Intraoperative Echocardiographic Detection of an Anomalous Left Main Coronary Artery

Abstract

Transesophageal echocardiography (TEE) has become a useful intraoperative tool for the cardiac anesthesiologist; however, it continues to extend its utility to noncardiac surgery as well. Hemodynamic instability, cardiac tamponade, and aortic dissection among others are readily diagnosed with TEE, providing an opportunity for prompt treatment. Many anesthesiologists, as well as intensivists and cardiac surgeons, seek proficiency with TEE in preparation for the National Board of Echocardiography's Perioperative Transesophageal Echocardiography examination and certification. Savage et al have developed a self-assessment DVD that in conjunction with a standard TEE textbook provides an excellent background for TEE competency and certification.The DVD, Interactive TEE Review: Self-Assessment Examination (Lippincott Williams & Wilkins, released October 1, 2007), is a fantastic supplement to a comprehensive TEE textbook for reviewing key principles and common pathologies. The review is divided into study and test modes, allowing for direct feedback or a video-based examination. Approximately 400 questions are used covering 31 chapters with topics including physics of ultrasound, surgical anatomy, assessment of valvular function, and organization of a TEE service, among others.Once the study or test mode is selected, easy-to-navigate menus allow the selection of any or all of the various chapters for review as well as the number of questions desired. The basic format provides a stem question in the top left with multiple-choice answers below. If a TEE loop or still image is involved, it is displayed conveniently on the right with the ability to enlarge to a full view for closer review. When in study mode, correctness and explanations are provided upon answer selection, whereas test mode provides a summary with opportunity for similar explanations upon examination completion. The 2 modes combined provide an opportunity to the echocardiographer for review and self-assessment within the same 31 essential chapters.The review provides an excellent variety of questions with superb image-quality video loops; however, future versions of the review may benefit from an increase in the volume of questions. Although the explanations to questions are mostly sufficient, another potential addition to further complete the review DVD may include references to standard TEE texts so that the trainee may further investigate areas of deficiency.This new interactive TEE review DVD offers a splendid coverage of echocardiography to both the established and training anesthesiologists within the cardiac and noncardiac realms. Savage et al are applauded for their work in creating a well-designed, easy-to-navigate, educational TEE resource. Intraoperative Echocardiographic Detection of an Anomalous Left Main Coronary ArteryTo the Editor:A nonsmoking 40-year-old man presented for elective coronary angiography because of atypical precordial pain in conjunction with dyspnea during heavy exercise for a duration of 3 months. The coronary angiography r...

Potential for Using 3D Technology to Image the Origins of the Coronary Arteries

“…Other examples of anomalous origins of coronary arteries that can occur include separate origins of left anterior descending and left circumflex coronary arteries from the left sinus of Valsalva, 38 left anterior descending or left circumflex coronary arteries originating from the pulmonary artery, 39 left anterior descending artery arising from the posterior coronary cusp, 3 or a single ostium giving rise to all of the coronary arteries (Figure 8). 5,40 In a study of 126,595 patients undergoing coronary angiography, separate ostia of the left anterior descending and left circumflex coronary arteries from the left coronary cusp were found in 0.41%.…”