Jaffrey Kalaiselvan, R. Kashav, Jasvinder K Kohli, R. Magoon, Iti Shri, V. Grover, Narender Singh Jhajharia
Abstract Over the past decades, there have been noteworthy advancements in the cardiac surgical practice that have assisted fast-tracking and enhanced recovery after cardiac surgery (ERACS). With that said, intensive care unit (ICU) readmission in this high-risk patient cohort entails a significant morbidity–mortality burden. As an extension of the same, there has been a heightened emphasis on a comprehensive evaluation of the predisposition to readmission following a primary ICU discharge. However, the variability of the institutional perioperative practices and the research complexities compound our understanding of this heterogeneous outcome of readmission, which is intricately linked to both patient and organizational factors. Moreover, a discussion on ICU readmission in the recent times can only be rendered comprehensive when staged in close conjunction to the fast-tracking practices in cardiac surgery. From a more positive probing of the matter, a preventative outlook can likely mitigate a part of the larger problem of ICU readmission. Herein, focused cardiac prehabilitation programs can play a potential role given the emerging literature on the positive impact of the former on the most relevant readmission causes. Therefore, the index review article aims to address the subject of cardiac surgical ICU readmission, highlighting the magnitude and burden, the causes and risk-factors, and the research complexities alongside deliberating the topic in the present-day context of ERACS and cardiac prehabilitation.
{"title":"ICU Readmission in Cardiac Surgical Subset: A Problem Worth Pondering","authors":"Jaffrey Kalaiselvan, R. Kashav, Jasvinder K Kohli, R. Magoon, Iti Shri, V. Grover, Narender Singh Jhajharia","doi":"10.1055/s-0042-1759816","DOIUrl":"https://doi.org/10.1055/s-0042-1759816","url":null,"abstract":"Abstract Over the past decades, there have been noteworthy advancements in the cardiac surgical practice that have assisted fast-tracking and enhanced recovery after cardiac surgery (ERACS). With that said, intensive care unit (ICU) readmission in this high-risk patient cohort entails a significant morbidity–mortality burden. As an extension of the same, there has been a heightened emphasis on a comprehensive evaluation of the predisposition to readmission following a primary ICU discharge. However, the variability of the institutional perioperative practices and the research complexities compound our understanding of this heterogeneous outcome of readmission, which is intricately linked to both patient and organizational factors. Moreover, a discussion on ICU readmission in the recent times can only be rendered comprehensive when staged in close conjunction to the fast-tracking practices in cardiac surgery. From a more positive probing of the matter, a preventative outlook can likely mitigate a part of the larger problem of ICU readmission. Herein, focused cardiac prehabilitation programs can play a potential role given the emerging literature on the positive impact of the former on the most relevant readmission causes. Therefore, the index review article aims to address the subject of cardiac surgical ICU readmission, highlighting the magnitude and burden, the causes and risk-factors, and the research complexities alongside deliberating the topic in the present-day context of ERACS and cardiac prehabilitation.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"11 1","pages":"201 - 205"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77088248","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}
Heart transplantation is the only cure for patients with end-stage heart failure; the shortage of donors has led to a high mortality rate among these patients. A left ventricular assist device (LVAD) is a device to provide mechanical circulatory support for patients unresponsive to heart failure therapy. Echocardiography should be considered an indispensable tool in the evaluation of patients with an LVAD. In fact, as outlined in this review, it provides useful and readily available information that could be crucial for the patient's survival. In the preoperative assessment, it is important to detect through echocardiography conditions and parameters that could hint the development of a postoperative complication, in order to treat them before LVAD implant or to consider the patient ineligible to this advanced treatment.
{"title":"Echocardiography for Left Ventricular Assist Device Patients","authors":"P. Menon, P. Kapoor, Minati Choudhury","doi":"10.1055/s-0042-1757363","DOIUrl":"https://doi.org/10.1055/s-0042-1757363","url":null,"abstract":"Heart transplantation is the only cure for patients with end-stage heart failure; the shortage of donors has led to a high mortality rate among these patients. A left ventricular assist device (LVAD) is a device to provide mechanical circulatory support for patients unresponsive to heart failure therapy. Echocardiography should be considered an indispensable tool in the evaluation of patients with an LVAD. In fact, as outlined in this review, it provides useful and readily available information that could be crucial for the patient's survival. In the preoperative assessment, it is important to detect through echocardiography conditions and parameters that could hint the development of a postoperative complication, in order to treat them before LVAD implant or to consider the patient ineligible to this advanced treatment.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83791131","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}
U. Chowdhury, Niwin George, S. B., Balaji Chandhirasekar, S. Goja, Nagasai Manjusha, N. Pandey, P. Kapoor
Abstract Obstructive coronary sinus totally anomalous pulmonary venous connection although rare, is associated with a high mortality. A 2-month-old female child diagnosed with obstructive coronary sinus type of totally anomalous pulmonary venous connection and severe pulmonary arterial hypertension underwent complete unroofing of the coronary sinus by the “coronary sinus cutback technique” of Malm with left atrial augmentation and atrial septal fenestration.
{"title":"Technical Details of Rechanneling of Obstructive Coronary Sinus Type of Totally Anomalous Pulmonary Venous Connection Using Malm's Coronary Sinus Cutback Technique and Left Atrial Augmentation: A Video Presentation","authors":"U. Chowdhury, Niwin George, S. B., Balaji Chandhirasekar, S. Goja, Nagasai Manjusha, N. Pandey, P. Kapoor","doi":"10.1055/s-0042-1759806","DOIUrl":"https://doi.org/10.1055/s-0042-1759806","url":null,"abstract":"Abstract Obstructive coronary sinus totally anomalous pulmonary venous connection although rare, is associated with a high mortality. A 2-month-old female child diagnosed with obstructive coronary sinus type of totally anomalous pulmonary venous connection and severe pulmonary arterial hypertension underwent complete unroofing of the coronary sinus by the “coronary sinus cutback technique” of Malm with left atrial augmentation and atrial septal fenestration.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"29 1","pages":"219 - 221"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77922058","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}
Sepsis in patients on extracorporeal membrane oxygenation (ECMO) remains a serious complication. Its presence is a poor prognostic marker and increases overall mortality. Adult patients with prolonged duration on ECMO are at high risk of developing sepsis. Ventilator-associated pneumonia and bloodstream infections are the main sources of infection these patients. A strong early suspicion, drawing adequate volume for blood cultures, and early and timely administration of empirical antibiotics can help control the infection and decrease the morbidity and mortality. The diagnostic and the treatment are both challenging. Cardiac patients have increased risk of nosocomial infection while on ECMO, which may be in part due to longer cannulation times, as well as increased likelihood of undergoing major procedures or having an open chest.
{"title":"Sepsis Associated with Extracorporeal Membrane Oxygenation","authors":"Aashish Jain, Y. Mehta","doi":"10.1055/s-0042-1757392","DOIUrl":"https://doi.org/10.1055/s-0042-1757392","url":null,"abstract":"Sepsis in patients on extracorporeal membrane oxygenation (ECMO) remains a serious complication. Its presence is a poor prognostic marker and increases overall mortality. Adult patients with prolonged duration on ECMO are at high risk of developing sepsis. Ventilator-associated pneumonia and bloodstream infections are the main sources of infection these patients. A strong early suspicion, drawing adequate volume for blood cultures, and early and timely administration of empirical antibiotics can help control the infection and decrease the morbidity and mortality. The diagnostic and the treatment are both challenging. Cardiac patients have increased risk of nosocomial infection while on ECMO, which may be in part due to longer cannulation times, as well as increased likelihood of undergoing major procedures or having an open chest.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89341998","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}
A 57-year-old male patient presented to the emergency department with acute onset severe and tearing pain in the back. He was a chronic smoker and was a known hypertensive. He was admitted in view of type B aortic dissection with entry tear distal to left subclavian artery (LSCA) and underwent thoracic endovascular aortic repair (TEVAR) procedure for the same. Two stents (34–30–200mm size, Ankura, Lifetech, Nanshan District, Shenzhen, China) were placed overlapping each other to cover the dissection flap starting from distal end of left common carotid artery to proximal part of celiac artery. Post-stenting, patient developed recurrent episodes of melena, abdominal distension, and fever that were managed conservatively. Two months later, a routine follow-up computed tomographic aortic angiography revealed a focal contrast filled outpouching (2.1*1.9cm) extending from the proximal part of endovascular stent with surrounding thrombosis from anterior wall of the aortic arch. On inspecting the arch vessels, an ostial occlusion of LSCA was also discovered. Routine blood investigations were all within normal limits. Two-dimensional echocardiography showed a normal biventricular function with concentric left ventricular hypertrophy. All valves were normal.
{"title":"The Importance of TEE Examination in Patients with Pseudoaneurysm of Arch of Aorta Post-TEVAR Procedure","authors":"Tanya Mital, P. Kapoor","doi":"10.1055/s-0042-1756473","DOIUrl":"https://doi.org/10.1055/s-0042-1756473","url":null,"abstract":"A 57-year-old male patient presented to the emergency department with acute onset severe and tearing pain in the back. He was a chronic smoker and was a known hypertensive. He was admitted in view of type B aortic dissection with entry tear distal to left subclavian artery (LSCA) and underwent thoracic endovascular aortic repair (TEVAR) procedure for the same. Two stents (34–30–200mm size, Ankura, Lifetech, Nanshan District, Shenzhen, China) were placed overlapping each other to cover the dissection flap starting from distal end of left common carotid artery to proximal part of celiac artery. Post-stenting, patient developed recurrent episodes of melena, abdominal distension, and fever that were managed conservatively. Two months later, a routine follow-up computed tomographic aortic angiography revealed a focal contrast filled outpouching (2.1*1.9cm) extending from the proximal part of endovascular stent with surrounding thrombosis from anterior wall of the aortic arch. On inspecting the arch vessels, an ostial occlusion of LSCA was also discovered. Routine blood investigations were all within normal limits. Two-dimensional echocardiography showed a normal biventricular function with concentric left ventricular hypertrophy. All valves were normal.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79458169","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}
Abstract Patient admitted to intensive care units frequently have fevers. A less common cause for fever is a drug-induced fever. For patients who are candidates for heart transplantation, persistent fevers can place a hold on their transplant candidacy until the etiology is found and the fevers resolve. We present a case of a patient with dilated cardiomyopathy who experienced fevers thought secondary to heparin that improved only with discontinuation of therapy and later underwent successful heart transplantation. Only three prior case reports of heparin-induced fevers are currently described in literature.
{"title":"Heparin-Induced Fever in a Cardiac Transplant Candidate","authors":"Payal R. Patel, Bria Giacomino","doi":"10.1055/s-0042-1759811","DOIUrl":"https://doi.org/10.1055/s-0042-1759811","url":null,"abstract":"Abstract Patient admitted to intensive care units frequently have fevers. A less common cause for fever is a drug-induced fever. For patients who are candidates for heart transplantation, persistent fevers can place a hold on their transplant candidacy until the etiology is found and the fevers resolve. We present a case of a patient with dilated cardiomyopathy who experienced fevers thought secondary to heparin that improved only with discontinuation of therapy and later underwent successful heart transplantation. Only three prior case reports of heparin-induced fevers are currently described in literature.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"18 1","pages":"222 - 224"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83322297","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}
Extracorporeal membrane oxygenation (ECMO) has a clearly defined role in preoperative and postoperative transplant management of both heart and lung transplant. It is used on the recipient as a bridge to transplant, until the organs are made available. It provides a good support during surgery as a partial cardiopulmonary bypass. Posttransplant, it again provides support in case of an acute rejection or when graft dysfunction occurs, postoperatively. When ECMO as an indication is continued to provide support. Thus, ECMO has a positive impact on lung transplant outcomes.1 In a randomized control study, known as the CAESAR TRIAL in 2009, ECMO was confirmed as a definitive modern of treatment for ARDS.2 It gained the popularity for treating adult ARDS. Veith et al in 19773 reported that can be used as a support or as a bridge to lung transplant, with both short-term and long-term results. Thus, today in 2022, ECMO has emerged as a preferred modality of intraoperative support over conventional CPB.4 It was the reports of successful therapy of post graft dysfunction (PGD) with ECMO that prompted the use of ECMO intraoperatively. Currently, ECMO for lung transplant patients is the only rescue therapy to salvage a graft affected by severe PGD.
{"title":"Extracorporeal Membrane Oxygenation for Lung Transplantation","authors":"P. Kapoor","doi":"10.1055/s-0042-1757364","DOIUrl":"https://doi.org/10.1055/s-0042-1757364","url":null,"abstract":"Extracorporeal membrane oxygenation (ECMO) has a clearly defined role in preoperative and postoperative transplant management of both heart and lung transplant. It is used on the recipient as a bridge to transplant, until the organs are made available. It provides a good support during surgery as a partial cardiopulmonary bypass. Posttransplant, it again provides support in case of an acute rejection or when graft dysfunction occurs, postoperatively. When ECMO as an indication is continued to provide support. Thus, ECMO has a positive impact on lung transplant outcomes.1 In a randomized control study, known as the CAESAR TRIAL in 2009, ECMO was confirmed as a definitive modern of treatment for ARDS.2 It gained the popularity for treating adult ARDS. Veith et al in 19773 reported that can be used as a support or as a bridge to lung transplant, with both short-term and long-term results. Thus, today in 2022, ECMO has emerged as a preferred modality of intraoperative support over conventional CPB.4 It was the reports of successful therapy of post graft dysfunction (PGD) with ECMO that prompted the use of ECMO intraoperatively. Currently, ECMO for lung transplant patients is the only rescue therapy to salvage a graft affected by severe PGD.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86089151","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}
Abstract Every health care professional does his best for mankind, but handling a patient on extracorporeal circulation places cardiac surgeons, cardiac anesthetists, and perfusionists in a separate class of health professional altogether. This is a humble effort to reminisce the research work done by Dr. Frank Gollan since his instrumental time to the current day practice, without whom it is impossible to imagine open heart surgery and circulatory arrest.
{"title":"A Trip Down the Memory Lane of Dr. Frank Gollan, an Achilles of Extracorporeal Oxygenation","authors":"Doniparthi Pradeep, Jaydeep Malakar","doi":"10.1055/s-0042-1759807","DOIUrl":"https://doi.org/10.1055/s-0042-1759807","url":null,"abstract":"Abstract Every health care professional does his best for mankind, but handling a patient on extracorporeal circulation places cardiac surgeons, cardiac anesthetists, and perfusionists in a separate class of health professional altogether. This is a humble effort to reminisce the research work done by Dr. Frank Gollan since his instrumental time to the current day practice, without whom it is impossible to imagine open heart surgery and circulatory arrest.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"21 1","pages":"235 - 238"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84792854","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}
Bleeding during or after cardiac surgery is common in adults and associated with signi fi cant utilization of blood products. 1 There is very little evidence available on patient blood management in pediatric cardiac surgery. Children typically receive transfusions perioperatively for many reasons, including developmental alterations of their hemostatic sys-tem, hemodilution, and hypothermia with cardiopulmonary bypass, systemic anticoagulation, etc. The complexity of their surgical procedures, complex cardiopulmonary inter-actions, and risk for inadequate oxygen delivery and post-operative bleeding further contribute to blood product utilization in this vulnerable population. Till date, most of the blood centers in India follow blood typing and crossmatch policy as a part of pretransfusion testing to select the right blood for these patients. In this policy, patients are typed for their ABO/RhD and received red cell transfusions based on the antihuman globulin crossmatch results. However, in type and screen policy, the transfusion services perform ABO/RhD typing and a screen for atypical antibodies of the patient ’ s blood and plasma. A negative antibodyscreen signi fi es that the patient does not demonstrate any clinically signi fi cant antibodies and, therefore, only an immediate spin or abbreviated crossmatch is required. Because an immediate spin crossmatch is a fairly simple test, taking approxi-mately 10minutes in comparison to full crossmatch that takes around 45minutes, blood is available rather quickly if the need should arise. Since blood is not unnecessarily crossmatched and reserved for a patient who might not
{"title":"Should We Implement Type and Screen Transfusion Policy in Pediatric Cardiac Surgery to Improve Patient Blood Management?","authors":"S. Datta","doi":"10.1055/s-0042-1759830","DOIUrl":"https://doi.org/10.1055/s-0042-1759830","url":null,"abstract":"Bleeding during or after cardiac surgery is common in adults and associated with signi fi cant utilization of blood products. 1 There is very little evidence available on patient blood management in pediatric cardiac surgery. Children typically receive transfusions perioperatively for many reasons, including developmental alterations of their hemostatic sys-tem, hemodilution, and hypothermia with cardiopulmonary bypass, systemic anticoagulation, etc. The complexity of their surgical procedures, complex cardiopulmonary inter-actions, and risk for inadequate oxygen delivery and post-operative bleeding further contribute to blood product utilization in this vulnerable population. Till date, most of the blood centers in India follow blood typing and crossmatch policy as a part of pretransfusion testing to select the right blood for these patients. In this policy, patients are typed for their ABO/RhD and received red cell transfusions based on the antihuman globulin crossmatch results. However, in type and screen policy, the transfusion services perform ABO/RhD typing and a screen for atypical antibodies of the patient ’ s blood and plasma. A negative antibodyscreen signi fi es that the patient does not demonstrate any clinically signi fi cant antibodies and, therefore, only an immediate spin or abbreviated crossmatch is required. Because an immediate spin crossmatch is a fairly simple test, taking approxi-mately 10minutes in comparison to full crossmatch that takes around 45minutes, blood is available rather quickly if the need should arise. Since blood is not unnecessarily crossmatched and reserved for a patient who might not","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"5 1","pages":"228 - 229"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78815484","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}
Paravalvular leak (PVL) is a common, yet challenging entity occurring due to dehiscence of the annular tissue around the prosthetic valve, resulting in regurgitation of blood retrogradely. Although any prosthetic valve can be subjected to the risk of developing PVL, it is most commonly reported with the mitral valve followed by the aortic valve. The incidence of mitral PVL is around 7 to 17%, whereas with the aortic valve it is 5 to 10%. Symptomology can vary from asymptomatic patients with mild PVL to disabling symptoms pertaining to heart failure and hemolysis. TEE plays a pivotal role in the overall assessment along with procedural guidance for their closure. Multiple two-dimensional (2D) imaging views are required to scan the entire sewing ring diameter of a prosthetic valve. Three-dimensional (3D) TEE can give crucial information such as the number, size, shape, and circumference of the defects. 3D mitral en face view can give anatomical localization of the defect. During the procedure, TEE can assist in the confirmation of the position of the guidewire through the defect and not through the prosthetic valve. It also helps to conform to the adequate positioning of the vascular plug device and unrestrictive movement of the native prosthetic heart valve. TEE when combined with fluoroscopy can help in real-time guidance of passage of the guidewire and transcatheter device in relation to the prosthetic valve. Recently, Ahmed et al have named this technology as “Fusion Technique,” where they have combined real-time 2D and 3D TEE with fluoroscopy to facilitate the closure of PVL. Now that the time of minimally invasive surgery has taken over conventional surgery and fast tracking and enhanced recovery after surgery (ERAS) is the need of the moment, percutaneous PVL closure is preferred over surgical PVL closure. A study done by Gakrinho et al showed that percutaneous PVL closure has a reasonable success rate along with a low complication rate and the results are comparable to surgical treatment in high-risk patients. We hereby share our experience of the successful closure of PVL via the transcatheter technique using various 2D and 3D techniques.
{"title":"Transesophageal Echocardiography (TEE)-Guided Paravalvular Leak (PVL) Closure: Expanding Horizons Beyond Operating Room","authors":"Rashmi Singh, P. Kapoor","doi":"10.1055/s-0042-1757369","DOIUrl":"https://doi.org/10.1055/s-0042-1757369","url":null,"abstract":"Paravalvular leak (PVL) is a common, yet challenging entity occurring due to dehiscence of the annular tissue around the prosthetic valve, resulting in regurgitation of blood retrogradely. Although any prosthetic valve can be subjected to the risk of developing PVL, it is most commonly reported with the mitral valve followed by the aortic valve. The incidence of mitral PVL is around 7 to 17%, whereas with the aortic valve it is 5 to 10%. Symptomology can vary from asymptomatic patients with mild PVL to disabling symptoms pertaining to heart failure and hemolysis. TEE plays a pivotal role in the overall assessment along with procedural guidance for their closure. Multiple two-dimensional (2D) imaging views are required to scan the entire sewing ring diameter of a prosthetic valve. Three-dimensional (3D) TEE can give crucial information such as the number, size, shape, and circumference of the defects. 3D mitral en face view can give anatomical localization of the defect. During the procedure, TEE can assist in the confirmation of the position of the guidewire through the defect and not through the prosthetic valve. It also helps to conform to the adequate positioning of the vascular plug device and unrestrictive movement of the native prosthetic heart valve. TEE when combined with fluoroscopy can help in real-time guidance of passage of the guidewire and transcatheter device in relation to the prosthetic valve. Recently, Ahmed et al have named this technology as “Fusion Technique,” where they have combined real-time 2D and 3D TEE with fluoroscopy to facilitate the closure of PVL. Now that the time of minimally invasive surgery has taken over conventional surgery and fast tracking and enhanced recovery after surgery (ERAS) is the need of the moment, percutaneous PVL closure is preferred over surgical PVL closure. A study done by Gakrinho et al showed that percutaneous PVL closure has a reasonable success rate along with a low complication rate and the results are comparable to surgical treatment in high-risk patients. We hereby share our experience of the successful closure of PVL via the transcatheter technique using various 2D and 3D techniques.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73573877","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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