ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography

Shanewise, Jack S.; Cheung, Albert T.; Aronson, Solomon; Stewart, William J.; Weiss, Richard L.; Mark, Jonathan B.; Savage, Robert M.; Sears-Rogan, Pamela; Mathew, Joseph P.; Quiñones, Miguel Á.; Cahalan, Michael K.; Savino, Joseph S.

doi:10.1097/00000539-199910000-00010

Cited by 226 publications

(180 citation statements)

References 44 publications

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“…After positioning of the mTEE probe, three standard TEE views [11] were acquired, recorded and evaluated at the time of ICU admission or at the time of occurrence of hemodynamic instability by the ICU specialist in charge of the patients care: transgastric mid-esophageal short axis view, mid-esophageal four chamber view, and mid-esophageal ascending aortic short axis view. Left ventricular (LV) area at end-systole (LVESA) and at end-diastole (LVEDA) was measured from the transgastric mid-esophageal short axis view, the fractional area change (FAC) was calculated as LVEDA-LVESA/LVEDA and used to grade LV ejection fraction as normal (FAC >50%), moderately decreased (FAC 40 to 50%) or severely decreased (FAC <40%).…”

Section: Methodsmentioning

confidence: 99%

“…Similarly, the ratio of right to left ventricular (RV) area was determined by measurements at end-diastole in the ME 4 chamber view. A ratio >0.6 was used as indicator of RV dysfunction [11]. The collapsibility of the superior vena cava was rated by calculating the collapsibility index, that is, the inspiratory decrease in superior vena cava diameter.…”

Section: Methodsmentioning

confidence: 99%

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Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe

et al. 2013

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IntroductionHemodynamic management in intensive care patients guided by blood pressure and flow measurements often do not sufficiently reveal common hemodynamic problems. Trans-esophageal echocardiography (TEE) allows for direct measurement of cardiac volumes and function. A new miniaturized probe for TEE (mTEE) potentially provides a rapid and simplified approach to monitor cardiac function. The aim of the study was to assess the feasibility of hemodynamic monitoring using mTEE in critically ill patients after a brief operator training period.MethodsIn the context of the introduction of mTEE in a large ICU, 14 ICU staff specialists with no previous TEE experience received six hours of training as mTEE operators. The feasibility of mTEE and the quality of the obtained hemodynamic information were assessed. Three standard views were acquired in hemodynamically unstable patients: 1) for assessment of left ventricular function (LV) fractional area change (FAC) was obtained from a trans-gastric mid-esophageal short axis view, 2) right ventricular (RV) size was obtained from mid-esophageal four chamber view, and 3) superior vena cava collapsibility for detection of hypovolemia was assessed from mid-esophageal ascending aortic short axis view. Off-line blinded assessment by an expert cardiologist was considered as a reference. Inter-rater agreement was assessed using Chi-square tests or correlation analysis as appropriate.ResultsIn 55 patients, 148 mTEE examinations were performed. Acquisition of loops in sufficient quality was possible in 110 examinations for trans-gastric mid-esophageal short axis, 118 examinations for mid-esophageal four chamber and 125 examinations for mid-esophageal ascending aortic short axis view. Inter-rater agreement (Kappa) between ICU mTEE operators and the reference was 0.62 for estimates of LV function, 0.65 for RV dilatation, 0.76 for hypovolemia and 0.77 for occurrence of pericardial effusion (all P < 0.0001). There was a significant correlation between the FAC measured by ICU operators and the reference (r = 0.794, P (one-tailed) < 0.0001).ConclusionsEchocardiographic examinations using mTEE after brief bed-side training were feasible and of sufficient quality in a majority of examined ICU patients with good inter-rater reliability between mTEE operators and an expert cardiologist. Further studies are required to assess the impact of hemodynamic monitoring by mTEE on relevant patient outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe

et al. 2013

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“…The sequences were measured with an oblique sagittal view which corresponded to a similar view seen with a parasternal long-axis view via transthoracic echocardiogram and a midesophageal long-axis view via TEE for valve measurement. 36,37 The annulus and aortic root sizes were 26+/−2 mm and 22+/−3 mm, respectively. A 26mm CoreValve ® bioprosthesis was used for all eight experiments.…”

Section: Resultsmentioning

confidence: 96%

Real-time magnetic resonance imaging–guided transcatheter aortic valve replacement

Miller

Mazilu

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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OBJECTIVES Transcatheter aortic valve replacement (TAVR) has become a treatment option for otherwise inoperable or high risk patients. Currently TAVR is performed with a combination of fluoroscopy and transesophageal echocardiography, which has visual limitations including a two dimensional view and poor soft tissue contrast. Real-time magnetic resonance imaging (rtMRI) guidance overcomes these limitations with a three dimensional view of anatomical structures, improved soft tissue contrast, and allows pinpoint accuracy of device delivery. To date a device clinically available in the US has not been used for rtMRI TAVR. We present our results using the CoreValve® device. METHODS The Medtronic CoreValve® delivery catheter system was minimally modified by the investigators to be MRI compatible by replacing the stainless steel components with fluoroplastic resin and high density polyethylene components. Eight swine ranging between 60 and 90 kg underwent rtMRI guided TAVR with an active guidewire via a left subclavian approach. RESULTS Two imaging planes (long axis view and short axis view) were utilized simultaneously for real-time imaging during implantation. Successful deployment was performed without rapid ventricular pacing or cardiopulmonary bypass. Post-deployment images were acquired to evaluate the final valve position in addition to valvular and cardiac function. CONCLUSIONS Our results show that the CoreValve® can be easily and effectively deployed from the left subclavian approach by utilizing rtMRI guidance, a minimally modified valve delivery catheter system, and an active guidewire. This method allows superior visualization prior to deployment, thereby allowing deployment of the valve with pinpoint accuracy. rtMRI has the added benefit of the ability to perform immediate post-procedural functional assessment, while eliminating the morbidity of radiation exposure, rapid ventricular pacing, contrast media renal toxicity, and a more invasive procedure. Use of a commercially available device brings this rtMRI guided approach closer to a clinical reality.

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“…TEE allows for a detailed evaluation of the entire LA by achieving a mid-esophageal (ME) four chamber view, two chamber view, and bi-caval view [6]. In the supine and Trendelenburg positions during weaning from CPB, particulates in the LA with a greater specific gravity than that of blood migrate posteriorly and superiorly, while air bubbles float up against the septum.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic detection of left atrial mobile calcium debris of trido valve surgery: a case report

Song

Shim

Sun

et al. 2014

Korean J Anesthesiol

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Calcification of the cardiac chambers is among the challenges associated with reoperative cardiac surgeries by increasing the risk of systemic embolization. We experienced a case of an unexpected detected mass by intraoperative transesophageal echocardiography during weaning from cardiopulmonary bypass in a patient undergoing trido mitral and tricuspid valve replacement surgery. The surgically removed mass was identified as calcified tissue. This case shows the importance of careful echocardiographic evaluation of the left heart in patients undergoing repeat valve surgery given their greater potential for embolic sources.

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Cited by 226 publications

References 44 publications

Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe

Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe

Real-time magnetic resonance imaging–guided transcatheter aortic valve replacement

Echocardiographic detection of left atrial mobile calcium debris of trido valve surgery: a case report

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