Comprehensive Textbook of Perioperative Transesophageal Echocardiography 2nd edition by Robert Savage,Solomon Aronson,Stanton Shernan 9781605472461 1605472468

SECTION 1: Basic Perioperative Echocardiography

CHAPTER 1 Physics of Echocardiography

Introduction

Echocardiography and the Properties of Ultrasound

The Piezoelectric Effect and Ultrasound

Ultrasound Transducers: the Basics

Ultrasound Beam Geometry

Pulse-Echo Operation: Time Equals Distance

Interaction of Ultrasound with Tissues

Image Display Formats

2D Echocardiography: Transducer Operation, Frames, and Frame Rate

Tissue Harmonic Imaging

Contrast Echocardiography

Doppler Echocardiography

Continuous-Wave Doppler Echocardiography

Pulsed Doppler Echocardiography

Graphical Display of Doppler Frequency Spectra

Tissue Doppler Echocardiography

Color Flow Doppler Echocardiography

CW, PW, and Color Flow Doppler Compared

Conclusions

References

CHAPTER 2 Imaging Artifacts and Pitfalls

Artifacts

Missing Structures

Degraded Images

Falsely Perceived Objects

Misregistered Locations

Conclusion

References

CHAPTER 3 Optimizing Two-Dimensional Echocardiographic Imaging

Introduction

The Impact of Ultrasound Instrumentation on Image Generation and Display

Master Synchronizer (Clock)

Transducers and Spatial Resolution

Amplification and Time-Gain Compensation

Preprocessing

Analog-to-Digital Converters

Scan Conversion and Storage in Computer Memory

Postprocessing

Image Display, Recording, and Storage

Conclusions

References

CHAPTER 4 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

References

CHAPTER 5 Comprehensive and Abbreviated Intraoperative TEE Examination

Prevention of TEE Complications

Intraoperative TEE Indications

Optimizing Image Quality

Comprehensive TEE Examination

TEE Examination of the Thoracic Aorta

Abbreviated TEE Examination

TEE and Noncardiac Surgery

References

CHAPTER 6 Updated Indications for Intraoperative TEE

Practice Guidelines

Indications for Specific Lesions or Procedures

New Applications

Complications

References

CHAPTER 7 Organization of an Intraoperative Echocardiographic Service: Personnel, Equipment, Maintenance, Safety, Infection, Economics, and Continuous Quality Improvement

Personnel

Equipment and Maintenance

Safety

Economics of an Intraoperative Echo Service

Assessing Quality in an Intraoperative Tee Service

References

CHAPTER 8 Organizing Education and Training in Perioperative Transesophageal Echocardiography

Introduction

History of Training in TEE

Department of Cardiothoracic Anesthesia: Advanced Perioperative TEE Training

References

CHAPTER 9 Assessment of Global Ventricular 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

Afterload

Systolic Index of Contractility (Dp/Dt)

Tissue Doppler Imaging

Speckle Tracking

Calculating Left Ventricular Filling Pressure

Interatrial Septum

Pulmonary Vein Flow

Mitral Inflow Velocities and Tissue Doppler

Three-Dimensional Evaluation of Global Ventricular Performance

References

CHAPTER 10 Assessment of Right Ventricular Function

Introduction

Structure and Function of the Right Ventricle

Transesophageal Echocardiographic Imaging of the Right Ventricle

Right Ventricular Hypertrophy and Dilatation

Right Ventricular Overload and the Ventricular Septum

Right Ventricular Systolic Function—Qualitative and Regional Assessment

Right Ventricular Global Systolic Function—Quantitative Echocardiographic Assessment

Right Ventricular Function—Hemodynamic Assessment

Right Ventricular Diastolic Function

References

CHAPTER 11 Assessment of Regional Ventricular Function

Introduction

Segmental Model of the Left Ventricle

Distribution of Coronary Artery Anatomy

Clinical Application of Regional Wall Motion Analysis

Assessment of Myocardial Viability

Emerging Echocardiographic Techniques for Assessing Regional Ventricular Function

References

CHAPTER 12 Assessment of Diastolic Dysfunction in the Perioperative Setting

Introduction

Clinical Importance of Diastolic Dysfunction

Physiology of Diastole and Pathophysiology of Dysfunction

Echocardiographic Evaluation of Left Ventricular Diastolic Function

Transmitral Inflow Velocities

Pulmonary Venous Flow

Mitral Annulus Tissue Doppler Imaging

Color M-Mode Doppler: Propagation Velocity

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

References

CHAPTER 13 Assessment of the Mitral Valve

Anatomy of the Mitral Valve

Structural Integrity of the Mitral Valve

ReferencesCHAPTER 14 Assessment of the Aortic Valve

Introduction

Anatomy

Approach

Aortic Stenosis

Aortic Regurgitation

References

CHAPTER 15 Assessment of the Tricuspid and Pulmonic Valves

Introduction

Structure and Function of the Tricuspid and Pulmonic Valves

Transesophageal Echocardiographic Evaluation of the Tricuspid and Pulmonic Valves

Congenital Diseases of the Tricuspid and Pulmonic Valves

Acquired Diseases of the Tricuspid and Pulmonic Valves

References

CHAPTER 16 Assessment of Prosthetic Valves

Types of Prosthetic Valves

Echocardiographic Evaluation of Prosthetic Heart Valves

Normal Imaging

Hemodynamic Measurements

Echocardiographic Characteristics of Specific Valve Types

Prosthetic Valve Dysfunction and Complications

Associated Complications

References

CHAPTER 17 Assessment of Cardiac Masses

Approach/Structures

Ivc/Svc/Right Atrium

Right Ventricle/Pulmonary Artery

Pulmonary Veins/Left Atrium/Left Atrial Appendage

Left Ventricle

Aorta/Valves

Pathology

Ivc/Svc/Right Atrium

Right Ventricle/Pulmonary Artery

Pulmonary Veins/Left Atrium/Left Atrial Appendage

Left Ventricle

Aorta/Valves

References

CHAPTER 18 Transesophageal Echocardiographic Evaluation for Noncardiac Surgery

Tee as a Diagnostic Rescue Tool

Tee as a Tool for Monitoring Cardiac Performance

Tee as a Confirmation Tool

Conclusions

References

CHAPTER 19 Ultrasound for Vascular Access

Indications for Vascular Access

Technical Considerations

Ultrasound-Guided Central Venous Access

Ultrasound-Guided Arterial Access

Development of Ultrasound Vascular Access Service

Future Directions

References

SECTION 2: Echocardiography in the Critical Care Setting

CHAPTER 20 Overview and Relevance of Transesophageal Echocardiography in Critical Care Medicine

Imaging Orientation and Nomenclature

Indications and Contraindications

Effect and Importance of Echocardiography

References

CHAPTER 21 Chest Wall Echocardiography in the Intensive Care Unit

Introduction

Basic Imaging Using Transthoracic Echocardiography

Hemodynamic Assessment of the Critically ill Patient

Valvular Function and Disease

Pulmonary Embolism

Pericardial Disease

Myocardial Ischemia and Its Complications

Intracardiac and Intrapulmonary Shunts

Conclusion

References

CHAPTER 22 The Assessment of a Patient with Endocarditis

Introduction

Epidemiology and Risk Factors

Diagnosis

Echocardiography

Surgical Indications for Infective Endocarditis

Intraoperative Assessment

Conclusion

References

CHAPTER 23 Rescue Echocardiography in the Critically Ill Patient

Unrecognized Hypovolemia

Pulmonary Embolism

Ventricular Dysfunction

Aortic Dissection

Severe Valvular Disease

Intracardiac Thrombi

Ischemia Monitoring

Pericardial Fluid

References

SECTION 3: Advanced Applications in Perioperative Echocardiography

CHAPTER 24 Epiaortic and Epicardial Imaging

Epicardial Imaging

Epiaortic Imaging

Technique

References

CHAPTER 25 Assessment of Congenital Heart Disease in the Adult Patient

Indications

Simple Lesions

Complex Lesions

Conclusions

References

CHAPTER 26 Assessment of Perioperative Hemodynamics

Doppler Measurements of Stroke Volume and Cardiac Output

Doppler Measurement of Pulmonary-To-Systemic Flow Ratio (Qp/Qs) (Fig. 26.12)

Doppler Assessment of Regurgitation

Doppler Measurement of Pressure Gradients

Doppler Determination of Valve Area

Doppler Determination of Intracardiac Pressures

Doppler Measurement of Dp/Dt

References

CHAPTER 27 Assessment in Higher Risk Myocardial Revascularization and Complications of Ischemic Heart Disease

Historical Perspectives

Indications for Myocardial Revascularization

Definition of Higher Risks in Patients Undergoing Coronary Artery Bypass Graft Surgery

Importance of Ischemic Heart Disease in Future Health Care Delivery

Principles of Performing Intraoperative Echo Examination in Cabg Surgery

Complications of Ischemic Heart Disease

Future Applications Table 27.14

References

CHAPTER 28 Assessment of the Mitral Valve in Ischemic Heart Disease

Scientific Principles

The Echocardiographic Examination

Procedure Evaluation

References

CHAPTER 29 Surgical Considerations in Mitral and Tricuspid Valve Surgery

Primary Mitral Valve Disease

Prosthetic Mitral Disease

Tricuspid Valve

Structure and Anatomy

Pathology

Surgical Management of Mitral Valve Disease

Surgical Procedures for Mitral Valve Regurgitation

Ring Annuloplasty

Triangular Resection and Annuloplasty Ring for Posterior Leaflet Prolapse or Flail

Chordal Transfer for Ruptured or Elongated Segment of the

Surgical Procedures for Mitral Valve Stenosis

Surgical Management of Tricuspid Valve Disease

Tricuspid Valve Replacement

References

CHAPTER 30 Surgical Considerations and Assessment in Nonischemic Mitral Valve Surgery

Historical Perspectives

Importance of Intraoperative Echocardiography (IOE) in Mv Surgery

Importance of Intraoperative Echocardiograpy (IOE) Mv Assessment in the Future of Cardiothoracic Anesthesia

Intraoperative Echocardiography and Critical Issues in MV Surgery

Organization of Chapter

Key Concepts

Mitral Valve Apparatus

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

Pathology

Mitral Valve Procedures

References

CHAPTER 31 Assessment in Aortic Valve Surgery

Critical Issues During Aortic Valve Surgery

Role of TEE in Surgical Decision Making

Approach

Specific Aortic Valve Procedures

Conclusions

References

CHAPTER 32 Surgical Considerations and Assessment in Aortic Surgery

Introduction

Anatomy of the Thoracic Aorta

Overview of Thoracic Aortic Diseases

Transesophageal Echocardiography in the Examination of the Aorta

Intraoperative Role of TEE in Aortic Disease

Conclusions

References

CHAPTER 33 Surgical Considerations and Assessment of Endovascular Management of Thoracic Vascular Disease

Introduction

Anatomy of the Thoracic Aorta

Thoracic Aortic Aneurysms

Thoracic Aortic Dissections

Thoracic Aortic Transections

Other Aortic Pathologies

Current Practice of Endovascular Repair of the Thoracic Aorta

Assessment of Thoracic Aortic Pathologies

Role of Transesophageal Echocardiography

Role of Intravascular Ultrasound

References

CHAPTER 34 Echocardiographic Assessment of Cardiomyopathies

Introduction

Dilated Cardiomyopathy

Hypertrophic Cardiomyopathy

Restrictive Cardiomyopathy

Arrhythmogenic Right Ventricular Cardiomyopathy

Unclassified Cardiomyopathies

Role of Echocardiography: Prognostication and Treatment

References

CHAPTER 35 Surgical Considerations and Assessment in Heart Failure Surgery

Impact of Congestive Heart Failure on the Population

Trends in Management of Patients with Congestive Heart Failure

Critical Issues Addressed by Intraoperative Echocardiography: Patients Undergoing Procedures for CHF

Intraoperative Echocardiography in Surgical Procedures for CHF

Ventricular Constraint Techniques

Mechanical Circulatory Support

Conclusion

References

CHAPTER 36 Assessment of Cardiac Transplantation

The Role of TEE in Cardiac Donor Screening

Intraoperative Monitoring in the Pretransplantation Period

Management of Early Postoperative Hemodynamic Abnormalities in the Intensive Care Unit

Postoperative Follow-up Studies of Cardiac Allograft Function

References

CHAPTER 37 Assessment in Cardiac Intervention

Percutaneous Aortic Valve Replacement

Mitral Valve Repair

Nonsurgical Septal Reduction for Hypertrophic Cardiomyopathy

Pericardiocentesis for Cardiac Tamponade

Myocardial Biopsy

Mitral Balloon Valvulotomy

Radiofrequency Ablation

Conclusion

References

CHAPTER 38 Perioperative Application of New Modalities: Strain Echocardiography and Three-Dimensional Echocardiography

Introduction

Myocardial Structure and Motion

Deformation

Principles of Doppler Tissue Imaging and Doppler Strain Echocardiography

Step-By-Step Guide on How to Obtain Doppler Strain

Principles of Speckle Tracking Imaging and 2d Strain

Shear Strain and Torsion

Step-By-Step Guide on How to Perform STI

Correlation of Strain Between Dti and STI

Applications of DTI- and STI-Derived Strain

Three-Dimensional Echocardiography

References

CHAPTER 39 Echocardiographic Evaluation of Pericardial Disease

Pericardial Anatomy

Pericardial Physiology

Pericardial Pathology