Intraoperative and Interventional Echocardiography

Atlas of Transesophageal Imaging E-Book

Donald Oxorn, Catherine M. Otto

• Publisher: Elsevier
• Year: 2016
• ISBN:
  9780323496193
• Edition: 2
• Topic: Medicine
• Subtopic: Cardiology

Case-based and heavily illustrated, Intraoperative and Interventional Echocardiography: Atlas of Transesophageal Imaging, 2nd Edition covers virtually every clinical scenario in which you're likely to use TEE. Drs. Donald C. Oxorn and Catherine M. Otto provide practical, how-to guidance on transesophageal echocardiography, including new approaches and state-of-the-art technologies. More than 1, 500 images sharpen your image acquisition and analysis skills and help you master this challenging technique.

• Real-world cases and abundant, detailed figures and tables show you exactly how to proceed, step by step, and get the best results.
• Each case begins with a brief presentation and discussion, and integrates clinical echocardiography, surgical pathology, and other imaging data.
• Clear descriptions of preoperative pathology guide you in choosing the best approach to common problems.
• The practice-based learning approach with expert commentary for each case helps you retain complex information and apply it in your daily practice.

• Every chapter has been thoroughly revised, with discussions of new technology and new techniques, including several techniques that are on the verge of becoming mainstream.
• New chapters cover current transcatheter valve therapies and device closures.

Chapter 1

Coronary artery disease

Visualization of the coronary arteries and regional wall motion

Case 1-1 Normal coronary arteries

Case 1-2 Right coronary artery dissection

Case 1-3 Right coronary artery air

Myocardial infarction

Case 1-4 Anterior myocardial infarction

Case 1-5 Inferior wall myocardial infarction with dyskinesis (true aneurysm)

Case 1-6 Lateral wall myocardial infarction

Case 1-7 Myocardial infarction followed by heart transplantation

Complications of myocardial infarction

Case 1-8 Postmyocardial infarction ventricular septal defect (anterior)

Case 1-9 Postmyocardial infarction ventricular septal defect (posterior)

Case 1-10 Left ventricular reconstructive surgery (Dor procedure)

Case 1-11 Postmyocardial infarction pseudoaneurysm

Visualization of the coronary arteries and regional wall motion

CASE 1-1 Normal coronary arteries

Fig 1.1In a magnified short-axis view of the aorta slightly cephalad to the valve plane, the right coronary artery (RCA) and left coronary artery (LCA) ostia are seen arising from the right and left coronary sinuses of Valsalva, respectively. The left main coronary artery is easily visualized in nearly all patients. The right coronary is visualized less often.

Fig 1.2Transesophageal echocardiography (TEE) images in a different patient demonstrate the course of the left main coronary artery as it passes behind the main pulmonary artery and bifurcates into the posterior direct circumflex (Cx) and more anteriorly the direct left anterior descending (LAD) coronary artery. This view was obtained starting in a short-axis view of the aorta to visualize the left main coronary ostium and then rotating the image plane until the bifurcation was seen. On the right, color Doppler demonstrates the predominantly diastolic flow in the left main, circumflex, and left anterior descending (LAD) coronary arteries.

Fig 1.3A pulsed Doppler sample volume is positioned in the left anterior descending coronary artery. The spectral tracing shows low-velocity diastolic flow, with small systolic component, typical for normal coronary blood flow.

Fig 1.4In this patient with an idiopathic dilated cardiomyopathy undergoing heart transplantation, the left main coronary artery is absent, and both the circumflex and left anterior descending arteries arise from the left coronary sinus of Valsalva as seen on TEE (left) and in the explanted heart (right).

Fig 1.5In this intraoperative photograph of the aortic valve from the aortic root side, the forceps tip is at the ostium of the right coronary artery (left). The right coronary ostium is anterior and slightly more cephalad than the left main coronary artery (right). The photograph is taken from the head of the operating table, and is therefore rotated 180 degrees from what is seen in TEE imaging.

Fig 1.6In a magnified short-axis TEE image, the ostium of the right coronary artery (RCA) is seen.

Fig 1.7The RCA is often more easily visualized in a long-axis view of the aortic root, as shown in this example.

Fig 1.8The left ventricular wall segments are shown for an anatomic specimen in the same orientation as a transgastric short-axis view of the ventricle. The ventricle is divided into six segments at the base and midventricular level, as shown. The posterior wall is also called the inferior–lateral wall, using the standard nomenclature for regional wall motion analysis.

Fig 1.9This schematic diagram of a short-axis view of the left (LV) and right ventricle (RV) in the same orientation as the transgastric short-axis views (left-side frame) illustrates the correlation between coronary anatomy and regional myocardial function. In the middle frame, the 17-segment model of the LV is seen, and in the right-side frame, the coronary perfusion of these segments is shown. There is some variability in the region supplied by the left circumflex artery (LCX), even at the base and midventricular levels. The apical region of the ventricle may be supplied by either the left anterior descending (LAD) or the right coronary artery (RCA) so that identification of the culprit vessel becomes problematic when only an apical abnormality is present. Source: (Reproduced with permission from Oxorn D, Edelist G, Smith MS. An introduction to transoesophageal echocardiography: II clinical applications. Can J Anaesth 1996; 43:278-294 [left-side frame], and from Lang R, Badano L, Victor Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1–39 [middle and right-side frames]).

Comments

As shown in these examples, the proximal coronary arteries can often be visualized on TEE. The left main coronary artery arises from the left coronary sinus of Valsalva, is easily visualized in over 85% of patients and has a normal diameter of 4.2 ± 0.7 mm, with a slightly smaller average diameter in women (3.5 mm) compared with men (4.3 mm). The left main coronary artery bifurcates into the left anterior descendin...