Comprehensive Textbook of Perioperative and Critical Care Echocardiography

 

Description:

Thoroughly revised to reflect new advances in the field, Savage & Aronson’s Comprehensive Textbook of Perioperative and Critical Care Echocardiography, Third Edition, remains the definitive text and reference on transesophageal echocardiography (TEE). Edited by Drs. Alina Nicoara, Robert M. Savage, Nikolaos J. Skubas, Stanton K. Shernan, and Christopher A. Troianos, this authoritative reference covers material relevant for daily clinical practice in operating rooms and procedural areas, preparation for certification examinations, use of echocardiography in the critical care setting, and advanced applications relevant to current certification and practice guidelines. 

 

Table of Contents:

 

Section I: Fundamentals of Perioperative Echocardiography

Chapter 1. Physics of Ultrasound

Introduction

Echocardiography and the Properties of Ultrasound

Propagation of Ultrasound: Reflection, Refraction, and Attenuation

Specular and Nonspecular Reflection

Acoustic Impedance

Attenuation

Ultrasound Interactions and the Challenges to Signal Processing

The Piezoelectric Effect and Ultrasound

Ultrasound Transducers: The Basics

How Is the Generated Ultrasound Beam Steered?

Ultrasound Beam Geometry

Pulse-Echo Operation: Time Equals Distance

Image Display Formats

2D Echocardiography: Frames and Frame Rate

Tissue Harmonic Imaging

Contrast Echocardiography

Doppler Echocardiography

Blood Flow Hemodynamics, Flow Velocity Profiles, and Doppler Echocardiography

Doppler Principle and Doppler Frequency Shift

Continuous Wave Doppler Echocardiography

Pulsed Wave Doppler Echocardiography

High PRF Mode and Multigate Doppler

Graphical Display of Doppler Frequency Spectra

Tissue Doppler Echocardiography

Color Flow Doppler Echocardiography

Instrumentation Factors in Color Flow Doppler Imaging

Conclusions

Chapter 1: Multiple Choice Questions

Chapter 2. Doppler Echocardiography

Introduction

Blood flow Hemodynamics, flow Velocity Profiles, and Doppler Echocardiography

The Doppler Principle and Doppler Frequency Shift

Continuous Wave Doppler Echocardiography

Pulsed Doppler Echocardiography

High PRF Mode and Multigate Doppler

Graphical Display of Doppler Frequency Spectra

Tissue Doppler Echocardiography

Color Flow Doppler Echocardiography

Instrumentation Factors in Color Flow Doppler Imaging

CW, PW, and Color Flow Doppler Compared

Conclusions

Chapter 2: Multiple Choice Questions

Chapter 3. Imaging Artifacts and Diagnostic Pitfalls

Artifacts

Missing Structures

Degraded Images

Falsely Perceived Objects

Misregistered Locations

Artifacts in Doppler Analysis

Artifacts in Three-Dimensional Ultrasound

Stitching (Reconstruction) Artifacts

Dropout Artifacts

Blurring (Amplification) Artifacts

Blooming Artifact

Railroad Artifacts

Pitfalls

Right Atrium

Right Ventricle

Left Atrium

Left Atrioventricular Groove

Left Ventricle

Aortic Valve

Aorta

Pericardium

Conclusion

Chapter 3: Multiple Choice Questions

Chapter 4. Optimizing Two-Dimensional and Three-Dimensional Echocardiographic Images

Introduction

The Impact of Ultrasound Instrumentation on Image Generation and Display

Master Synchronizer (Clock)

Transducers and Spatial Resolution

Temporal Resolution and Real-Time Imaging

Amplification and Time Gain Compensation

Preprocessing

Analog-to-Digital Converters

Scan Conversion and Storage in Computer Memory

Postprocessing

Image Display, Recording, and Storage

Optimizing Three-Dimensional (3D) Images

Data Acquisition

Image Display

Specific Strategies to Optimize 3D Echo Imaging of the Cardiac Chambers

Specific Strategies to Optimize 3D Echo Imaging of the Valves

Conclusions

Chapter 4: Multiple Choice Questions

Chapter 5. Surgical Anatomy of the Heart

Fibrous Skeleton of the Heart

Cardiac Ventricles

Tricuspid Valve

Pulmonic Valve

Mitral Valve Apparatus

Mitral Valve Leaflets: Carpentier-SCA Terminology

Mitral Valve Apparatus—Duran Terminology

Aortic Root

Coronary Anatomy

Conclusion

Chapter 5: Multiple Choice Questions

Chapter 6. Comprehensive and Basic Perioperative TEE Examination

Prevention of TEE Complications

Intraoperative TEE Indications

Optimizing Image Quality

Comprehensive TEE Examination

General Considerations

TEE Probe Insertion

TEE Probe Manipulation

Left Atrium and Pulmonary Veins

Mitral Valve Midesophageal Views

Aortic Valve Midesophageal Views

Left Ventricle Midesophageal Views

Right Heart Midesophageal Views

Left Ventricle Transgastric Views

Mitral Valve Transgastric Views

Right Heart Transgastric Views

Aortic Valve Transgastric Views

TEE Examination of the Thoracic Aorta

Basic Perioperative TEE Examination

Limitations

Perioperative TEE Indications for Noncardiac Surgery

Training

Chapter 6: Multiple Choice Questions

Chapter 7. Indications for Intraoperative Transesophageal Echo

Introduction

Cardiac Surgery

Hemodynamic Instability

Trauma

Pulmonary Embolism

Venous Air Embolism

Lung Transplantation

Liver Transplantation

Renal Cell Carcinoma With IVC Extension

Adults With Congenital Heart Disease Undergoing Noncardiac Surgery

Complications

Chapter 7: Multiple Choice Questions

Chapter 8. Organization of a Perioperative Echocardiographic Service: Personnel, Equipment, Maintenance, Safety, Infection, Economics, and Continuous Quality Improvement

Personnel

Equipment and Maintenance

Safety

Complications Related to the Gastrointestinal System

Complications Related to Compression of Adjacent Structures

Contraindications

Cleaning and Disinfection of TEE Probes

Economics of an Intraoperative Echo Service

TEE Reporting and Billing

Billing for TEE

Billing Codes for Intraoperative TEE

Use of Modifiers

Bundling Issues

Diagnosis Codes

Credentialing

Assessing Quality in a Perioperative TEE Service

Chapter 8: Multiple Choice Questions

Chapter 9. Education and Training in Perioperative Echocardiography

Perioperative Echocardiography Training Programs

Resources for Perioperative Echocardiography Education

Certification in Perioperative Echocardiography

Chapter 9: Multiple Choice Questions

Chapter 10. Assessment of Global Left Ventricular Systolic Function

Normal Anatomy and Physiology of the Left Ventricle

Phases of Ventricular Systole

Left Ventricular Systolic Function

Two-Dimensional Examination of the Left Ventricle

Ejection Phase Indices of Left Ventricular Performance

Cardiac Output

Fractional Shortening

Fractional Area Change

Ejection Fraction

Calculating Preload and Afterload

Preload

Afterload

Systolic Index of Contractility (dP/dT)

Myocardial Performance Index

Tissue Doppler Imaging

Myocardial Strain by Tissue Doppler Imaging

Myocardial Deformation by Speckle Tracking

Three-Dimensional Evaluation of Global Ventricular Performance

Chapter 10: Multiple Choice Questions

Chapter 11. Regional Left Ventricular Systolic Function

Introduction

Segmental Model of the Left Ventricle

Distribution of Coronary Artery Anatomy

Clinical Application of Regional Wall Motion Analysis

Regional Ventricular Function and Ischemia Detection

Regional Ventricular Function and Nonischemic Conditions

Assessment of Myocardial Viability

Dobutamine Stress Echocardiography

Contrast-Enhanced Echocardiography

Other Echocardiographic Techniques for Assessing Regional Ventricular Function

Tissue Doppler Imaging

Speckle Tracking

Three-Dimensional Echocardiography

Chapter 11: Multiple Choice Questions

Chapter 12. Assessment of Right Ventricular Function

Introduction

Structure and Function of the Right Ventricle

Transesophageal Echocardiographic Scan Planes for Assessing the Right Ventricle

Right Ventricular Hypertrophy and Dilatation

Right Ventricular Pressure and Volume Overload and the Ventricular Septum

Right Ventricular Systolic Function—Qualitative and Regional Assessment

Right Ventricular Global Systolic Function—Quantitative Echocardiographic Assessment

Longitudinal Motion

Two-Dimensional and Three-Dimensional RV Quantification

Dimensionless RV Quantification

Right Ventricular Function—Hemodynamic Assessment

Right Ventricular Diastolic Function

Diastolic Function: Right Atrial Dimensions

Chapter 12: Multiple Choice Questions

Chapter 13. Assessment of Diastolic Function in the Perioperative Setting

Introduction

Clinical Importance of Diastolic Dysfunction

Physiology of Diastole and Pathophysiology of Dysfunction

LV Relaxation

LV Compliance

Left Atrial Function

Mitral Annular Excursion

Echocardiographic Evaluation of Left Ventricular Diastolic Function

Transmitral Inflow Velocities

Stage I: Impaired Relaxation Pattern

Stage II: Pseudonormal Pattern

Stage III: Restrictive Pattern

Pulmonary Venous Flow

Mitral Annulus Tissue Doppler Imaging

Color M-Mode Doppler: Propagation Velocity

Left Atrial Strain

Grading of Diastolic Dysfunction

Limitations of Current Techniques of Echocardiographic Assessment of Diastolic Dysfunction

Emerging Techniques for Assessing LV Diastolic Function

Right Ventricular Diastolic Function

Clinical Implications of Diastolic Dysfunction in the Perioperative Setting

Conclusions

Chapter 13: Multiple Choice Questions

Chapter 14. Assessment of the Mitral Valve

Anatomy of the Mitral Valve

Structural Integrity of the Mitral Valve

Mitral Regurgitation

Ischemic Mitral Regurgitation

Severity Estimation

Two-Dimensional Echocardiography

Qualitative Techniques

Continuous Wave Doppler Signal

Peak E-Wave Velocity

Semiquantitative Techniques

Spatial Area Mapping—Jet Area

Pulmonary Venous Waveform Patterns

Quantitative Techniques

Vena Contracta

Effective Regurgitant Orifice Area

Regurgitant Volume and Regurgitant Fraction

Three-Dimensional Echocardiography

Mitral Stenosis

Two-Dimensional Echocardiography

Mitral Valve Scoring Systems

Severity Estimation

Valve Area Calculations

Nonrheumatic Etiologies of Mitral Stenosis

Cor Triatriatum

Chapter 14: Multiple Choice Questions

Chapter 15. Assessment of the Aortic Valve

Introduction

Anatomy of the Aortic Valve

Assessing the Aortic Valve With Transesophageal Echocardiography

Midesophageal AV Short-Axis (ME AV SAX) View

Midesophageal AV Long-Axis (ME AV LAX) View

Deep Transgastric Five Chamber View

Transgastric Long-Axis View

Three-Dimensional Imaging of the AV

Aortic Stenosis

Pathophysiology

Quantification of Aortic Stenosis

Peak Aortic Valve Jet Velocity

Aortic Valve Mean Gradient Measurement

Aortic Valve Area

Indexed Aortic Valve Area

Velocity Ratio and Dimensionless Index (VTI Ratio)

Limitations With the Velocity Ratio and Dimensionless Index

Low-Flow, Low-Gradient Aortic Stenosis

Low-Flow, Low-Gradient Aortic Stenosis With Decreased LV Ejection Fraction

Low-Flow, Low-Gradient Aortic Stenosis With Preserved LV Ejection Fraction

Aortic Regurgitation

Pathophysiology

Quantification of Aortic Regurgitation

Chapter 15: Multiple Choice Questions

Chapter 16. Assessment of the Tricuspid and Pulmonic Valves

Introduction

Structure and Function of the Tricuspid and Pulmonic Valves

Structure and Function of the Tricuspid Valve

Structure and Function of the Pulmonic Valve

Transesophageal Echocardiographic Evaluation of the Tricuspid and Pulmonic Valves

Two-Dimensional and Color Flow Doppler Examination

Spectral Doppler Examination

Three-Dimensional Examination

Tricuspid Regurgitation

Pulmonic Regurgitation

Tricuspid Stenosis

Pulmonic Stenosis

Congenital Diseases of the Tricuspid and Pulmonic Valves

Ebstein Anomaly

Tricuspid Atresia

Congenital Anomalies of the Pulmonic Valve

Acquired Diseases of the Tricuspid and Pulmonic Valves

Functional Tricuspid Regurgitation

Endocarditis

Carcinoid Heart Disease

Rheumatic Heart Disease

Other Pathologic Conditions

The Ross Procedure

Chapter 16: Multiple Choice Questions

Chapter 17. Prosthetic Heart Valves

Types of Prosthetic Valves

Mechanical Valves

High-Profile Valves

Low-Profile Valves

Medtronic Hall Valve

OmniScience Valve

Gott-Daggett Valve

St. Jude Valve

Carbomedics Valve

On-X Valve

Bioprosthetic Valves

Mitral Homograft Valves

Aortic Homograft Valves

Xenografts

Hancock Porcine Valve

Carpentier-Edwards Porcine Valves

Ionescu-Shiley Valve

Carpentier-Edwards Perimount

Carpentier-Edwards Perimount Magna, Magna Ease, and Inspiris

St. Jude Medical Biocor and Trifecta

Sorin Mitroflow

Medtronic Mosaic and Mosaic Ultra

Echocardiographic Evaluation of Prosthetic Heart Valves

Standard Echo Exam

Pressure Gradients

Effective Orifice Area

Pressure Half-Time

Normal Prosthetic Valve Flow Patterns

Mechanical Valves

Physiologic Regurgitation

Pressure Recovery

Imaging Artifact With Prosthetic Valves

Star-Edwards Valve (Mitral Position)

Disc Valves

Bjork-Shiley Valve (Mitral Position)

Medtronic-Hall Valve (Mitral Position)

Bileaflet Valves

Stented Bioprosthetic Valves

Stentless Bioprosthetic Valves

Aortic Valve Homografts

Three-Dimensional TEE

Echocardiographically Detectable Pathology

Structural vs Nonstructural Damage

Prosthetic Valve Stenosis

Patient Prosthesis Mismatch

Prosthetic Valve Regurgitation

Prosthetic Valve Endocarditis

Associated Systemic Complications

Thromboembolism

Hemorrhage

Hemolysis

Chapter 17: Multiple Choice Questions

Chapter 18. Assessment of Cardiac Masses

Approach/Structures

Inferior Vena Cava/Superior Vena Cava/Right Atrium

Right Ventricle/Pulmonary Artery

Pulmonary Veins/Left Atrium/Left Atrial Appendage

Left Ventricle

Aorta

Valves

Pathology

Inferior Vena Cava/Superior Vena Cava/Right Atrium

Right Ventricle/Pulmonary Artery

Pulmonary Veins/Left Atrium/Left Atrial Appendage

Left Ventricle

Aorta/Valves

Chapter 18: Multiple Choice Questions

Chapter 19. Pericardial Diseases

Pericardial Anatomy

Pericardial Physiology

Macrophysiology

Microphysiology

Respirophasic Variation

Pericardial Pathology

Congenital Pericardial Defects

Pericarditis

Pericardial Effusion and Tamponade

Constrictive Pericarditis

Pericardial Masses

Chapter 19: Multiple Choice Questions

Section II: Advanced Perioperative Applications of Echocardiography in Cardiothoracic Surgery

Chapter 20. Cannulation and Perfusion Strategies for Cardiopulmonary Bypass

Peripheral Venous Cannulation

Femoral Arterial Cannulation

Endovascular Aortic Cross-Clamp

Percutaneous Coronary Sinus Catheters and Pulmonary Artery Vents

Percutaneous Coronary Sinus Catheters

Imaging the Coronary Sinus

Placement

Confirmation

Percutaneous PA Vents

Chapter 20: Multiple Choice Questions

Chapter 21. Epiaortic and Epicardial Imaging

Epicardial Imaging

Indications

Imaging Guidelines

Epiaortic Imaging

Indications

Imaging Guidelines

Grading Systems

Implications for Surgical Management

Imaging Technique

Epicardial Views

Epiaortic Views

Chapter 21: Multiple Choice Questions

Chapter 22. Assessment of Perioperative Hemodynamics

Doppler Measurements of Stroke Volume and Cardiac Output

Calculation of Stroke Volume

Calculation of Cardiac Output

Calculation of LVOT Stroke Volume (Fig. 22.7)

Calculation of Transaortic Valve Stroke Volume (Fig. 22.8)

Calculation of Pulmonary Annulus Stroke Volume (Fig. 22.9)

Calculation of RVOT Stroke Volume (Fig. 22.10)

Calculation of Transmitral Stroke Volume (Fig. 22.11)

Doppler Measurement of Pulmonary-To-Systemic Flow Ratio (Qp/Qs) (Fig. 22.12)

Doppler Assessment of Regurgitation

Regurgitant volume and fraction—Volumetric Method (Fig. 22.13)

Assessment of Mitral Regurgitation (Fig. 22.14)

Assessment of Aortic Regurgitation (Fig. 22.15)

Proximal Convergence Method

Simplified Proximal Convergence Method

Doppler Measurement of Pressure Gradients

Doppler Determination of Valve Area

Continuity Equation (Fig. 22.22)

Continuity Equation in Aortic Stenosis (Fig. 22.23)

Continuity Equation in Mitral Regurgitation (the Flow Convergence Method)

Continuity Equation in Mitral Stenosis (the Flow Convergence Method)

Pressure Half-time

Doppler Determination of Intracardiac Pressures

Estimation of RVSP (Fig. 22.29)

Estimation of PASP

Estimation of PADP (Fig. 22.30)

Estimation of MPAP

Estimation of LAP (Fig. 22.31)

Estimation of LVEDP (Fig. 22.32)

Doppler Measurement of DP/DT

Doppler Measurement of Vascular Resistance

Chapter 22: Multiple Choice Questions

Chapter 23. Assessment and Surgical Considerations in Ischemic/Functional Mitral Valve Surgery

Introduction

Pathophysiology

Acute Ischemic Mitral Regurgitation

Chronic Ischemic Mitral Regurgitation

Assessment of Ischemic/Functional Regurgitation Severity

Hemodynamic Considerations in Assessing MR Severity

Surgical Management

Predictors of Failed MV Repair in Ischemic MR

Dyssynchrony and Chronic Ischemic MR

Percutaneous Interventions for Ischemic/Functional MR

Chapter 23: Multiple Choice Questions

Chapter 24. Surgical Considerations and Assessment in Nonischemic Mitral Valve Surgery

Historical Perspectives

Importance of Intraoperative Echocardiography (IOE) in MV Surgery

Importance of Intraoperative EchocardiograpHy (IOE) MV Assessment in the Future of Cardiothoracic Anesthesia

Intraoperative Echocardiography and Critical Issues in MV Surgery

Organization of Chapter

Mitral Valve Apparatus

Normal Anatomy of the Mitral Valve Apparatus

Fibrous Skeleton

Mitral Annulus

Mitral Valve Leaflets

Chordae Tendinae

Papillary Muscles

Left Ventricle

Nomenclature of the Mitral Valve Apparatus

Correlation With Imaging Planes: the 2D Examination of the Mitral Valve

Midesophageal Four-Chamber MV and Variations

Midesophageal Four-Chamber MV (ME 4Ch MV)

Midesophageal Five-Chamber MV (ME 5Ch MV)

Lower-Esophageal Four-Chamber MV (LE 4Ch MV)

Midesophageal Commissural MV and Variations

Midesophageal Commissural MV (ME Com MV)

Midesophageal Commissural Right MV (ME ComR MV)

Midesophageal Commissural Left MV (ME ComL MV)

Midesophageal Two-Chamber MV and Variations

Midesophageal Two-Chamber MV (ME 2Ch MV)

Midesophageal Two-Chamber Right MV (ME 2ChR MV)

Midesophageal Two-Chamber Left MV (ME 2ChL MV)

Midesophageal Long-Axis MV and Variations

Midesophageal Long-Axis MV (ME LAX MV)

Midesophageal Long-Axis Right MV (ME LAXR MV)

Midesophageal Long-Axis Left MV (ME LAXL MV)

Transgastric Basal Short Axis (TG SAXB)

Transgastric Two Chamber (TG 2Ch)

Intraoperative Examination Approach

Principles of Intraoperative Examination (Table 24.5)

Intraoperative Echocardiography Examination and Outcomes

Pre–Cardiopulmonary Bypass (Pre-CPB IOE)

The Pre-CPB IOE Exam and Outcome Studies (Table 24.7)

New Clinical Information

Determine Mechanism and Probability of Repair

Variances With Preoperative MV Dysfunction Severity

Predicting Complications

Systolic Anterior Motion With LVOT Obstruction (LVOTO)

Periannular Annular Disruption

LV Dysfunction

Cannulation-Perfusion and Myocardial Protection Strategy

Post-CPB Exam and Outcomes

Post-CPB Clinical Issues (Tables 24.8, 24.9, 24.17, and 24.18)

Post-CPB Complications

Post-CPB Outcomes

Mitral Stenosis

Micro-Air and LV Function

Aortic Dissection

Post-CPB LV Dysfunction

Annular Disruption Following Surgical Debridement

Iatrogenic Shunts and Fistulas

Perivalvular MR Following MVR

Systematic IOE Examination in MV Surgery

Abbreviated Overview Exam (Table 24.10; Fig. 24.24) (II)

Focused Diagnostic IOE Exam in MV Surgery (Table 24.11)

General Comprehensive Exam

Pathology

Mitral Regurgitation

Etiology and Mechanisms of Mitral Regurgitation (Tables 24.12-24.14)

Mechanisms of Mitral Regurgitation (Fig. 24.63; Tables 24.13-24.15)

Type I: Normal Leaflet Motion (Fig. 24.63)

Type II: Excessive Leaflet Motion (Fig. 24.63)

Type III: Restricted Leaflet Motion (Fig. 24.63)

Intraoperative Echocardiography and Mechanisms of MVAp Dysfunction

Type I: Normal Leaflet Motion (Fig. 24.63)

Type II: Excessive Leaflet Motion (Fig. 24.63)

Type III Restricted Leaflet Motion (Fig. 24.63)

Comparison of IOE Exam and Direct Surgical Inspection (Tables 24.14 and 24.15)

Surgical Technique and IOE Characterization (Tables 24.14 and 24.15)

IOE Assessment of MR Severity (Tables 24.16-24.18)

Two-Dimensional IOE

Doppler Assessment of MR

Color-Flow Doppler Maximal Jet Area (MJA)

Vena Contracta Diameter (VCD)

Proximal Flow Convergence

Simplified PISA Method (Fig. 24.65; Table 24.18)

Continuous Wave Doppler

Pulse Wave Doppler

Mitral Stenosis

Severity Assessment (Table 24.21)

IOE Two-Dimensional Assessment of Severity of MS

Doppler Methods of Severity Assessment

IOE Findings Associated With MV Dysfunction

Associated Valvular or Coexisting Cardiac Pathology

Aortic Stenosis or Regurgitation in Patient for MV Surgery

Endocarditis of the Mitral and Aortic Valves

Mitral Valve Procedures

Introduction

Mitral Valve Repair Historical Perspective

MV Repair for Rheumatic Disease

MV Repair for Endocarditis

MV Repair for Ischemic Heart Disease

MV Repair for Myxomatous MV Disease

Clinical Guidelines for MV Repair

Moderate MR in Patients for Aortic Valve Surgery

Mitral Valve Replacement

Transcatheter Approaches to Mitral Valve Disease

Pre-CPB IOE Exam

Post-CPB IOE Exam

Intraoperative Three-Dimensional Echocardiography of the Mitral Valve

Chapter 24: Multiple Choice Questions

Chapter 25. Assessment and Surgical Considerations in Aortic Valve Surgery

Role of TEE During Aortic Valve Surgery

Clinical Dilemmas During Aortic Valve Surgery

Moderate Aortic Stenosis

Low-Gradient Aortic Stenosis

Hemodynamic Management With Altered Ventricular Compliance

Focused Intraoperative Echocardiography Examination for Aortic Valve Surgery

Specific Aortic Valve Procedures

Aortic Valve Replacement

Stentless and Sutureless Prosthetic Aortic Valves

Aortic Valve Repair

Combined Aortic Valve and Aortic Root Surgery

Ross Procedure

Commando Procedure

Cor-Knot

Chapter 25: Multiple Choice Questions

Chapter 26. Assessment and Surgical Considerations During Open and Endovascular Thoracic Aortic Surgery

Anatomy of the Thoracic Aorta

Transesophageal Echocardiography in the Examination of the Aorta

Introduction

Transesophageal Echocardiography Views

Overview of Thoracic Aortic Diseases

Aortic Aneurysms

Aortic Dissections

Traumatic Injuries

Intramural Hematoma

Atherosclerotic Disease

Coarctation and Other Congenital Anomalies

Intraoperative Role of TEE in Aortic Disease

Thoracic Aortic Aneurysm

Thoracic Aortic Atheroma

Type A Aortic Dissections

Confirmation of the Diagnosis

Assessment of the Aortic Root, Aortic Valve, and Coronary Ostia

Assessment of Global and Regional Myocardial Function

Monitoring for LV Distention Cooling

Postrepair Assessment

Type B Aortic Dissections Open Surgical Repairs

Thoracic Endovascular Aortic Repair Procedure

Guiding Stent-Graft Placement

Endoleaks Classification

Detecting Endoleaks

Monitoring Cardiac Performance During TEVAR

Limitations of TEE

Role of Intravascular Ultrasound

Summary and Future Directions

Chapter 26: Multiple Choice Questions

Chapter 27. The Assessment of a Patient With Endocarditis

Epidemiology and Risk Factors

Diagnosis

Echocardiography

Vegetation

Complications Secondary to IE

Valvular Regurgitation

Abscess and Perivalvular Involvement

Pseudoaneurysms and Intracardiac Fistulae

The Prognostic Utility of Echocardiography and IE

The Role of 3D Echocardiography

Surgical Indications for Infective Endocarditis

Intraoperative Assessment

Conclusion

Chapter 27: Multiple Choice Questions

Chapter 28. Hemodynamic Assessment While Weaning Off Cardiopulmonary Bypass

Introduction

Epidemiology

A Proposed Focused TEE Examination During Weaning Off CPB

Echocardiographic Associations for Hemodynamic Aims

Preload

Regional LV function

Difficult Weaning Off CPB

Preload

LV Failure

RV Failure

Structural Defects

Inappropriate Vasodilation

Conclusion

Chapter 28: Multiple Choice Questions

Section III: Advanced Perioperative Applications of Echocardiography in End-Stage Heart and Lung Failure

Chapter 29. Echocardiographic Assessment of Cardiomyopathies

Dilated Cardiomyopathy

Echocardiographic Features

Hypertrophic Cardiomyopathy

Echocardiographic Features

Restrictive Cardiomyopathy

Echocardiographic Features

Arrhythmogenic Right Ventricular Cardiomyopathy

Echocardiographic Features

Unclassified Cardiomyopathies

Role of Echocardiography: Prognostication and Treatment

Summary

Chapter 29: Multiple Choice Questions

Chapter 30. Assessment and Surgical Consideration in Pericardiectomy

The Normal Pericardium

Clinical Perspectives

Pericardial Clinical Syndromes

Epidemiology and Etiologies of Constrictive Pericarditis

Clinical Presentation of Constrictive Pericarditis

Constrictive Pericarditis—Echocardiographic Assessment

Two-Dimensional Imaging and M-Mode

Doppler Echocardiography and Strain Assessment

Diagnostic Criteria

Other Multimodality Imaging

Pericardiectomy—Surgical Considerations

Indications

Surgical Approach

Intraoperative Echocardiography

Outcomes

Conclusion

Chapter 30: Multiple Choice Questions

Chapter 31. Assessment and Surgical Considerations in Cardiac Transplantation

Transesophageal Echocardiography in Cardiac Transplantation

The Role of TEE in Cardiac Donor Screening

Intraoperative Monitoring in the Pretransplantation Period

Left Ventricular Volume

Left Ventricular Contractility

Intracavitary Thrombus

Atherosclerosis of the Ascending Aorta and Aortic Arch

Right Ventricular Dilation or Hypertrophy

Assessment of Left Ventricular Assist Device Explant

Hemodynamic Calculations

Intraoperative Monitoring in the Posttransplantation Period

Assisting With Venting and De-airing Maneuvers

Separation From Cardiopulmonary Bypass

Assessment of the Left Ventricle Systolic Function

Assessment of LV Diastolic Function

Assessment of the Right Ventricle

Etiology, Pathophysiology, and Diagnosis of Acute RV Dysfunction

Management of Acute RV Dysfunction

Assessment of the Atria and Atrial Anastomoses

Assessment of the Vena Cava Anastomoses

Assessment of the Pulmonary Artery Anastomosis

Assessment of the Pulmonary Venous Anastomoses

Assessment of the Atrioventricular Valves

Management of Early Postoperative Hemodynamic Abnormalities in the Intensive Care Unit

Postoperative Follow-up Studies of Cardiac Allograft Function

New Advances in Heart Transplantation

Chapter 31: Multiple Choice Questions

Chapter 32. Assessment and Surgical Considerations in Lung and Heart-Lung Transplantation

Lung Transplantation

Surgical Considerations

TEE Assessment of Patients Undergoing Lung Transplantation

Right Ventricular Function

Intracardiac Shunts

Vascular Anastomoses

Posttransplantation

TEE Guidance for Mechanical Circulatory Support

Heart-Lung Transplantation

Summary

Chapter 32: Multiple Choice Questions

Section IV: Advanced Perioperative Applications of Echocardiography in Structural Heart Disease

Chapter 33. Assessment and Procedural Considerations During Transcatheter Aortic Valve Replacement

Related Anatomy

Prosthesis

Periprocedural Imaging for Tavr

Preprocedural Imaging

Deployment

Complications

Chapter 33: Multiple Choice Questions

Chapter 34. Assessment and Considerations During Left Atrial Appendage Closure Procedures

Left Atrial Appendage Anatomy

The Watchman LAA Occluder

Preprocedural Imaging

Procedural Guidance

Baseline Comprehensive Assessment

Left Atrial Appendage Sizing

Transseptal Puncture

Accessing the LAA

Device Delivery

Post Deployment Assessment

Device Release and Assessment

Complications

Postprocedural Management and Follow-up

Future Directions

Chapter 34: Multiple Choice Questions

Chapter 35. Assessment and Considerations During Transcatheter Mitral Valve Procedures

Mitral Valve Pathology

Anatomical Implications for Transcatheter Mitral Valve Therapy

Decision-making in Mitral Regurgitation: Surgical vs Transcatheter Repair or Replacement

Role of Echocardiography in Transcatheter Mitral Interventions

Transseptal Puncture

Transcatheter Mitral Valve Repair Techniques

Transcatheter Edge-to-Edge Repair

Mitraclip

PASCAL Leaflet Plication Device

Percutaneous Annuloplasty Techniques

Percutaneous Chordal Repair Techniques

Transcatheter Mitral Valve Replacement

General Considerations and Echocardiographic Principles

Potential Complications

Transcatheter Mitral Valve Paravalvular Leak Closure

Transcatheter Therapy for Mitral Stenosis

Percutaneous Balloon Valvuloplasty

Considerations Surrounding the Use of Three-Dimensional Echocardiography and Other Imaging Adjuncts

Acknowledgment

Chapter 35: Multiple Choice Questions

Chapter 36. Assessment and Considerations During Transcatheter Tricuspid Valve Repair and Replacement

Lessons Learned from Surgery: Avoiding the Mistakes of the Past

Current Recommendations

Outcomes of Surgical Intervention for TR

Efficacy and Durability of Tricuspid Valve Repair Techniques

Tricuspid Valve Replacement

Pre-procedural Imaging for Transcatheter Tricuspid Valve Interventions: Cardiac Magnetic Resonance, Computed Tomography and Echocardiography

Cardiac Magnetic Resonance

Right Ventricular Size and Function

Tissue Characterization and Fibrosis Imaging

Tricuspid Valve Assessment

Cardiac Computed Tomography Angiography

Evaluation of Right Heart and Tricuspid Valve Anatomy

Pretranscatheter Tricuspid Valve Intervention Planning

Transthoracic Echocardiography

TR Severity Assessment

Annular Dilation

Papillary Muscle Displacement and Leaflet Tethering

Right Ventricular Size and Function

RV-RA Gradient and Pulmonary Hypertension

Transesophageal Echocardiography

Three-Dimensional (3D) Echocardiography

Transcatheter Tricuspid Valve Devices

Annular Devices

Leaflet Coaptation Devices

Heterotopic Transcatheter Tricuspid Valve Replacement

Orthotopic Transcatheter Tricuspid Valve Replacement

Chapter 36: Multiple Choice Questions

Chapter 37. Assessment and Considerations for Atrial Septal Defect Closure

Anatomy of the Interatrial Septum

Echocardiographic Anatomy of the Interatrial Septum

ASD Subtype Amenable to Percutaneous Closure

Secundum Atrial Septal Defect Closure

Indications

Suitability for Percutaneous Closure

ASD Size, Shape, and Number of Defects

Length of Rims

Patent Foramen Ovale Closure

Indications

Anatomic Considerations

Choice of Device

Step by Step Guidance for Secundum ASD Percutaneous Closure

STEP 1: Rule Out Contraindications to the Procedure

STEP 2: Confirm ASD Anatomy and Suitability for Device Closure

STEP 3: Device Positioning

STEP 4: Rule Out Immediate Complications

Guidance for PFO Closure

Complications

Device Erosion

Embolization

Wire Fracture

Procedural Guidance Using Intracardiac Echocardiography

Chapter 37: Multiple Choice Questions

Section V: Advanced Perioperative Applications of Echocardiography During Electrophysiologic Procedures

Chapter 38. Procedural Intracardiac Ultrasound Imaging in Ablation of Arrhythmias

Imaging Technology

Radial Intracardiac Echocardiography Technology

Phased Array Technology

Insertion Technique

Basic Imaging

Home View

Cavotricuspid Isthmus View

Coronary Sinus View

Right Ventricular Outflow Tract

Septal Views

Left Pulmonary Veins

Right Pulmonary Veins

LV Structures

Pulmonary Artery Views

Fluoroless Transseptal Puncture

Technique

Atrial Fibrillation Ablation

Atrial Flutter Ablation

Ventricular Tachycardia Ablation

Ice-Guided Watchman Implant

Complication Prevention

Pericardial Effusion

Radiofrequency Ablation

Tissue Heating

Ice Guidance for Other Procedures

Coronary Sinus Catheter Placement

Interventricular Septal Puncture

Chapter 38: Multiple Choice Questions

Chapter 39. Insertion of Rhythm Management Devices and Cardiac Resynchronization Therapy

Introduction

Rationale for CRT

Indications for CRT

Echocardiography for Selection of CRT Responders

Cardiac Mechanical Dyssynchrony

Mechanical Discoordination

Myocardial Viability and CRT Response

Contribution of RV Function to CRT Response

Specific Echocardiographic Evaluation of Dyssynchrony

Speckle Tracking Echocardiography for Strain

Novel TDI-Based Methods

Three-Dimensional Echocardiography

Additional Echocardiographic Assessment Prior to CRT

Intraprocedural Echocardiographic Guidance

Complications of CRT Implantation

Chapter 39: Multiple Choice Questions

Chapter 40. Transvenous Lead Extraction

Introduction

Pathology

Traumatic Tricuspid Valve Injury

Infective Endocarditis

Cardiac Perforation and Tamponade

Embolic Events

Chapter 40: Multiple Choice Questions

Section VI: Diagnostic Echocardiography and Ultrasound in Critical Care Settings

Chapter 41. Overview of Transesophageal Echocardiography and Transthoracic Echocardiography in Critical Care

Introduction

Terminology and Use

Rationale and Approach to CCE

Cardiac Ultrasound Protocols

Ultrasound Equipment

Chest Wall Windows

Essential Transthoracic Views

The Parasternal Window

Parasternal Short Axis

Apical Four-Chamber View (A4C) and Five-Chamber View (A5C)

Apical Tow-Chamber (A2C) and Apical Three-Chamber View (A3C)

The Subcostal Window

Conclusion

Chapter 41: Multiple Choice Questions

Chapter 42. Hemodynamic Assessment of the Critically Ill Patient

Introduction

Left Ventricular Function

Right Ventricular Function

Stroke Volume and Cardiac Output

Left Ventricular Outflow (LVOT) Obstruction

Cardiac Arrest

Intracardiac Filling Pressures and Volume Status

Left Heart Filling Pressures

Right Heart Filling Pressures

Overall Intravascular Volume Status

Valvular Function and Disease

Valvular Stenosis

Aortic Valve Stenosis

Mitral Valve Stenosis

Valvular Insufficiency

Aortic Valve Regurgitation

Mitral Valve Regurgitation

Prosthetic Valve Dysfunction

Pulmonary Artery Pressures

Pulmonary Embolism

Pericardial Disease

Intracardiac and Intrapulmonary Shunts

Acute Coronary Syndrome and Its Complications

Complications After Cardiac Surgery

Mechanical Circulatory Support Devices

Intraaortic Balloon Pump

Impella

Venoarterial Extracorporeal Membrane Oxygenation

Left Ventricular Assist Devices

Conclusion

Chapter 42: Multiple Choice Questions

Chapter 43. Rescue Echocardiography in the Unstable Patient

Left Ventricular Failure

Right Ventricular Failure

Severe Valve Disease

Systolic Anterior Motion

Pericardial Tamponade

Hypovolemia

Low Arterial Tone and Hemodynamics

Chapter 43: Multiple Choice Questions

Chapter 44. Acute and Chronic Pulmonary Hypertension

Introduction

Definition of Pulmonary Hypertension

Classification of Pulmonary Hypertension Using Echocardiography

Tricuspid Regurgitation

Pulmonary Regurgitation

Acceleration Time

Pulmonary Vascular Resistance

Right Ventriculo-Pulmonary Arterial Coupling

The Anatomic and Functional Correlates of Pulmonary Hypertension

Acute and Chronic Pulmonary Embolic Disease

Chapter 44: Multiple Choice Questions

Chapter 45. Assessment of the Lung and Thoracic Cavity in ICU

Introduction

Approach: the “P3-D Method”

Pleural Interface Integrity

Lung Parenchyma

Pleural Effusion and Diaphragm Motion

Normal Anatomic Findings

Ultrasonographic Pathological Findings

Pneumothorax

Probe Selection and Placement

Evaluation Process

Pulmonary Edema

Probe Selection and Placement

Evaluation

Acute Respiratory Distress Syndrome

Evaluation and Ultrasound Findings

Clinical Utility

Pneumonia

Evaluation and Ultrasound Findings

Limitations

Chapter 45: Multiple Choice Questions

Chapter 46. Assessment of Acute Kidney Injury and Renal Function

Introduction

Approach and Structures

Pathology

Pathophysiology of Acute Kidney Injury

Diagnosis and Evaluation of Acute Kidney Injury

Diagnosis and Prediction of Acute Kidney Injury Using Ultrasound

Renal Resistive Index

Renal Venous Assessment

Hepatic Vein and Portal Vein Assessment

Delineation of Acute Kidney Injury Etiology

Obstruction (Bladder, Hydronephrosis)

Volume Status and Renal Perfusion

Summary

Chapter 46: Multiple Choice Questions

Chapter 47. Vascular Access

Indications for Vascular Access

Central Venous Access

Arterial Access

Peripheral Access

Technical Considerations

Two-Dimensional vs Doppler Ultrasound

Transducer Probes

Style of Probe Use: “Free-Hand” vs Needle Guide

Short Axis vs Long Axis vs Oblique Axis

Ultrasound-Guided Central Venous Access

Evidence-Based Analysis for Ultrasound Use

Meta-analyses

Landmark- vs Ultrasound-Guided Technique

Anatomic Considerations

Variable Location of IJV

Overlap of IJV and CA

Other Anatomic Variables

Complications

Cannulation Site

Operator Experience

Patient Variables

Ultrasound Use in Pediatric Patients

Practice Guidelines for Ultrasound-Guided Central Venous Access

Ultrasound-Guided Arterial Access

Transesophageal Echocardiography for Vascular Access

Central Venous Access

Pulmonary Artery Catheters

Coronary Sinus Catheters

Acknowledgments

Chapter 47: Multiple Choice Questions

Chapter 48. Procedural Access in the Intensive Care Unit

Introduction

Structures

The Thoracic Cavity (Illustration of Normal Anatomy?)

The Pericardium and Pericardial Space

The Peritoneal Space

Pathology

Pleural Effusion

Pericardial Effusion

Ascites

Approach

Thoracentesis

Pericardiocentesis

Paracentesis

Chapter 48: Multiple Choice Questions

Section VII: Echocardiography in Noncardiac Settings

Chapter 49. Transesophageal Echocardiography for Nonthoracic Transplants

Introduction

Utility of TEE for Liver Transplantation

Patterns of TEE Utilization for Liver Transplantation and Barriers to Use

Phases of Liver Transplant/Postreperfusion Syndrome

Cardiovascular Comorbidities

TEE Findings During Liver Transplantation

Contraindications and Complications

Other Solid Organ Transplantation

Chapter 49: Multiple Choice Questions

Chapter 50. Intraoperative Imaging of the Inferior Vena Cava and Hepatic Vein by Transesophageal Echocardiography

Introduction

Structures: Anatomy and Physiology

Approach: TEE Imaging of the IVC and Hepatic Vein

2D Imaging Windows

IVC Variants

Doppler Interrogation of the Hepatic Veins

A-Wave

S-Wave

V-Wave

D-Wave

Pathology: Clinical Imaging of the IVC and Hepatic Veins

Renal Cell Carcinoma

Budd-Chiari Syndrome and Hepatic Vein Occlusion

Conclusion

Chapter 50: Multiple Choice Questions

Index

 

An aparitie	17 Oct. 2022
Autor	Savage
Dimensiuni	21.59 x 2.54 x 25.4 cm
Editura	LWW
Format	Hardcover
ISBN	9781975102920
Limba	Engleza
Nr pag	816
Versiune digitala	DA