ABSTRACT
Introduction: Intraoperative trans-esophageal echocardiography (TEE) has been found to underestimate severity of aortic stenosis (AS) compared to trans-thoracic echo (TTE). We conducted a prospective study comparing pre induction TTE and intra operative TEE grading of AS in patients posted for aortic valve replacement surgeries. Methods: Sixty patients with isolated AS who were undergoing aortic valve replacement were enrolled in our study. Baseline TTE was done and after induction of anesthesia, TEE was done. Mean gradient across aortic valve, peak jet velocity, aortic valve area (AVA) by continuity equation and dimensionless index (DI) were assessed in both. Results: Mean gradient decreased from 56.4 in TTE to 39.8 mm Hg in TEE leading to underestimation of AS in 74.5% of patients (P < 0.0). Mean of peak jet velocity also decreased from 500 in TTE to 386cm/s in TEE (P < 0.01). In 76 % of patients this led to reduction of AS grade from severe to moderate. Mean AVA was 0.67 cm2 in TTE and 0.69 cm2 in TEE. Though there was 0.02 cm2 increase, it was not statistically significant (P = 0.07). All the patients remained as severe AS in TEE. DI mean was 0.19 in both TTE and TEE (P = 0.14).It led to underestimation of severity in 6% of patients in TEE. Conclusion: Our study shows that AVA measurement by continuity equation and DI are reliable in grading aortic stenosis while performing intraoperative TEE. Mean gradient and jet velocity can be significantly reduced.
ABSTRACT
Background: A prospective study was carried out in our hospital to predict morbidity and mortality in middle and old aged surgical patients by adding echocardiography to standard scoring system with hemodynamic studies. Methods: A total of 50 patients of either sex ranging from 40-70 years of ASA grade 1 & 2 scheduled for various types of noncardiac surgeries were enrolled for the study in our hospital. Patients were divided in two groups according to echocardiographic examinations. The patients with normal echocardiographic values were kept in control group and the patients with abnormal values were kept under study group. The patients in study group were further divided in three groups according to LVEF. Group1-LEVF≥60%, Group2-LVEF≥50-59%, Gr3≥40-49% Tab lorazepam was given to all the patients’ orally prior night of surgery. All the patients were induced with same type inducing agents according to body weight. All the patients were maintained on IPPV by anaesthesia machine with supplemental fentanyl, N2O, O2 and muscle relaxant. SPO2, electrocardiograph (ECG), Non-invasive/invasive blood pressure (BP), Spirometry, Capnography and temperature were monitored. At the end of the research project data’s were compiled systematically and were subjected to statistical analysis using odd’s ratio(OR),95% confidence interval (CI), z value and p value, two statistical software programme were used. Results: Significant difference in the results seen between the three study groups (Gr1, Gr2, Gr3) for perioperative ischemic changes, CHF and arrhythmias. Conclusions: In conclusion preoperative TTE before non-cardiac surgery can predict the risk of perioperative cardiac complications in known or suspected cases of cardiac disease patients.
ABSTRACT
ObjectiveTo assess the values of 320-detector row dynamic volume CT angiography (CTA) and transthoracic echocardiography (TTE) in follow up of coronary artery aneurysm (CAA) caused by Kawasaki disease (KD).Methods320-de-tector row CTA and TTE were applied in long-term follow-up of 8 patients with CAA caused by KD.ResultsIn 8 patients, the mean age at onset was 41.63±22.70 months and the mean follow up time was 43.50±10.99 months. In acute phase, 3 cases of giant coronary artery aneurysms (GCAA) and 5 cases of mid-small CAA were diagnosed by TTE. A total of 16/32 arteries (50%) were involved. At the end of follow-up, 3 cases of GCAA and 2 cases of mid-small CAA were still diagnosed by TTE, and small CAAs were regressed in another 3 cases. A total of 6/32 arteries (18.75%) were involved. Simultaneously at the end of follow-up, a total of 7/32 arteries (21.9%) were involved by 320-detector row CTA. The distribution was consistent with that of TTE. Mean-while, there were one case of left circumlfex artery, one case of GCAA at distal of the right coronary artery, 2 cases of thrombus, 1 case of coronary stenosis and 2 cases of calciifcation.ConclusionsCAA caused by KD may be persistent for a long time. The thrombus, stenosis, and calciifcation of coronary can occurr at late phase in GCAA. TTE is sensitive and reliable to detect proxi-mal and middle segment of coronary lesions, but has limitations in detection of distal segment of coronary arteries. 320-detector row CTA has more comprehensively view of each coronary artery lesions and is especially sensitive and reliable to detect coro-nary thrombosis, calciifcation and narrowing in proximal and distal coronary arteries after acute phase.