The role of endosonography in cardiology: case series and literature review.

Aims: Endosonography (EUS) is the diagnostic tool with the highest resolution for the local staging of gastrointestinal tumours and, due to the detailed visualization of the wall layers, is recommended in current guidelines for cancer management. In addition, an endoscope has an ultrasound tip design and balloon insufflation control design, and a 120° bending mechanism to deflect the endoscope tip. These advantages could be beneficial and valuable while investigating the cardiovascular structures during routine gastrointestinal procedures using this diagnostic tool. Methods and results: We present six cases of incidentally diagnosed cardiac pathologies (pulmonary thromboembolism of the main pulmonary artery, patent foramen oval with right to left shunt under Valsalva, left atrial appendage thrombus, aortic dissection, moderate aortic valve stenosis, mitral and aortic valve endocarditis) during routine gastrointestinal endosonographic procedures. These diagnoses influenced changes in management strategies in four cases. Conclusion: The introduction of EUS in cardiovascular medicine allows for a real-time high-resolution assessment of cardiovascular structures and allows early detection of silent cardiac pathologies during routine gastrointestinal procedures. It is the diagnostic tool with the highest resolution for accurate definition of variable gastrointestinal anatomy. Thus, help for accurate definitions of cardiovascular anatomy and pathology, which could influence optimal management strategies with improved safety, efficacy, and economic outcomes.

Effects of pulmonary acid aspiration on the lungs and extra-pulmonary organs: a randomized study in pigs.

INTRODUCTION: There is mounting evidence that injury to one organ causes indirect damage to other organ systems with increased morbidity and mortality. The aim of this study was to determine the effects of acid aspiration pneumonitis (AAP) on extrapulmonary organs and to test the hypothesis that these could be due to circulatory depression or hypoxemia. METHODS: Mechanically ventilated anesthetized pigs were randomized to receive intrabronchial instillation of hydrochloric acid (n = 7) or no treatment (n = 7). Hydrochloric acid (0.1 N, pH 1.1, 2.5 ml/kg BW) was instilled into the lungs during the inspiratory phase of ventilation. Hemodynamics, respiratory function and computer tomography (CT) scans of lung and brain were followed over a four-hour period. Tissue samples of lung, heart, liver, kidney and hippocampus were collected at the end of the experiment. RESULTS: Acid instillation caused pulmonary edema, measured as increased extravascular lung water index (ELWI), impaired gas exchange and increased mean pulmonary artery pressure. Gas exchange tended to improve during the course of the study, despite increasing ELWI. In AAP animals compared to controls we found: a) cardiac leukocyte infiltration and necrosis in the conduction system and myocardium; b) lymphocyte infiltration in the liver, spreading from the periportal zone with prominent areas of necrosis; c) renal inflammation with lymphocyte infiltration, edema and necrosis in the proximal and distal tubules; and d) a tendency towards more severe hippocampal damage (P > 0.05). CONCLUSIONS: Acid aspiration pneumonitis induces extrapulmonary organ injury. Circulatory depression and hypoxemia are unlikely causative factors. ELWI is a sensitive bedside parameter of early lung damage.

Effects of high-frequency oscillatory ventilation on systemic and cerebral hemodynamics and tissue oxygenation: an experimental study in pigs.

BACKGROUND: In this study, we compare the effects of high frequency oscillatory ventilation (HFOV) with those of lung-protective volume-controlled ventilation (VCV) on cerebral perfusion, tissue oxygenation, and cardiac function with and without acute intracranial hypertension (AICH). METHODS: Eight pigs with healthy lungs were studied during VCV with low tidal volume (V(T): 6 ml kg(-1)) at four PEEP levels (5, 10, 15, 20 cm H(2)O) followed by HFOV at corresponding transpulmonary pressures, first with normal ICP and then with AICH. Systemic and pulmonary hemodynamics, cardiac function, cerebral perfusion pressure (CPP), cerebral blood flow (CBF), cerebral tissue oxygenation, and blood gases were measured after 10 min at each level. Transpulmonary pressures (TPP) were calculated at each PEEP level. The measurements were repeated with HFOV using continuous distending pressures (CDP) set at TPP plus 5 cm H(2)O for the corresponding PEEP level. Both measurement series were repeated after intracranial pressure (ICP) had been raised to 30-40 cm H(2)O with an intracranial balloon catheter. RESULTS: Cardiac output, stroke volume, MAP, CPP, and CBF were significantly higher during HFOV at normal ICP. Systemic and cerebral hemodynamics was significantly altered by AICH, but there were no differences attributable to the ventilatory mode. CONCLUSION: HFOV is associated with less hemodynamic compromise than VCV, even when using small tidal volumes and low mean airway pressures. It does not impair cerebral perfusion or tissue oxygenation in animals with AICH, and could, therefore, be a useful ventilatory strategy to prevent lung failure in patients with traumatic brain injury.