Pub Date : 1900-01-01DOI: 10.5005/jp-journals-10034-1094
S. Negi, I. Bhat, Srinath Damodaran, K. Gourav, Indranil Biswas, M. Revanth, Vinay Upadhyay
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.
{"title":"Perioperative Concerns and Management of Patients with Right Atrial Thrombus in Chronic Constrictive Pericarditis Undergoing Pericardiectomy: A Case Series","authors":"S. Negi, I. Bhat, Srinath Damodaran, K. Gourav, Indranil Biswas, M. Revanth, Vinay Upadhyay","doi":"10.5005/jp-journals-10034-1094","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1094","url":null,"abstract":"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.","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126747366","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 : 1900-01-01DOI: 10.5005/jp-journals-10034-1101
S. Negi, K. Gourav, S. Niyogi
Coronavirus disease-2019 (COVID-19) pandemic has created new challenges for the healthcare systems all over the world. The incidence of myocardial injury ranges between 7 and 20% in hospitalized COVID-19 patients. 1 The term myocardial injury applies to any patient in whom at least one cardiac troponin (cTn) concentration is above the 99th percentile upper reference limit. The death rate in COVID-19 patients with cardiac disease as comorbidity has around 10%. Myocardial injuries might be related to the fulminant cytokine release and systemic inflammation seen in severe COVID-19 cases. 2 The role of echocardiographer is crucial as echocardiography is an easily available non-invasive bedside modality to assess for cardiac involvement as well as cardiorespiratory interactions in patients with COVID-19. However, sonographers are also at risk of being infected during the performance of echocardiogram, due to the prolonged and close contact with COVID-19 patients. Hence, appropriate protective measures are necessary to enable the best medical care for patients while also maintaining the health of the sonographer, especially in the setting of a shortage of expert staff (sickness or quarantine after duty) and to prevent transmission to other staff and patients. This article presents a clinical case series of a range of cardiac involvement in COVID-19 and offers guidance on indications of echocardiogram and safe practices for performing safe and effective echocardiography during the COVID-19 pandemic, with particular focus on echocardiography of suspected or confirmed COVID-19 cases. Echocardiography during COVID-19 is a clinically useful tool. Due to concerns about transmission of disease during performing an echo, the procedure should be streamlined, performed by skilled practitioners who are not at high-risk for COVID-19 severe disease, and with a focus on obtaining the best possible transthoracic images.
{"title":"Role of Echocardiography in COVID-19 Patients","authors":"S. Negi, K. Gourav, S. Niyogi","doi":"10.5005/jp-journals-10034-1101","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1101","url":null,"abstract":"Coronavirus disease-2019 (COVID-19) pandemic has created new challenges for the healthcare systems all over the world. The incidence of myocardial injury ranges between 7 and 20% in hospitalized COVID-19 patients. 1 The term myocardial injury applies to any patient in whom at least one cardiac troponin (cTn) concentration is above the 99th percentile upper reference limit. The death rate in COVID-19 patients with cardiac disease as comorbidity has around 10%. Myocardial injuries might be related to the fulminant cytokine release and systemic inflammation seen in severe COVID-19 cases. 2 The role of echocardiographer is crucial as echocardiography is an easily available non-invasive bedside modality to assess for cardiac involvement as well as cardiorespiratory interactions in patients with COVID-19. However, sonographers are also at risk of being infected during the performance of echocardiogram, due to the prolonged and close contact with COVID-19 patients. Hence, appropriate protective measures are necessary to enable the best medical care for patients while also maintaining the health of the sonographer, especially in the setting of a shortage of expert staff (sickness or quarantine after duty) and to prevent transmission to other staff and patients. This article presents a clinical case series of a range of cardiac involvement in COVID-19 and offers guidance on indications of echocardiogram and safe practices for performing safe and effective echocardiography during the COVID-19 pandemic, with particular focus on echocardiography of suspected or confirmed COVID-19 cases. Echocardiography during COVID-19 is a clinically useful tool. Due to concerns about transmission of disease during performing an echo, the procedure should be streamlined, performed by skilled practitioners who are not at high-risk for COVID-19 severe disease, and with a focus on obtaining the best possible transthoracic images.","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131172247","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 : 1900-01-01DOI: 10.5005/jp-journals-10034-1103
A. Bhalla, Arun Sharma, N. Kaur, M. Garg, Neeti Dogra, G. Puri, R. Ganesan, Karan Singla, S. Niyogi, Alisha Goel, N. Kaloria, V. Ashok, Nischitha Gowda, V. Mahajan, Sujitha R Karri
Ab s t r Ac t Background: Lung ultrasound is an easily available bedside imaging modality that has good specificity for the diagnosis of coronavirus disease2019 (COVID-19). Limited evidence is available on its utility to predict clinical severity. Materials and methods: In this prospective observational study, adult patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) of a tertiary care hospital between June 2020 and August 2020 were included. Lung ultrasound was performed in at least four areas in each examination and video loops were scored by two independent observers. The statistical relationship was assessed between median lung ultrasound score, chest X-ray score, P/F ratio (ratio of the partial pressure of oxygen in arterial blood to the fraction of inspired oxygen), ROX index, SOFA score, ICU stay, and mortality. Results: Fifty lung ultrasound examinations were performed in 29 patients of age 54.7 ± 15.3 years. P/F ratio was <300 mm Hg during 80% of the examinations. There was moderate correlation between median lung ultrasound score and both ROX index (Spearman’s rho = −0.543, p < 0.001) and P/F ratio (rho = −0.522, p < 0.001), while there was weak correlation between chest X-ray score and ROX index (rho = −0.0.345, p = 0.019) and no correlation between chest X-ray score and P/F ratio. There was correlation between chest X-ray score and ICU stay (rho = 0.434, p = 0.049). There was no difference in any of the parameters between survivors and non-survivors. Moderate inter-observer agreement was present between the two observers. Conclusion: Bedside lung ultrasound examination, even with a limited number of views, can reflect the clinical severity of COVID-19 pneumonia.
背景:肺超声是一种易于获得的床边成像方式，对冠状病毒病2019 (COVID-19)的诊断具有良好的特异性。其用于预测临床严重程度的证据有限。材料与方法:本前瞻性观察研究纳入2020年6月至2020年8月在某三级医院重症监护病房(ICU)住院的成年COVID-19肺炎患者。每次检查至少在四个区域进行肺部超声检查，视频循环由两名独立观察员评分。评估肺超声中位评分、胸片评分、P/F比(动脉血氧分压与吸入氧分数之比)、ROX指数、SOFA评分、ICU住院时间、死亡率之间的统计关系。结果:29例患者，年龄54.7±15.3岁，共行肺超声检查50次。80%的检查P/F < 300mmhg。肺超声中位评分与ROX指数(Spearman’s rho = - 0.543, p < 0.001)和p /F比值(rho = - 0.522, p < 0.001)均有中度相关性，胸片评分与ROX指数相关性较弱(rho = - 0.0.345, p = 0.019)，胸片评分与p /F比值无相关性。胸片评分与ICU住院时间有相关性(rho = 0.434, p = 0.049)。幸存者和非幸存者之间的任何参数都没有差异。两名观察员之间存在适度的观察员间协议。结论:床边肺超声检查，即使检查片数有限，也能反映COVID-19肺炎的临床严重程度。
{"title":"Lung Ultrasound Predicts Clinical Severity of COVID-19 Pneumonia","authors":"A. Bhalla, Arun Sharma, N. Kaur, M. Garg, Neeti Dogra, G. Puri, R. Ganesan, Karan Singla, S. Niyogi, Alisha Goel, N. Kaloria, V. Ashok, Nischitha Gowda, V. Mahajan, Sujitha R Karri","doi":"10.5005/jp-journals-10034-1103","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1103","url":null,"abstract":"Ab s t r Ac t Background: Lung ultrasound is an easily available bedside imaging modality that has good specificity for the diagnosis of coronavirus disease2019 (COVID-19). Limited evidence is available on its utility to predict clinical severity. Materials and methods: In this prospective observational study, adult patients with COVID-19 pneumonia admitted to the intensive care unit (ICU) of a tertiary care hospital between June 2020 and August 2020 were included. Lung ultrasound was performed in at least four areas in each examination and video loops were scored by two independent observers. The statistical relationship was assessed between median lung ultrasound score, chest X-ray score, P/F ratio (ratio of the partial pressure of oxygen in arterial blood to the fraction of inspired oxygen), ROX index, SOFA score, ICU stay, and mortality. Results: Fifty lung ultrasound examinations were performed in 29 patients of age 54.7 ± 15.3 years. P/F ratio was <300 mm Hg during 80% of the examinations. There was moderate correlation between median lung ultrasound score and both ROX index (Spearman’s rho = −0.543, p < 0.001) and P/F ratio (rho = −0.522, p < 0.001), while there was weak correlation between chest X-ray score and ROX index (rho = −0.0.345, p = 0.019) and no correlation between chest X-ray score and P/F ratio. There was correlation between chest X-ray score and ICU stay (rho = 0.434, p = 0.049). There was no difference in any of the parameters between survivors and non-survivors. Moderate inter-observer agreement was present between the two observers. Conclusion: Bedside lung ultrasound examination, even with a limited number of views, can reflect the clinical severity of COVID-19 pneumonia.","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127833745","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 : 1900-01-01DOI: 10.5005/jp-journals-10034-1093
I. Bhat, Srinath Damodaran, K. Gourav, Kamal Kajal
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.
{"title":"Left Atrial Myxoma Causing Mitral Valve Obstruction with Right Ventricular Dysfunction Complicated by Atrial Fibrillation","authors":"I. Bhat, Srinath Damodaran, K. Gourav, Kamal Kajal","doi":"10.5005/jp-journals-10034-1093","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1093","url":null,"abstract":"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.","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130750156","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 : 1900-01-01DOI: 10.5005/jp-journals-10034-1108
G. Puri
Bedside ultrasound has been integrated as a vital diagnostic and monitoring tool in most of the intensive care and emergency care units. The Society of Critical Care Medicine and American College of Emergency Physicians have provided guidelines for performing bedside ultrasound.1–3 Coronavirus disease-2019 (COVID-19) has been shown to have severe extrapulmonary manifestations owing to endothelial damage, dysregulation of the immune system, and maladaptation of ACE2-related pathways.4 The involvement of multiple systems in the disease process means that routine vitals monitoring and daily chest X-ray will seldom be enough to arrive at a definitive diagnosis when complications occur. The case series’ by Biswas et al. and Negi et al. highlight the role of bedside ultrasound in COVID-19. While the case series by Biswas et al. describes the utility of point-of-care ultrasound in general, Negi et al. describe the utility of echocardiography and guide on performing it. Bedside ultrasound has either helped guide the management or avoided further investigations in all these cases. The first set of statements in the Society of Critical Care Medicine guidelines for ultrasound deals with extracardiac thoracic imaging which includes the diagnosis of pleural effusion, pneumothorax, and parenchymal lung diseases. Pleural effusion is an uncommon finding in COVID-19 unless there is associated superadded bacterial infection, hepatic, renal or cardiac dysfunction, or malignancy.5 Hence, the presence of pleural effusion in COVID-19 would imply a potentially treatable alternative diagnosis. On the other hand, pneumothorax is seen in around 1% of COVID-19 admissions and is seen in spontaneously breathing patients as well.6 The timely diagnosis of this complication is important as it has been shown to not adversely affect the prognosis. In abdominal imaging, the intensivist is trained to visualize the inferior vena cava, examine for free fluid, and image the bladder. Coronavirus disease 2019 can result in acute kidney injury in more than 50% of critical patients.7 Hyperpyrexia and gastrointestinal loss often result in hypovolemia which needs to be corrected expeditiously to avoid pre-renal damage. Volume resuscitation guided by dynamic indices of inferior vena cava dimension is crucial to achieve this. Apart from this, the presence of free fluid or abnormal appearance of the kidneys in COVID-19 patients could prompt evaluation by a radiologist. Vascular ultrasound has an immense role to play in the management of COVID-19 patients. Around one in five critical COVID-19 patients have been identified to have thromboembolism and the mortality is also higher in these patients.8 Intensivists have 88% sensitivity and 98% specificity in identifying deep venous thrombosis when compared with ultrasound technicians.1 Right ventricle dilation and dysfunction are common in COVID-19 and have been found to occur with or without deep venous thrombosis. Finally, ultrasound for procedura
{"title":"Ultrasound in COVID-19","authors":"G. Puri","doi":"10.5005/jp-journals-10034-1108","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1108","url":null,"abstract":"Bedside ultrasound has been integrated as a vital diagnostic and monitoring tool in most of the intensive care and emergency care units. The Society of Critical Care Medicine and American College of Emergency Physicians have provided guidelines for performing bedside ultrasound.1–3 Coronavirus disease-2019 (COVID-19) has been shown to have severe extrapulmonary manifestations owing to endothelial damage, dysregulation of the immune system, and maladaptation of ACE2-related pathways.4 The involvement of multiple systems in the disease process means that routine vitals monitoring and daily chest X-ray will seldom be enough to arrive at a definitive diagnosis when complications occur. The case series’ by Biswas et al. and Negi et al. highlight the role of bedside ultrasound in COVID-19. While the case series by Biswas et al. describes the utility of point-of-care ultrasound in general, Negi et al. describe the utility of echocardiography and guide on performing it. Bedside ultrasound has either helped guide the management or avoided further investigations in all these cases. The first set of statements in the Society of Critical Care Medicine guidelines for ultrasound deals with extracardiac thoracic imaging which includes the diagnosis of pleural effusion, pneumothorax, and parenchymal lung diseases. Pleural effusion is an uncommon finding in COVID-19 unless there is associated superadded bacterial infection, hepatic, renal or cardiac dysfunction, or malignancy.5 Hence, the presence of pleural effusion in COVID-19 would imply a potentially treatable alternative diagnosis. On the other hand, pneumothorax is seen in around 1% of COVID-19 admissions and is seen in spontaneously breathing patients as well.6 The timely diagnosis of this complication is important as it has been shown to not adversely affect the prognosis. In abdominal imaging, the intensivist is trained to visualize the inferior vena cava, examine for free fluid, and image the bladder. Coronavirus disease 2019 can result in acute kidney injury in more than 50% of critical patients.7 Hyperpyrexia and gastrointestinal loss often result in hypovolemia which needs to be corrected expeditiously to avoid pre-renal damage. Volume resuscitation guided by dynamic indices of inferior vena cava dimension is crucial to achieve this. Apart from this, the presence of free fluid or abnormal appearance of the kidneys in COVID-19 patients could prompt evaluation by a radiologist. Vascular ultrasound has an immense role to play in the management of COVID-19 patients. Around one in five critical COVID-19 patients have been identified to have thromboembolism and the mortality is also higher in these patients.8 Intensivists have 88% sensitivity and 98% specificity in identifying deep venous thrombosis when compared with ultrasound technicians.1 Right ventricle dilation and dysfunction are common in COVID-19 and have been found to occur with or without deep venous thrombosis. Finally, ultrasound for procedura","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"223 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115649285","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 : 1900-01-01DOI: 10.5005/jp-journals-10034-1106
G. Puri, S. Negi, K. Gourav, Tsering Morup
Ab s t r Ac t Introduction: Anesthesia at high altitudes is challenging due to vast variations in physiology, which are further complicated by the positioning and pneumoperitoneum during laparoscopic surgeries. These changes can be better understood and managed with the help of echocardiography. Here, we demonstrate the effect of laparoscopy on hemodynamics with the help of transesophageal echocardiography (TEE) at high altitudes in three patients. Materials and methods: Three ASA I patients (patient 1, laparoscopic cholecystectomy; patient 2, laparoscopic vaginal hysterectomy; patient 3, laparoscopic hernioplasty with mesh repair) who underwent laparoscopic surgeries at an altitude of 3,500 m were studied. Various parameters were measured by TEE which included left ventricle ejection fraction (EF), left ventricular outflow tract (LVOT) velocity time integral (VTI), cardiac output (CO), E/A, E/eI, tricuspid annular plane systolic excursion (TAPSE), and pulmonary artery acceleration time (PAAT). The mean arterial pressure (MAP), heart rate, SpO2, and end-tidal carbon dioxide were also measured. These parameters were recorded at 10-time points: before induction of anesthesia (T1), before insufflation (T2), after positioning (T3), 5 mm Hg pneumoperitoneum (T4), 10 mm Hg pneumoperitoneum (T5), 14 mm Hg pneumoperitoneum (T6), 10 minutes after 14 mm Hg pneumoperitoneum (T7), 20 minutes after 14 mm Hg pneumoperitoneum (T8), 30 minutes after 14 mm Hg pneumoperitoneum (T9), and 5 minutes after desufflation (T10). Results: We observed a decrease in MAP, LVOT VTI, and CO after pneumoperitoneum when associated with reverse RT position and an increase in MAP, LVOT VTI, and CO when associated with Trendelenburg position. The right ventricular systolic function measured by TAPSE, left ventricular EF, and LV diastolic function remained the same throughout the procedure in all the three patients. Pulmonary artery acceleration time gradually decreased after pneumoperitoneum in all the three patients but stayed in a normal range throughout the procedure. The results of our study are consistent with the previous studies performed at sea level. Conclusion: The present study showed that laparoscopic surgeries may be safely performed in healthy individuals at high altitudes. However, the study was limited by small sample size and done only in healthy subjects.
{"title":"Transesophageal Echocardiographic Assessment of Hemodynamic Changes during Laparoscopic Surgeries at High Altitude","authors":"G. Puri, S. Negi, K. Gourav, Tsering Morup","doi":"10.5005/jp-journals-10034-1106","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1106","url":null,"abstract":"Ab s t r Ac t Introduction: Anesthesia at high altitudes is challenging due to vast variations in physiology, which are further complicated by the positioning and pneumoperitoneum during laparoscopic surgeries. These changes can be better understood and managed with the help of echocardiography. Here, we demonstrate the effect of laparoscopy on hemodynamics with the help of transesophageal echocardiography (TEE) at high altitudes in three patients. Materials and methods: Three ASA I patients (patient 1, laparoscopic cholecystectomy; patient 2, laparoscopic vaginal hysterectomy; patient 3, laparoscopic hernioplasty with mesh repair) who underwent laparoscopic surgeries at an altitude of 3,500 m were studied. Various parameters were measured by TEE which included left ventricle ejection fraction (EF), left ventricular outflow tract (LVOT) velocity time integral (VTI), cardiac output (CO), E/A, E/eI, tricuspid annular plane systolic excursion (TAPSE), and pulmonary artery acceleration time (PAAT). The mean arterial pressure (MAP), heart rate, SpO2, and end-tidal carbon dioxide were also measured. These parameters were recorded at 10-time points: before induction of anesthesia (T1), before insufflation (T2), after positioning (T3), 5 mm Hg pneumoperitoneum (T4), 10 mm Hg pneumoperitoneum (T5), 14 mm Hg pneumoperitoneum (T6), 10 minutes after 14 mm Hg pneumoperitoneum (T7), 20 minutes after 14 mm Hg pneumoperitoneum (T8), 30 minutes after 14 mm Hg pneumoperitoneum (T9), and 5 minutes after desufflation (T10). Results: We observed a decrease in MAP, LVOT VTI, and CO after pneumoperitoneum when associated with reverse RT position and an increase in MAP, LVOT VTI, and CO when associated with Trendelenburg position. The right ventricular systolic function measured by TAPSE, left ventricular EF, and LV diastolic function remained the same throughout the procedure in all the three patients. Pulmonary artery acceleration time gradually decreased after pneumoperitoneum in all the three patients but stayed in a normal range throughout the procedure. The results of our study are consistent with the previous studies performed at sea level. Conclusion: The present study showed that laparoscopic surgeries may be safely performed in healthy individuals at high altitudes. However, the study was limited by small sample size and done only in healthy subjects.","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"746 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116096185","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 : 1900-01-01DOI: 10.5005/jp-journals-10034-1096
A. Mishra, Alok Kumar, R. Ganesan, K. Gourav, S. Niyogi, Mandeep Kumar
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.
{"title":"Transesophageal Echocardiographic Identification of Anomalous Course of the Left Atrial Appendage","authors":"A. Mishra, Alok Kumar, R. Ganesan, K. Gourav, S. Niyogi, Mandeep Kumar","doi":"10.5005/jp-journals-10034-1096","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1096","url":null,"abstract":"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.","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129988996","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 : 1900-01-01DOI: 10.5005/jp-journals-10034-1104
J. Muralidharan, G. Puri, K. Gourav, M. Rohit, S. Angurana, I. Biswas, Dheemta Toshkhani, A. Agarwal, A. Gawalkar, Vivek Jaswal
Ab s t r Ac t Introduction: Hereby, we describe a series of four critically ill COVID-19 patients where point-of-care ultrasound (POCUS) helped in guiding specific management. Case description: The first case is a 62-year-old COVID-19 positive woman where severe aortic stenosis and severe left ventricular dysfunction were diagnosed by POCUS, which led to the institution of specific medical management leading to resolution of her symptoms and referral to the cardiac surgical department for further surgical management. The second case is a 51-year-old woman admitted with severe hypoxia secondary to COVID-19 infection. She was being considered for tocilizumab therapy. However, POCUS revealed the presence of pericardial effusion, which, on evaluation, was found to be due to tubercular. This led to withholding tocilizumab therapy. Anti-tubercular therapy, instead, was instituted. The third case is a 13-month-old child, who presented with a history of recurrent syncopes and was diagnosed as a case of congenital heart block on electrocardiography (ECG). However, due to his COVID-19 positive status, rescue temporary pacing could not be performed at the catheterization laboratory. Point-of-care ultrasound helped in the successful placement of a temporary pacemaker lead at the bedside, leading to the achievement of optimum heart rate till he got an epicardial pacemaker inserted at a later date. The fourth case is of a 45-year-old man, who had to undergo endotracheal intubation due to refractory COVID-19 related hypoxia. Upon connection to the mechanical ventilator, the peak airway pressure was found to be unusually high. On POCUS, lung sliding on the left side was missing, which led to the diagnosis of rightmainstem endobronchial intubation. Repositioning of the endotracheal tube led to a decrease in peak airway pressures and optimal delivery of mechanical ventilation to the patient. Conclusion: Point-of-care ultrasound can help diagnose and manage significant underlying diseases, help take/modify decisions on specific therapies, and overcome resource limitations for performing specialized therapeutic procedures in COVID-19 patients.
{"title":"Role of Point-of-care Ultrasound in Management of Critically Ill COVID-19 Patients: A Case Series","authors":"J. Muralidharan, G. Puri, K. Gourav, M. Rohit, S. Angurana, I. Biswas, Dheemta Toshkhani, A. Agarwal, A. Gawalkar, Vivek Jaswal","doi":"10.5005/jp-journals-10034-1104","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1104","url":null,"abstract":"Ab s t r Ac t Introduction: Hereby, we describe a series of four critically ill COVID-19 patients where point-of-care ultrasound (POCUS) helped in guiding specific management. Case description: The first case is a 62-year-old COVID-19 positive woman where severe aortic stenosis and severe left ventricular dysfunction were diagnosed by POCUS, which led to the institution of specific medical management leading to resolution of her symptoms and referral to the cardiac surgical department for further surgical management. The second case is a 51-year-old woman admitted with severe hypoxia secondary to COVID-19 infection. She was being considered for tocilizumab therapy. However, POCUS revealed the presence of pericardial effusion, which, on evaluation, was found to be due to tubercular. This led to withholding tocilizumab therapy. Anti-tubercular therapy, instead, was instituted. The third case is a 13-month-old child, who presented with a history of recurrent syncopes and was diagnosed as a case of congenital heart block on electrocardiography (ECG). However, due to his COVID-19 positive status, rescue temporary pacing could not be performed at the catheterization laboratory. Point-of-care ultrasound helped in the successful placement of a temporary pacemaker lead at the bedside, leading to the achievement of optimum heart rate till he got an epicardial pacemaker inserted at a later date. The fourth case is of a 45-year-old man, who had to undergo endotracheal intubation due to refractory COVID-19 related hypoxia. Upon connection to the mechanical ventilator, the peak airway pressure was found to be unusually high. On POCUS, lung sliding on the left side was missing, which led to the diagnosis of rightmainstem endobronchial intubation. Repositioning of the endotracheal tube led to a decrease in peak airway pressures and optimal delivery of mechanical ventilation to the patient. Conclusion: Point-of-care ultrasound can help diagnose and manage significant underlying diseases, help take/modify decisions on specific therapies, and overcome resource limitations for performing specialized therapeutic procedures in COVID-19 patients.","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126488358","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 : 1900-01-01DOI: 10.5005/jp-journals-10034-1102
Sambhunath Das, Devishree Das
Intraoperative transesophageal echocardiography (TEE) examination has evolved in cardiac and major vascular surgeries. It is not only useful in guiding hemodynamic interventions but also useful in surgical decision-making. It is necessary for the detection of intracardiac mass. Primary leiomyosarcoma confined to inferior vena cava (IVC) and without cardiac extension entails en bloc excision which seldom requires intracardiac exploration unless embolization. The embolization of the tumor causes hemodynamic alteration and can be confirmed by perioperative TEE evaluation. We are reporting a case where TEE salvaged from the wreckage by converting an extracardiac vascular procedure to intracardiac exploration under cardiopulmonary bypass.
{"title":"Resection of Inferior Vena Cava Leiomyosarcoma: Transesophageal Echocardiography Salvaged from Wreckage","authors":"Sambhunath Das, Devishree Das","doi":"10.5005/jp-journals-10034-1102","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1102","url":null,"abstract":"Intraoperative transesophageal echocardiography (TEE) examination has evolved in cardiac and major vascular surgeries. It is not only useful in guiding hemodynamic interventions but also useful in surgical decision-making. It is necessary for the detection of intracardiac mass. Primary leiomyosarcoma confined to inferior vena cava (IVC) and without cardiac extension entails en bloc excision which seldom requires intracardiac exploration unless embolization. The embolization of the tumor causes hemodynamic alteration and can be confirmed by perioperative TEE evaluation. We are reporting a case where TEE salvaged from the wreckage by converting an extracardiac vascular procedure to intracardiac exploration under cardiopulmonary bypass.","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134122931","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 : 1900-01-01DOI: 10.5005/jp-journals-10034-1098
B. Kumar, R. Ganesan, Srinath Damodaran, K. Gourav, Indranil Biswas
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.
{"title":"Indispensable Role of Transesophageal Echocardiography in Elucidating the Mechanism of Bioprosthetic Heart Valve Dysfunction Causing Severe Regurgitation: A Case Report","authors":"B. Kumar, R. Ganesan, Srinath Damodaran, K. Gourav, Indranil Biswas","doi":"10.5005/jp-journals-10034-1098","DOIUrl":"https://doi.org/10.5005/jp-journals-10034-1098","url":null,"abstract":"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.","PeriodicalId":344660,"journal":{"name":"Journal of Perioperative Echocardiography","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130075713","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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