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Intraoperative Echocardiography

Intraoperative Echocardiography . Harold G. Jackson II Tulane University Anesthesiology Elective . Indications . ASSESSMENT . MONITORING . Chamber Size Valvular Function Septal Thickness Shunts Masses Perfusion Myocardial Ischemia Global Ventricular Function

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Intraoperative Echocardiography

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  1. Intraoperative Echocardiography • Harold G. Jackson II • Tulane University Anesthesiology Elective

  2. Indications ASSESSMENT MONITORING • Chamber Size • Valvular Function • Septal Thickness • Shunts • Masses • Perfusion • Myocardial Ischemia • Global Ventricular Function • Regional Wall Motion abnormalities • Valve Abnormalities • Intracardiac contrast • Venous Paradoxical Air Embolism

  3. Contraindications ABSOLUTE RELATIVE • Esophageal Pathology • Coagulopathy or Heparinization • Left Atrial Myxoma with Embolization

  4. Advantage of TEE vs Pulmonary Catheterization • Ventricular Wall motion abnormality detected by TEE is the most sensitive indicator of myocardial ischemia. • Most sensitive modality for detecting intracardiac air embolism. • Only device for monitoring paradoxical air embolism.

  5. American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Recommendations: TEE should be used for all cardiac or thoracic surgery patients. Including cardiac catheterization when general anesthesia is used.

  6. Functional Mitral Regurgitationb • Indicator of acute or chronic ischemia. Marked apical tenting of the mitral leaflets along with reduced leaflet coaptation. • The anterior mitral leaflet has a "dog's leg" shape in systole due to tethering of chordae which attach to the belly of the leaflet.

  7. TAKE A BETTER LOOK... http://pie.med.utoronto.ca/TEE/TEE_content/assets/applications/standardViews/index.htm

  8. Recap: Intraoperative Diagnosis • Early Ischemia and Air Embolism • Hypotensive etiology i.e. separation from cardiopulmonary bypass • Adequacy of valve repair and myectomy • Masses (myxoma, thrombus, embolus, vegetation) • Contrast techniques for shunts

  9. References • 1. Incidental finding of a large pulmonary valve fibroelastoma: A case report • 2. Practice Guidelines for Perioperative Transesophageal Echocardiography:An Updated Report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography* • 3. Transesophageal Echocardiography: Intraoperative Uses • Anesthesiology Review Chapter 85; Cook M.D.,David J. • 4. http://echocardiographer.org/TEE.html • 5. http://pie.med.utoronto.ca/TEE/TEE_content/assets/applications/standardViews/index.htm

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