Measurement of the Aortic Annulus Area and Diameter by Three-Dimensional Transesophageal Echocardiography in Transcatheter Aortic Valve Replacement.

OBJECTIVES: Sizing of the aortic valve is crucial for transcatheter aortic valve replacement (TAVR). Multidetector computed tomography (MDCT) is used for sizing. Recently, three-dimensional transesophageal echocardiography (3DTEE) has enabled accurate measurement of the aortic annulus area and diameter in cases that are difficult to measure. The authors compared measurements of aortic annulus areas and diameters acquired by MDCT and 3DTEE. DESIGN: Retrospective observational study. SETTING: Single national center. PARTICIPANTS: Sixty-eight patients who underwent TAVR replacement between September 2015 and March 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The authors extracted and compared preoperative measurements of the aortic annulus area, as well as the long- and short-axis diameter, measured by MDCT and 3DTEE. There was no significant difference in the aortic annulus area (409 ± 74 v 414 ± 70 mm2, p = 0.15) or short-axis diameter (20.4 ± 2.0 v 20.6 ± 1.9 mm, p = 0.103) between 3DTEE and MDCT, but the long-axis diameter differed significantly (25.0 ± 2.4 v 25.8 ± 2.0 mm, p < 0.001), respectively. Prosthesis sizes based on 3DTEE and MDCT were the same, except in 3 patients who could not stay still during MDCT measurement; in those cases, prosthesis sizes based on 3DTEE were adopted. CONCLUSIONS: Measurements of the aortic annulus area and diameter in TAVR were similar between 3DTEE and MDCT. Patients who have difficulty remaining still during MDCT measurement because of dementia should have their prostheses sized based on 3DTEE measurements.

Contralateral tension pneumothorax during video-assisted thorascoscopic surgery for lung cancer: a case report.

Contralateral tension pneumothorax during one-lung ventilation is a rare but catastrophic surgical complication. A 72-year-old Japanese male with lung cancer underwent right upper lobectomy with video-assisted thoracoscopic surgery. Despite use of various methods for maintaining oxygenation during one-lung ventilation, percutaneous oxygen saturation was unstable from the start of surgery and suddenly decreased with a drop in blood pressure. An intraoperative chest X-ray revealed a tension pneumothorax of the dependent lung. Insertion of a chest drain saved the patient's life. This case suggests that a contralateral tension pneumothorax should be considered as a possible cause when adequate oxygenation cannot be maintained during one-lung ventilation.

Accuracy and Trending Ability of the Fourth-Generation FloTrac/Vigileo System in Patients With Low Cardiac Index.

OBJECTIVES: To determine the accuracy and trending ability of the fourth-generation FloTrac/Vigileo in patients with low cardiac index by comparing FloTrac/Vigileo-derived cardiac index with that measured by 3-dimensional echocardiography. DESIGN: Prospective clinical study. SETTING: Cardiac surgery operating room in a single cardiovascular center. PARTICIPANTS: Twenty-five patients undergoing elective cardiac resynchronization therapy lead implantation. INTERVENTIONS: FloTrac/Vigileo-derived cardiac index and 3-dimensional echocardiography-derived cardiac index were determined simultaneously before and after phenylephrine bolus and cardiac resynchronization therapy using 3-dimensional echocardiography-derived cardiac index as the reference method. MEASUREMENTS AND MAIN RESULTS: Cardiac index measured by the fourth-generation FloTrac/Vigileo had a wide limit of agreement with that measured by 3-dimensional echocardiography, with a percentage error of 59.1%. The tracking ability of the unit after both phenylephrine administration and cardiac resynchronization therapy were measured by concordance rate, and both were below the acceptable limit (72.7% and 85%, respectively). CONCLUSIONS: The degree of accuracy of the fourth-generation FloTrac/Vigileo in patients with low cardiac index was not acceptable, and high systemic vascular resistance in patients with low cardiac index may have contributed to this inaccuracy. The tracking ability of the fourth-generation FloTrac/Vigileo after phenylephrine administration or cardiac resynchronization therapy was below acceptable limits.