Pub Date : 2018-09-01DOI: 10.1093/MED/9780198759089.003.0009
D. Sidebotham, A. Merry, M. Legget, Gavin Wright
Chapter 9 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. In the first part of the chapter, the indications for MV repair are reviewed, and areas of controversy are highlighted. Next, the surgical techniques used for valve repair for different mitral pathologies are summarized, in particular the use of leaflet resection or neochordae for repair of degenerative disease. Considerations for minimally invasive mitral repair are briefly reviewed. The bulk of the chapter is given over to TOE assessment prior to, and following, surgical repair. Characteristic features of, and associated complications encountered with, different mitral pathologies are presented. In particular, the risk factors for post-operative systolic anterior motion (SAM) in patients with degenerative disease and failure of a reduction annuloplasty in patients with secondary mitral regurgitation are described. The final section of the chapter details the post-repair assessment, with an emphasis on the features of an optimal repair, quantifying residual mitral regurgitation, mechanisms of repair failure, and assessment and treatment of post-operative SAM.
{"title":"Surgical repair of the mitral valve","authors":"D. Sidebotham, A. Merry, M. Legget, Gavin Wright","doi":"10.1093/MED/9780198759089.003.0009","DOIUrl":"https://doi.org/10.1093/MED/9780198759089.003.0009","url":null,"abstract":"Chapter 9 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. In the first part of the chapter, the indications for MV repair are reviewed, and areas of controversy are highlighted. Next, the surgical techniques used for valve repair for different mitral pathologies are summarized, in particular the use of leaflet resection or neochordae for repair of degenerative disease. Considerations for minimally invasive mitral repair are briefly reviewed. The bulk of the chapter is given over to TOE assessment prior to, and following, surgical repair. Characteristic features of, and associated complications encountered with, different mitral pathologies are presented. In particular, the risk factors for post-operative systolic anterior motion (SAM) in patients with degenerative disease and failure of a reduction annuloplasty in patients with secondary mitral regurgitation are described. The final section of the chapter details the post-repair assessment, with an emphasis on the features of an optimal repair, quantifying residual mitral regurgitation, mechanisms of repair failure, and assessment and treatment of post-operative SAM.","PeriodicalId":153040,"journal":{"name":"Practical Perioperative Transoesophageal Echocardiography","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130477515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1093/MED/9780198759089.003.0014
D. Sidebotham, A. Merry, M. Legget, Gavin Wright
The first part of Chapter 12 details the relevant anatomy, physiology, and TOE views required for accurate assessment of the RV. Included are several useful imaging planes that are not presented in Chapter 4: Standard views. Next, the techniques for assessing global, regional, and diastolic RV function are outlined. The characteristic features of RV pressure and volume overload are described. The final part of the chapter brings together the information from the previous sections to provide an approach to assessing RV function during the perioperative period.
{"title":"The right ventricle","authors":"D. Sidebotham, A. Merry, M. Legget, Gavin Wright","doi":"10.1093/MED/9780198759089.003.0014","DOIUrl":"https://doi.org/10.1093/MED/9780198759089.003.0014","url":null,"abstract":"The first part of Chapter 12 details the relevant anatomy, physiology, and TOE views required for accurate assessment of the RV. Included are several useful imaging planes that are not presented in Chapter 4: Standard views. Next, the techniques for assessing global, regional, and diastolic RV function are outlined. The characteristic features of RV pressure and volume overload are described. The final part of the chapter brings together the information from the previous sections to provide an approach to assessing RV function during the perioperative period.","PeriodicalId":153040,"journal":{"name":"Practical Perioperative Transoesophageal Echocardiography","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130133518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1093/med/9780198759089.003.0020
D. Sidebotham, A. Merry, M. Legget, Gavin Wright
In Chapter 20, TOE imaging relevant to the assessment of different forms of mechanical cardiorespiratory support is reviewed. Topics covered are intra-aortic balloon pumps, extracorporeal membrane oxygenation (ECMO), and ventricular assist devices (VADs); however, the focus of the chapter is on ECMO and VADs. For ECMO, both venovenous (VV) and venoarterial (VA) configurations are discussed. Issues such as cannula placement, assessment of complications (e.g. recirculation with VV ECMO, LV distension with VA ECMO), and weaning are dealt with. For left-sided VAD (LVAD) implantation, assessment during the pre- and post-implantation periods is outlined. Normal and abnormal flow patterns within the inflow and outflow cannulae are reviewed. Issues related to patent foramen ovale, RV dysfunction, AV dysfunction, and over-pumping and under-pumping are covered. Also, the indications for right-sided support in patients undergoing LVAD implantation are discussed.
{"title":"Echocardiography for mechanical support","authors":"D. Sidebotham, A. Merry, M. Legget, Gavin Wright","doi":"10.1093/med/9780198759089.003.0020","DOIUrl":"https://doi.org/10.1093/med/9780198759089.003.0020","url":null,"abstract":"In Chapter 20, TOE imaging relevant to the assessment of different forms of mechanical cardiorespiratory support is reviewed. Topics covered are intra-aortic balloon pumps, extracorporeal membrane oxygenation (ECMO), and ventricular assist devices (VADs); however, the focus of the chapter is on ECMO and VADs. For ECMO, both venovenous (VV) and venoarterial (VA) configurations are discussed. Issues such as cannula placement, assessment of complications (e.g. recirculation with VV ECMO, LV distension with VA ECMO), and weaning are dealt with. For left-sided VAD (LVAD) implantation, assessment during the pre- and post-implantation periods is outlined. Normal and abnormal flow patterns within the inflow and outflow cannulae are reviewed. Issues related to patent foramen ovale, RV dysfunction, AV dysfunction, and over-pumping and under-pumping are covered. Also, the indications for right-sided support in patients undergoing LVAD implantation are discussed.","PeriodicalId":153040,"journal":{"name":"Practical Perioperative Transoesophageal Echocardiography","volume":"129 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114506642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1093/med/9780198759089.003.0012
D. Sidebotham, A. Merry, M. Legget, Gavin Wright
The first section of Chapter 12 details an approach to a systematic examination of the aortic root and thoracic aorta. The limitations (due to interposition of the large airways) and artefacts encountered when assessing the thoracic aorta are discussed. Normal aortic dimensions are listed in tabular format. The remainder of the chapter is concerned with the pathologies affecting the thoracic aorta, namely: aortic atheroma, aortic aneurysm, acute aortic syndromes (dissection, intramural haematoma, and penetrating ulcer), and traumatic aortic injury. Where relevant, reference to appropriate guidelines and surgical techniques are made.
{"title":"The thoracic aorta","authors":"D. Sidebotham, A. Merry, M. Legget, Gavin Wright","doi":"10.1093/med/9780198759089.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780198759089.003.0012","url":null,"abstract":"The first section of Chapter 12 details an approach to a systematic examination of the aortic root and thoracic aorta. The limitations (due to interposition of the large airways) and artefacts encountered when assessing the thoracic aorta are discussed. Normal aortic dimensions are listed in tabular format. The remainder of the chapter is concerned with the pathologies affecting the thoracic aorta, namely: aortic atheroma, aortic aneurysm, acute aortic syndromes (dissection, intramural haematoma, and penetrating ulcer), and traumatic aortic injury. Where relevant, reference to appropriate guidelines and surgical techniques are made.","PeriodicalId":153040,"journal":{"name":"Practical Perioperative Transoesophageal Echocardiography","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128786846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1093/med/9780198759089.003.0016
D. Sidebotham, A. Merry, M. Legget, Gavin Wright
Chapter 16 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a short summary on the echocardiographic assessment of the normal pericardium and on pericardial disease. The characteristic TOE features of pericardial pathology (cysts, acute pericarditis, pericardial effusion, pericardial tamponade, and constrictive pericarditis) are reviewed. In particular, pericardial constriction is discussed in detail, including outlining the features that distinguish pericardial constriction from restrictive cardiomyopathy. Wherever possible, the spectral Doppler abnormalities associated with pericardial constriction and pericardial tamponade are discussed with reference to patients who are mechanically ventilated.
{"title":"The pericardium and pericardial disease","authors":"D. Sidebotham, A. Merry, M. Legget, Gavin Wright","doi":"10.1093/med/9780198759089.003.0016","DOIUrl":"https://doi.org/10.1093/med/9780198759089.003.0016","url":null,"abstract":"Chapter 16 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a short summary on the echocardiographic assessment of the normal pericardium and on pericardial disease. The characteristic TOE features of pericardial pathology (cysts, acute pericarditis, pericardial effusion, pericardial tamponade, and constrictive pericarditis) are reviewed. In particular, pericardial constriction is discussed in detail, including outlining the features that distinguish pericardial constriction from restrictive cardiomyopathy. Wherever possible, the spectral Doppler abnormalities associated with pericardial constriction and pericardial tamponade are discussed with reference to patients who are mechanically ventilated.","PeriodicalId":153040,"journal":{"name":"Practical Perioperative Transoesophageal Echocardiography","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133381451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1093/med/9780198759089.003.0006
D. Sidebotham, A. Merry, M. Legget, Gavin Wright
Chapter 6 is subdivided into three sections: global LV systolic function, regional LV systolic function, and cardiomyopathies. In Section 1, commonly used indices of global systolic function, such as fractional area change and ejection fraction, are reviewed, along with their limitations related to oesophageal imaging. The relationship between stroke volume and ejection fraction is explored. Newer techniques such as quantitative 3D imaging and strain-rate imaging are described. In Section 2, the causes of regional systolic dysfunction are reviewed, along with the different aetiologies of real and apparent segmental wall motion abnormalities. Complications of myocardial infarction such as mitral regurgitation, true and false LV aneurysms, and ventricular septal rupture are also dealt with in this section. Section 3 provides an overview of the echocardiographic findings associated with various cardiomyopathies: dilated, hypertrophic, restrictive, acute myocarditis, LV non-compaction, and Takotsubo.
{"title":"Left ventricular systolic function","authors":"D. Sidebotham, A. Merry, M. Legget, Gavin Wright","doi":"10.1093/med/9780198759089.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780198759089.003.0006","url":null,"abstract":"Chapter 6 is subdivided into three sections: global LV systolic function, regional LV systolic function, and cardiomyopathies. In Section 1, commonly used indices of global systolic function, such as fractional area change and ejection fraction, are reviewed, along with their limitations related to oesophageal imaging. The relationship between stroke volume and ejection fraction is explored. Newer techniques such as quantitative 3D imaging and strain-rate imaging are described. In Section 2, the causes of regional systolic dysfunction are reviewed, along with the different aetiologies of real and apparent segmental wall motion abnormalities. Complications of myocardial infarction such as mitral regurgitation, true and false LV aneurysms, and ventricular septal rupture are also dealt with in this section. Section 3 provides an overview of the echocardiographic findings associated with various cardiomyopathies: dilated, hypertrophic, restrictive, acute myocarditis, LV non-compaction, and Takotsubo.","PeriodicalId":153040,"journal":{"name":"Practical Perioperative Transoesophageal Echocardiography","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127982829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1093/med/9780198759089.003.0004
D. Sidebotham, A. Merry, M. Legget, Gavin Wright
In Chapter 4, the 28 standard 2D TOE views, as recommended by the American Society of Echocardiography (ASE) and the Society of Cardiovascular Anesthesiologists (SCA), are described. For each view, a line drawing is provided, indicating relevant cardiac structures. Line drawings of normal spectral Doppler waveforms are also provided. 3D images of normal mitral, aortic, and tricuspid valves, displayed in their recommended orientations, are demonstrated. In addition to standard views, a sequential approach to performing a comprehensive TOE examination is described. Tables summarizing the indications and contraindications to TOE examination, as outlined by the ASE/SCA, are provided.
{"title":"Standard views","authors":"D. Sidebotham, A. Merry, M. Legget, Gavin Wright","doi":"10.1093/med/9780198759089.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780198759089.003.0004","url":null,"abstract":"In Chapter 4, the 28 standard 2D TOE views, as recommended by the American Society of Echocardiography (ASE) and the Society of Cardiovascular Anesthesiologists (SCA), are described. For each view, a line drawing is provided, indicating relevant cardiac structures. Line drawings of normal spectral Doppler waveforms are also provided. 3D images of normal mitral, aortic, and tricuspid valves, displayed in their recommended orientations, are demonstrated. In addition to standard views, a sequential approach to performing a comprehensive TOE examination is described. Tables summarizing the indications and contraindications to TOE examination, as outlined by the ASE/SCA, are provided.","PeriodicalId":153040,"journal":{"name":"Practical Perioperative Transoesophageal Echocardiography","volume":"104 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117346504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-01DOI: 10.1093/MED/9780198759089.003.0017
D. Sidebotham, A. Merry, M. Legget, Gavin Wright
Chapter 17 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a description of the use of TOE for patients undergoing a range of procedures in the catheter laboratory, including transcatheter AV implantation, LA appendage occlusion, edge-to-edge MV repair, balloon mitral valvotomy, and device closure of ASDs and paravalvular leaks. Important measurements and the associated image planes that are required for each procedure are outlined, along with a description of the ideal imaging plane and puncture site for placing transatrial catheters. Potential complications associated with each procedure are also reviewed.
{"title":"Transoesophageal echocardiography for interventional cardiology procedures","authors":"D. Sidebotham, A. Merry, M. Legget, Gavin Wright","doi":"10.1093/MED/9780198759089.003.0017","DOIUrl":"https://doi.org/10.1093/MED/9780198759089.003.0017","url":null,"abstract":"Chapter 17 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a description of the use of TOE for patients undergoing a range of procedures in the catheter laboratory, including transcatheter AV implantation, LA appendage occlusion, edge-to-edge MV repair, balloon mitral valvotomy, and device closure of ASDs and paravalvular leaks. Important measurements and the associated image planes that are required for each procedure are outlined, along with a description of the ideal imaging plane and puncture site for placing transatrial catheters. Potential complications associated with each procedure are also reviewed.","PeriodicalId":153040,"journal":{"name":"Practical Perioperative Transoesophageal Echocardiography","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116158084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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