two patients presenting for corrective surgery of their underlying congenital cardiac anomalies. While abnormal position of the LAA was detected in the first patient, juxtaposition of LAA was detected in second patient by TEE and confirmed intraoperatively.



Kamal Kajal, Sunder Negi, Rupesh Kumar

Post-cardiopulmonary Bypass Pacing: A Potential Pitfall in Assessment of Mitral Regurgitation

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:2] [Pages No:22 - 23]

Keywords: Echocardiography, Mitral regurgitation, Pacing

   DOI: 10.5005/jp-journals-10034-1095  |  Open Access |  How to cite  | 


Temporary pacing acts as an essential modality for maintaining hemodynamic stability in some life-threatening arrhythmias developed after cardiac surgery. We hereby discuss a case of partial balanced atrioventricular septal defect (AVSD) in which temporary pacemaker acted as a potential pitfall in the assessment of mitral regurgitation (MR). This case highlights the impact of pacing mode on MR severity and hence influencing perioperative decision-making after intracardiac repair.


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Srinath Damodaran, Komal Gandhi, Rupesh Kumar

Massive Purulent Pericardial Effusion Secondary to Knee Infection

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:2] [Pages No:24 - 25]

Keywords: Pericardial effusion, Pericardiectomy, Staphylococcus aureus, Transesophageal echocardiography

   DOI: 10.5005/jp-journals-10034-1097  |  Open Access |  How to cite  | 


Perioperative echocardiography is a useful guide in the management of hemodynamically unstable patients. We, hereby, describe a case of massive pericardial effusion with interesting images on echocardiography.


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