RESUMO
Coronary artery fistula are anomalous connections with coronary vessels or cardiac chambers, potentially resulting in coronary dilatation and pseudoaneurysm formation. We present the case of a 68-year-old woman referred to our institution for a voluminous coronary pseudoaneurysm secondary to coronary artery fistula presenting as a nearly completely obstructive left atrial mass. (Level of Difficulty: Intermediate.).
Assuntos
Anti-Hipertensivos/uso terapêutico , Cardiotônicos/uso terapêutico , Epoprostenol/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Neoplasias Cardíacas/complicações , Hipertensão Pulmonar/tratamento farmacológico , Hipóxia Encefálica/tratamento farmacológico , Hipóxia Encefálica/etiologia , Milrinona/uso terapêutico , Mixoma/complicações , Administração por Inalação , Adulto , Anti-Hipertensivos/administração & dosagem , Química Encefálica/fisiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiotônicos/administração & dosagem , Epoprostenol/administração & dosagem , Feminino , Neoplasias Cardíacas/fisiopatologia , Humanos , Hipertensão Pulmonar/complicações , Complicações Intraoperatórias/tratamento farmacológico , Milrinona/administração & dosagem , Mixoma/fisiopatologiaRESUMO
Percutaneous aortic valve replacement (PAVR) is an emerging therapy for nonsurgical patients with severe aortic stenosis (AS). We examined the role of transesophageal echocardiography (TEE) in PAVR. TEE was used initially to assess the native valve and aortic root, and served as a guide during PAVR. Following prosthetic valve deployment, TEE was used to assess valve function. Eleven patients aged 82 +/- 10 years with NYHA III-IV underwent PAVR. Periprocedural TEE gave immediate information on prosthetic position and function, LV function, mitral regurgitation, pericardium, and thoracic aorta anatomy. There was excellent visual agreement between fluoroscopic and TEE images of prosthetic positioning and deployment. TEE facilitated the detection and management of procedure-related complications. Compared with pre-PAVR, AV area (0.56 +/- 0.19 cm(2) vs. 1.3 +/- 0.4 cm(2); P < 0.001) and LVEF (49 +/- 17% vs. 56 +/- 11%; P < 0.001) increased. TEE provides key anatomical and functional information, and serves as a diagnostic guide for complications, which may arise during PAVR.
Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Ecocardiografia Transesofagiana/métodos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVES: Dilatation of the aortic annulus is a cause of recurrent aortic regurgitation following the Ross or Yacoub procedures. Use of an extra-aortic annuloplasty ring is a potentially useful adjunct procedure. The aim of this study was to analyze the early effectiveness and mid-term stability of this surgical approach. METHODS: From 2011 to 2015, 50 patients (mean age, 43 ± 14 years) underwent adjunct extra-aortic annuloplasty ring implantation (n = 39 Dacron rings and n = 11 ExAo rings [CORONEO Inc, Montreal, Canada]). Median ring size was 28 mm (range, 27-32 mm). All patients had aortic regurgitation or a dilated aortic annulus. Concomitant surgical procedure was a valve-sparing remodeling procedure (n = 32) or a Ross procedure (n = 18). Baseline and follow-up echocardiographic systolic and diastolic aortic annular dimensions were prospectively collected. Longitudinal analyses were performed using mixed-effect models. Median follow-up was 12 months (98% complete). RESULTS: Use of an extra-aortic annuloplasty ring resulted in a significant decrease in both systolic (27.9 ± 0.5 mm preoperatively vs 23.6 ± 0.3 mm at discharge, P < .001) and diastolic (24.8 ± 0.4 mm preoperatively vs 20.3 ± 0.3 mm at discharge, P < .001) dimensions. Mean systolic and diastolic dimensions remained statistically unchanged up to 2 years postoperatively, compared with their predischarge values. Systolic expansion of the annulus was conserved early after surgery (16% systolic expansion) and preserved up to 2 years after ring implantation. CONCLUSIONS: Use of an extra-aortic annuloplasty ring is effective at reducing annular diameters. This remains stable at mid-term follow-up, with preservation of aortic annular dynamics. Longer-term studies are required to determine the continued stability and impact on long-term clinical outcomes.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas , Desenho de Prótese/métodos , Adulto , Insuficiência da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Anuloplastia da Valva Cardíaca/métodos , Estudos de Coortes , Ecocardiografia Doppler , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos/farmacologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
The role of exercise testing and stress imaging in the management of patients with valvular heart disease (VHD) is reviewed in this article. The American College of Cardiology/American Heart Association and the European Society of Cardiology/European Association of Cardiothoracic Surgery have recently put emphasis on the role of exercise testing to clarify symptom status and the use of stress imaging to assess the dynamic component of valvular abnormalities and unmask subclinical myocardial dysfunction that could be missed at rest. Recent studies have demonstrated the incremental prognostic value of exercise echocardiography for asymptomatic patients with severe aortic stenosis, moderate-severe mitral stenosis, and severe primary mitral regurgitation. In patients with low-flow, low-gradient aortic stenosis, dobutamine stress echocardiography is recommended to differentiate true severe from pseudosevere aortic stenosis. Data on the prognostic value of stress echocardiography in aortic regurgitation and functional mitral regurgitation are less robust. Data are sparse on the use of stress imaging in right-sided VHD, however recent studies using stress cardiovascular magnetic resonance imaging offer some prognostic information. Although the strongest recommendations for surgical treatment continue to be based on symptom status and resting left ventricular repercussions, stress imaging can be useful to optimize risk stratification and timing of surgery in VHD. Randomized clinical trials are required to confirm that clinical decision-making based on stress imaging can lead to improved outcomes.
Assuntos
Teste de Esforço , Doenças das Valvas Cardíacas/diagnóstico , Insuficiência da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/diagnóstico , Pressão Sanguínea , Tomada de Decisões , Dobutamina , Ecocardiografia sob Estresse , Eletrocardiografia , Teste de Esforço/métodos , Doenças das Valvas Cardíacas/cirurgia , Humanos , Insuficiência da Valva Mitral/diagnóstico , Estenose da Valva Mitral/diagnóstico , Prognóstico , Artéria Pulmonar/fisiologia , Função Ventricular EsquerdaRESUMO
OBJECTIVES: To evaluate intra-procedural imaging with transesophageal echocardiography and angiography during left atrial appendage occlusion using the Amplatzer™ Cardiac Plug with regard to sizing and final device shape. METHODS: Left atrial appendage ostium dimensions and diameter at a depth of 10mm from the ostium were measured by transesophageal echocardiography (0-180°) and angiography (RAO 30° - Cranial 20°) in consecutive patients undergoing left atrial appendage occlusion using the ACP with an oversizing strategy of 10-20% relative to the baseline measurements. After delivery, ACP dimensions were measured and device shape was assessed. RESULTS: Twenty-seven consecutive patients underwent successful uncomplicated left atrial appendage closure with Amplatzer™ Cardiac Plug. We found a significant difference between the largest and smallest left atrial appendage diameter measured with transesophageal echocardiography (22.3±4.2 vs. 18.1±4.1mm, p<0.001). By the end of the procedure (by angiography), ACP had an optimal shape in 17 patients (63%), a strawberry-like shape in 7 patients (26%), and a square-like shape in 3 patients (11%). ACP was oversized on average by 1.5±2.7 and 3.3±2.3mm compared to transesophageal echocardiography and angiography, respectively. The final shape of the device was not significantly associated with the degree of oversizing. CONCLUSIONS: We found a considerable variability in the assessment of the left atrial appendage, using transesophageal echocardiography and angiography. The degree of Amplatzer™ Cardiac Plug expansion within the left atrial appendage and the final shape of the device were not associated with the degree of oversizing.
Assuntos
Apêndice Atrial/diagnóstico por imagem , Ecocardiografia Transesofagiana , Cuidados Intraoperatórios , Dispositivo para Oclusão Septal , Cirurgia Assistida por Computador , Idoso , Angiografia , Apêndice Atrial/anatomia & histologia , Apêndice Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Humanos , Masculino , Tamanho do Órgão , Estudos Prospectivos , Desenho de Prótese , Implantação de Prótese/métodosRESUMO
BACKGROUND: The Amplatzer Cardiac Plug (ACP) is a relatively new system for left atrial appendage (LAA) closure. In general, the particular design of the device and the variability of the LAA anatomy make the sizing process challenging. The objective of our study was to analyze the impact of the shape and sizing of the device on the presence of follow-up leaks. METHODS: The shape was evaluated by angiography and classified as "strawberry-like", "square-like" and "tire-like". The presence of peri-device leaks was assessed by transesophageal echocardiography (TEE) and graded as: 1) severe, 2) major, 3) moderate, 4) minor and 5) absent. RESULTS: Twenty five patients were included. Overall, the device was oversized by 3.38 ± 2.26 mm and 1.58 ± 2.75 mm in relation to the largest angiographic and TEE diameter respectively. None of the patients presented any intra-procedural complication. After discharge, one patient was admitted for cardiac tamponade and another for stroke. In both, the device was optimally deployed. Follow-up TEE was done after a mean time of 7.9 ± 5.9 months. The presence of a leak was associated with a lower degree of device over-sizing by TEE (0.06 ± 3.31 mm if leak vs. 2.73 ± 1.85 mm if no leak; p=0.04) and a trend towards by angiography (2.39 ± 3.06 mm if leak vs. 3.98 ± 1.57 mm if no leak; p=0.16). The shape of the device was not associated with the presence of TEE leaks. Neither the shape nor the presence of leaks was associated with worse clinical outcomes. CONCLUSIONS: Although the shape and sizing of the device were not linked to any particular clinical outcome, we found an association between a lower degree of over-sizing and the presence of follow-up leaks.
Assuntos
Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Desenho de Equipamento/normas , Dispositivo para Oclusão Septal/normas , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Transesofagiana/métodos , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Resultado do TratamentoAssuntos
Falso Aneurisma/etiologia , Falso Aneurisma/patologia , Ablação por Cateter/efeitos adversos , Síndrome de Wolff-Parkinson-White/terapia , Falso Aneurisma/diagnóstico , Falso Aneurisma/cirurgia , Ecocardiografia , Ventrículos do Coração/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síncope/etiologia , Síndrome de Wolff-Parkinson-White/complicaçõesRESUMO
The purpose of this paper is to review the usefulness of multiplanar transesophageal echocardiography before, during and after percutaneous transcatheter closure of secundum atrial septal defects. Transesophageal echocardiography imaging techniques,including their role in patient selection, procedural guidance and immediate assessment of technical success and complications are described and discussed in this review. Percutaneous transcatheter closure is indicated for ostium secundum atrial septal defects of less than 40 mm in maximal diameter. The defect must have a favorable anatomy, with adequate rims of at least 5 mm to anchor the prosthesis. Transesophageal echocardiography plays a critical role before the procedure in identifying potential candidates for percutaneous closure and to exclude those with unfavorable anatomy or associated lesions, which could not be addressed percutaneously. Transesophageal echocardiography is also important during the procedure to guide the deployment of the device. After device deployment, the echocardiographer must assess the device (integrity, position and stability), residual shunt, atrio-ventricular valve regurgitation, obstruction to systemic or venous return and pericardial effusion, in order to determine procedural success and diagnose immediate complications.
Assuntos
Ecocardiografia Transesofagiana/métodos , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Cirurgia Assistida por Computador , Adulto , HumanosRESUMO
OBJECTIVES: This study sought to describe and compare a novel fluoroscopic method and a 2-dimensional transesophageal echocardiographic (TEE) method to localize mitral periprosthetic leaks (PPLs) for transcatheter reduction. BACKGROUND: Transcatheter reduction of significant regurgitation represents a modern and attractive alternative to surgery for the treatment of mitral PPL in high-risk patients. Accurate localization and precise communication between the echocardiographer and the interventional cardiologist are essential for procedural success. METHODS: We analyzed TEE and fluoroscopic studies of patients with mitral PPL who underwent multiplane 2-dimensional TEE-guided transcatheter reduction in our institution. Periprosthetic leaks were routinely localized using the "surgeon's-view" time-clock method during periprocedural TEE assessments. The 2-dimensional TEE examinations were later retrospectively reviewed by an echocardiographer blinded to procedural TEE findings. A corresponding surgeon's-view time-clock method was plotted for fluoroscopic PPL localization. Using this fluoroscopic method, offline fluoroscopic images were reviewed by an independent interventional cardiologist blinded to TEE results. Agreement between methods was evaluated. RESULTS: Complete imaging data were available for analysis in 20 patients who, between 2002 and 2009, underwent transcatheter reduction in which the defect was successfully crossed. There was excellent agreement between procedural TEE and retrospective TEE review for PPL localization (100%; p < 0.0001) and between fluoroscopic and procedural TEE localization (90%; 95% confidence interval [CI]: 77% to 100%; p = 0.0003). In the 2 cases where there was disagreement, fluoroscopic PPL localization was adjacent to TEE localization. CONCLUSIONS: The surgeon's-view time-clock method of localizing PPL using 2-dimensional TEE is highly reproducible and allows fluoroscopic localization using the same reference system with very good agreement.
Assuntos
Cateterismo Cardíaco , Ecocardiografia Transesofagiana/normas , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/diagnóstico , Valva Mitral/diagnóstico por imagem , Falha de Prótese , Radiografia Intervencionista/normas , Ultrassonografia de Intervenção/normas , Idoso , Ecocardiografia Doppler em Cores/normas , Feminino , Fluoroscopia/normas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/terapia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Quebeque , Padrões de Referência , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
BACKGROUND: The definition and incidence of patient-prosthesis mismatch (PPM) in the mitral position are unclear. OBJECTIVES: To determine the impact of PPM on late survival and functional status after mitral valve replacement with a mechanical valve. METHODS: Between 1992 and 2005, 714 patients (mean [± SD] age 60±10 years) underwent valve replacement with either St Jude (St Jude Medical Inc, USA) (n=295) or Carbomedics (Sulzer Carbomedics Inc, USA) (n=419) valves. There were 52 concomitant procedures (50 tricuspid annuloplasties, 25 foramen oval closures and 20 radiofrequency mazes). The mean clinical follow-up period was 4.4±3.3 years. The severity of PPM was established with cut-off values for an indexed effective orifice area (EOAi) of lower than 1.2 cm(2)/m(2), lower than 1.3 cm(2)/m(2) and lower than 1.4 cm(2)/m(2). Parametric and nonparametric tests were used to determine predictors of outcome. RESULTS: The prevalence of PPM was 3.7%, 10.1% and 23.5% when considering values of lower than 1.2 cm(2)/m(2), lower than 1.3 cm(2)/m(2) and lower than 1.4 cm(2)/m(2), respectively. When considering functional improvement, patients with an EOAi of 1.4 cm(2)/m(2) or greater had a better outcome than those with an EOAi of lower than 1.4 cm(2)/m(2) (OR 1.98; P=0.03). When building a Cox-proportional hazard model, PPM with an EOAi of less than 1.3 cm(2)/m(2) was an independent predictive factor for midterm survival (HR 2.24, P=0.007). Other factors affecting survival were age (HR 1.039), preoperative New York Heart Association class (HR 1.96) and body surface area (HR 0.31). CONCLUSIONS: In a large cohort of patients undergoing mitral valve replacement with mechanical prostheses, PPM defined as an EOAi of lower than 1.3 cm(2)/m(2) significantly decreased midterm survival. This level of PPM was observed in 10.2% of patients. Patients with an EOAi of 1.4 cm(2)/m(2) or greater had greater improvement of their functional status.
Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Falha de Prótese , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Perflutren cardiac ultrasound agents improve diagnostic accuracy in patients whose imaging is technically difficult. This report describes a case of sudden death approximately 5 minutes after the intravenous administration of 0.5 mL of perflutren contrast agent (Definity) during transthoracic echocardiography with suboptimal baseline images performed 10 days after coronary artery bypass graft surgery because of hypotension and tachycardia in a 73-year-old patient with severe left ventricular systolic dysfunction. Autopsy did not reveal a clear direct relationship between perflutren and death. This is the first reported case of death related temporally to an echocardiographic contrast agent occurring in Canada and could represent a case of pseudocomplication.
Assuntos
Meios de Contraste/efeitos adversos , Morte Súbita/etiologia , Morte Súbita/prevenção & controle , Fluorocarbonos/efeitos adversos , Ultrassonografia/efeitos adversos , Idoso , Humanos , Injeções Intravenosas/efeitos adversos , MasculinoRESUMO
Objectives: To evaluate intra-procedural imaging with transesophageal echocardiography and angiography during left atrial appendage occlusion using the Amplatzer™ Cardiac Plug with regard to sizing and final device shape. Methods: Left atrial appendage ostium dimensions and diameter at a depth of 10 mm from the ostium were measured by transesophageal echocardiography (0-180°) and angiography (RAO 30° - Cranial 20°) in consecutive patients undergoing left atrial appendage occlusion using the ACP with an oversizing strategy of 10-20% relative to the baseline measurements. After delivery, ACP dimensions were measured and device shape was assessed. Results: Twenty-seven consecutive patients underwent successful uncomplicated left atrial appendage closure with Amplatzer™ Cardiac Plug. We found a significant difference between the largest and smallest left atrial appendage diameter measured with transesophageal echocardiography (22.3 ± 4.2 vs. 18.1 ± 4.1 mm, p <0.001). By the end of the procedure (by angiography), ACP had an optimal shape in 17 patients (63%), a strawberry-like shape in 7 patients (26%), and a square-like shape in 3 patients (11%). ACP was oversized on average by 1.5±2.7 and 3.3±2.3mm compared to transesophageal echocardiography and angiography, respectively. The final shape of the device was not significantly associated with the degree of oversizing. Conclusions: We found a considerable variability in the assessment of the left atrial appendage, using transesophageal echocardiography and angiography. The degree of Amplatzer™ Cardiac Plug expansion within the left atrial appendage and the final shape of the device were not associated with the degree of oversizing.
Objetivos: Evaluar las dimensiones de la orejuela izquierda antes del cierre percutáneo y la correlación de sus dimensiones finales y la forma del dispositivo Amplatzer™ cardiac plug con ecocardiografia transesofágica y angiografia. Métodos: Se midieron las dimensiones de la orejuela izquierda a una distancia de 10 mm a partir del ostium con ecocardiografia transesofágica (0 a 180°) y angiografia (RAO 30° Craneal 20°). Se utilizó una estrategia para sobre dimensionar el tamano del dispositivo del 10 al 20% con respecto a las mediciones iniciales. Se evaluaron las dimensiones y la forma final del dispositivo. Resultados: Se realizó el procedimiento en 27 pacientes. Se encontró una diferencia significativa entre el diámetro mayor y menor de orejuela izquierda medido por ecocardiografia transesofágica (22.3±4.2 vs 18.1 ±4.1 mm, p< 0.001). Una vez liberado el dispositivo, se encontró que en 17 pacientes (63%) adoptó una forma óptima, de "fresa" en 7 (26%) y cuadrada en 3 (11%). El tamaño del dispositivo seleccionado se sobre dimensionó en promedio 1.5 ± 2.7mm con la ecocardiografia transesofágica y 3.3 ± 2.3 mm con la angiografia. La forma final del dispositivo no se asoció de manera significativa con el grado de sobre dimensionamiento del mismo. Conclusiones: Existe variabilidad considerable en la evaluación de la orejuela izquierda entre la ecocardiografia transesofágica y la angiografia. No se encontró asociación entre el grado de expansión del dispositivo dentro de la orejuela izquierda ni de su forma final con el grado de sobre dimensionamiento del mismo.
Assuntos
Idoso , Feminino , Humanos , Masculino , Apêndice Atrial , Apêndice Atrial , Ecocardiografia Transesofagiana , Cuidados Intraoperatórios , Dispositivo para Oclusão Septal , Cirurgia Assistida por Computador , Angiografia , Apêndice Atrial/anatomia & histologia , Apêndice Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Tamanho do Órgão , Estudos Prospectivos , Desenho de Prótese , Implantação de Prótese/métodosRESUMO
The purpose of this paper is to review the usefulness of multiplanar transesophageal echocardiography before, during and after percutaneous transcatheter closure of secundum atrial septal defects. Transesophageal echocardiography imaging techniques, including their role in patient selection, procedural guidance and immediate assessment of technical success and complications are described and discussed in this review. Percutaneous transcatheter closure is indicated for ostium secundum atrial septal defects of less than 40 mm in maximal diameter. The defect must have a favorable anatomy, with adequate rims of at least 5 mm to anchor the prosthesis. Transesophageal echocardiography plays a critical role before the procedure in identifying potential candidates for percutaneous closure and to exclude those with unfavorable anatomy or associated lesions, which could not be addressed percutaneously. Transesophageal echocardiography is also important during the procedure to guide the deployment of the device. After device deployment, the echocardiographer must assess the device (integrity, position and stability), residual shunt, atrio-ventricular valve regurgitation, obstruction to systemic or venous return and pericardial effusion, in order to determine procedural success and diagnose immediate complications.
El propósito de esta revisión es analizar la utilidad de la ecocardiografía transesofágica multiplanar antes, durante y después del cierre percutáneo de la comunicación interauricular tipo ostium secundum. Las consideraciones técnicas de imagen durante la ecocardiografía transesofágica multiplanar, su utilidad en la evaluación de los pacientes, la guía peri-procedimiento, la evaluación del éxito técnico y las complicaciones son descritas y discutidas en esta revisión. El cierre percutáneo está indicado en la comunicación interauricular tipo ostium secundum con diámetro máximo de 40 mm. El defecto debe tener una anatomía favorable con bordes de al menos 5 mm. La ecocardiografía transesofágica multiplanar tiene un papel determinante antes del procedimiento para identificar a candidatos potenciales para el cierre percutáneo y para excluir aquéllos con anatomía no favorable o lesiones asociadas que no pueden ser manejados vía percutánea. La ecocardiografía transesofágica multiplanar es importante durante el procedimiento para guiar la liberación del dispositivo. Después de la liberación del dispositivo el ecocardiografista debe evaluar la posición y estabilidad del dispositivo, la presencia de corto-circuito residual, la regurgitación de las válvulas A-V, el retorno venoso sistémico y pulmonar, y el pericardio, a fin de determinar el éxito del procedimiento y descartar complicaciones asociadas.
Assuntos
Adulto , Humanos , Ecocardiografia Transesofagiana/métodos , Comunicação Interatrial/cirurgia , Comunicação Interatrial , Cirurgia Assistida por ComputadorRESUMO
Hemodynamic modifications induced by general anesthesia could lead to underestimation of mitral regurgitation (MR) severity in the operating department and potentially serious consequences. The intraoperative severity of MR was prospectively compared with the preoperative baseline evaluation using dynamic quantitative transesophageal echocardiography in 25 patients who were stable with MR 2/4 or greater undergoing coronary bypass, mitral valve operation, or both. Significant changes in the severity of MR using transesophageal echocardiographic criteria occurred after the induction of general anesthesia and with phenylephrine. Quantitative transesophageal echocardiographic evaluation of MR using effective orifice area and vena contracta, and the use of phenylephrine challenge, were useful to avoid underestimating MR severity in the operating department.