Asunto(s)
Anestesiología/normas , Enfermedades Cardiovasculares/diagnóstico por imagen , Ecocardiografía Transesofágica/normas , Sociedades Médicas/normas , Anestesiología/métodos , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Ecocardiografía/métodos , Ecocardiografía/normas , Ecocardiografía Transesofágica/métodos , Humanos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: Effects of temporary biventricular pacing after cardiopulmonary bypass are unpredictable, and the utility of speckle-tracking echocardiography in this setting is unclear. Accordingly, speckle-tracking analysis of transgastric echocardiograms taken during cardiac surgery was assessed as a potential tool to measure strain, synchrony, and twist as indices to predict response. DESIGN: Prospective observational study, in part, with a randomized controlled study of temporary permanent biventricular pacing after cardiopulmonary bypass. SETTING: Single-center study at university-affiliated tertiary care hospital. PARTICIPANTS: Twenty-one cardiac surgery candidates with ejection fraction ≤40% and QRS duration ≥100 ms or who were undergoing double-valve surgery. INTERVENTIONS: Transgastric views of the basal, midpapillary, and apical levels of the left ventricle were acquired before and after bypass. MEASUREMENTS AND MAIN RESULTS: Midpapillary sections were analyzable in 38% of patients. The remainder had epicardial borders extending beyond the field of view (24%) or inadequate image quality (38%). Only 9% of basal or apical sections were analyzable. Midpapillary radial strain and synchrony changed insignificantly after bypass. Variation in fractional area change correlated with changes in radial strain (p = 0.041) but not with synchrony. CONCLUSIONS: Intraoperative transgastric echocardiography is inadequate for speckle-tracking analysis with current techniques. Intraoperative predictors of temporary biventricular pacing response are lacking.
Asunto(s)
Puente Cardiopulmonar/efectos adversos , Ecocardiografía/métodos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Anciano , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Disfunción Ventricular Izquierda/etiologíaAsunto(s)
Ecocardiografía Transesofágica/normas , Cardiopatías Congénitas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Adulto , Benchmarking , Ecocardiografía Tridimensional/métodos , Ecocardiografía Tridimensional/normas , Ecocardiografía Transesofágica/métodos , Humanos , Sensibilidad y Especificidad , Sociedades Médicas , Estados UnidosAsunto(s)
Anestesiología/normas , Ecocardiografía Transesofágica/normas , Anestesia , Consenso , Embolia Aérea/diagnóstico por imagen , Corazón/fisiología , Cardiopatías Congénitas/cirugía , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Humanos , Procedimientos Neuroquirúrgicos , Atención Perioperativa , Embolia Pulmonar/diagnóstico por imagen , Garantía de la Calidad de Atención de Salud , Sociedades Médicas , Estados Unidos , Función Ventricular Izquierda , Función Ventricular DerechaAsunto(s)
Ecocardiografía Transesofágica/normas , Adulto , Anestesiología , Cardiología/educación , Ecocardiografía , Ecocardiografía Transesofágica/métodos , Embolia Aérea/diagnóstico por imagen , Cardiopatías Congénitas/diagnóstico por imagen , Humanos , Derrame Pericárdico/diagnóstico por imagen , Periodo Perioperatorio , Garantía de la Calidad de Atención de Salud , Sociedades Médicas , Traumatismos Torácicos/diagnóstico por imagen , Estados UnidosAsunto(s)
Anestesiología/tendencias , Estenosis de la Válvula Aórtica/cirugía , Cateterismo Cardíaco/tendencias , Procedimientos Quirúrgicos Cardíacos/tendencias , Prótesis Valvulares Cardíacas/tendencias , Anestesiología/métodos , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Procedimientos Quirúrgicos Cardíacos/métodos , HumanosAsunto(s)
Cardiopatía Carcinoide/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Pulmonar/diagnóstico por imagen , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Anciano , Cardiopatía Carcinoide/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hipertrofia Ventricular Derecha/diagnóstico por imagen , Masculino , Válvula Pulmonar/diagnóstico por imagen , Serotonina/metabolismo , UltrasonografíaRESUMEN
We report a case of congenital inferior wall left ventricular diverticulum (LVD), atrial septal defect and mental retardation detected by intraoperative transesophageal echocardiography. The combination of three features strongly suggests that genetic factors play important role in the pathogenesis of the disorder. Most LVDs are asymptomatic. Echocardiographers and cardiac anesthesiologists should be aware of this anomaly, and include it in the differential diagnosis of abnormally shaped ventricular wall and seek other congenital abnormalities if LVD is detected.
Asunto(s)
Divertículo/complicaciones , Defectos del Tabique Interatrial/complicaciones , Ventrículos Cardíacos/anomalías , Discapacidad Intelectual/complicaciones , Divertículo/diagnóstico por imagen , Ecocardiografía Transesofágica , Femenino , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Persona de Mediana EdadRESUMEN
Aortic valvular stenosis remains the most common debilitating valvular heart lesion. Despite the benefit of aortic valve (AV) replacement, many high-risk patients cannot tolerate surgery. AV implantation treats aortic stenosis without subjecting patients to sternotomy, cardiopulmonary bypass (CPB), and aorta cross-clamping. This transcatheter procedure is performed via puncture of the left ventricular (LV) apex or percutaneously, via the femoral artery or vein. Patients undergo general anesthesia, intense hemodynamic manipulation, and transesophageal echocardiography (TEE). To elucidate the role of the anesthesiologist in the management of transcatheter AV implantation, we review the literature and provide our experience, focusing on anesthetic care, intraoperative events, TEE, and perioperative complications. Two approaches to the aortic annulus are performed today: transfemoral retrograde and transapical antegrade. Iliac artery size and tortuosity, aortic arch atheroma, and pathology in the area of the (LV) apex help determine the preferred approach in each patient. A general anesthetic is tailored to achieve extubation after procedure completion, whereas IV access and pharmacological support allow for emergent sternotomy and initiation of CPB. Rapid ventricular pacing and cessation of mechanical ventilation interrupts cardiac ejection and minimizes heart translocation during valvuloplasty and prosthesis implantation. Although these maneuvers facilitate exact prosthesis positioning within the native annulus, they promote hypotension and arrhythmia. Vasopressor administration before pacing and cardioversion may restore adequate hemodynamics. TEE determines annulus size, aortic pathology, ventricular function, and mitral regurgitation. TEE and fluoroscopy are used for positioning the introducer catheter within the aortic annulus. The prosthesis, crimped on a valvuloplasty balloon catheter, is implanted by inflation. TEE immediately measures aortic regurgitation and assesses for aortic dissection. After repair of femoral vessels or LV apex, patients are allowed to emerge and assessed for extubation. Observed and published complications include aortic regurgitation, prosthesis embolization, mitral valve disruption, hemorrhage, aortic dissection, CPB, stroke, and death. Transcatheter AV implantation relies on intraoperative hemodynamic manipulation for success. Transfemoral and transapical approaches pose unique management challenges, but both require rapid ventricular pacing, the management of hypotension and arrhythmias during beating-heart valve implantation, and TEE. Anesthesiologists will care for debilitated patients with aortic stenosis receiving transcatheter AV implantation.