ABSTRACT
We present a case report of a 55‑year‑old lady who presented with progressive dysphagia and was diagnosed with a Kommerell’s aneurysm and a right‑sided aortic arch. This case report outlines our management strategy and the challenges encountered during the perioperative period in a patient with this rare anomaly.
Subject(s)
Aorta, Thoracic/pathology , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/surgery , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Tomography, X-Ray Computed/methodsABSTRACT
Left ventricular assist devices (LVAD) are increasingly used for mechanical circulatory support of patients with severe heart failure, primarily as a bridge to heart transplantation. Transesophageal echocardiography (TEE) plays a major role in the clinical decision making during insertion of the devices and in the post‑operative management of these patients. The detection of structural and device‑related mechanical abnormalities is critical for optimal functioning of assist device. In this review article, we describe the usefulness of TEE for optimal perioperative management of patients presenting for HeartWare LVAD insertion.
Subject(s)
Aortic Valve Insufficiency/physiopathology , Catheters , Echocardiography, Transesophageal , Foramen Ovale, Patent/physiopathology , Heart-Assist Devices , Humans , Tricuspid Valve Insufficiency/physiopathology , Ventricular Function, RightABSTRACT
Transesophageal echocardiography (TEE) is a semi-invasive, monitoring and diagnostic tool, which is used in the perioperative management of cardiac surgical and hemodynamically unstable patients. The low degree of invasiveness and the capacity to visualize and assimilate dynamic information that can change the course of the patient management is an important advantage of TEE. Although TEE is reliable, comprehensive, credible, and cost-effective, it must be performed by a trained echocardiographer who understands the indications and the potential complications of the procedure, and has the ability to achieve proper acquisition and interpretation of the echocardiographic data. Adequate knowledge of the physics of ultrasound and the TEE machine controls is imperative to optimize image quality, reduce artifacts, and prevent misinterpretation of diagnosis. Two-dimensional (2D) and Motion (M) mode imaging are used for obtaining anatomical information, while Doppler and Color Flow imaging are used for information on blood flow. 3D technology enables us to view the cardiac structures from different perspectives. Despite the recent advances of 3D TEE, a sharp, optimized 2D image is pivotal for the reconstruction. This article describes the relevant underlying physical principles of ultrasound and focuses on a systematic approach to instrumentation and use of controls in the practical use of transesophageal echocardiography.