Article from Critical Care Medicine

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Lamia, Bouchra ; Maizel, Julien ; Ochagavia, Ana ; Chemla, Denis ; Osman, David et al
Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation
Critical Care Medicine. 37(5):1696-1701, May 2009.
Abstract
Objective: Weaning-induced pulmonary edema is a cause of weaning failure in high-risk patients. The diagnosis may require pulmonary artery catheterization to demonstrate increased pulmonary artery occlusion pressure (PAOP) during weaning. Transthoracic echocardiography can estimate left ventricular filling pressures using early (E) and late (A) peak diastolic velocities measured with Doppler transmitral flow, and tissue Doppler imaging of mitral annulus velocities including early (Ea) peak diastolic velocity. We tested the hypothesis that E/A and E/Ea could be used to detect weaning-induced PAOP elevation defined by a PAOP >=18 mm Hg during a spontaneous breathing trial (SBT).Measurements and Main Results: We included 39 patients who previously failed two consecutive SBTs. A third SBT was performed over a maximum 1-hour period using a T-piece. The PAOP, E/A, and E/Ea were measured before and during this SBT. Receiver operating characteristic curves were constructed to determine the optimal sensitivity and specificity values of E/A and E/Ea obtained at the end of the SBT for predicting a weaning-induced PAOP elevation. Weaning-induced PAOP elevation occurred in 17 patients. A value of E/A >0.95 at the end of the SBT predicted weaning-induced PAOP elevation with a sensitivity of 88% and a specificity of 68%. A value of E/Ea >8.5 at the end of the SBT predicted weaning-induced PAOP elevation with a sensitivity of 94% and a specificity of 73%. The combination of E/A >0.95 and E/Ea >8.5 predicted a weaning-induced PAOP elevation with a sensitivity of 82% and a specificity of 91%.Conclusion: At the end of an SBT, the combination of E/A >0.95 and E/Ea >8.5 measured with transthoracic echocardiography allowed an accurate noninvasive detection of weaning-induced PAOP elevation.

Articles from Anesthesia and Analgesia

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Dzwonczyk, Roger; Fujii, Jeffrey T. ; Simonetti, Orlando ; Nieves-Ramos, Ricardo ; Bergese, Sergio D.
Electrical Noise in the Intraoperative Magnetic Resonance Imaging Setting
Anesthesia & Analgesia. 108(1):181-186, January 2009.
Abstract
BACKGROUND: Intraoperative magnetic resonance imaging (iMRI) is a tool now commonly used in neurosurgery. Safe and reliable patient care in this (or any other) operating room setting depends on an environment, where electrical noise (EN) does not interfere with the operation of the electronic monitoring or imaging equipment. In this investigation, we evaluated the EN generated by the iMRI system and the anesthesia patient monitor used at this institution that impacts the performance of these two devices.METHODS: We measured the EN generated by our iMRI-compatible anesthesia patient monitor as detected by the EN analysis algorithm in our iMRI system. We measured the EN generated by our iMRI system during scanning as detected in the electrocardiogram (ECG) waveform of our patient monitor. We analyzed the effects on EN reduction and signal quality of the ECG noise filters provided in our iMRI-compatible anesthesia patient monitor.RESULTS: Our patient monitor generated EN that was detectable by the iMRI EN analysis algorithm; however, this interference was within the iMRI manufacturer's acceptable limits for an iMRI scan (<10%>

Skubas, Nikolaos

Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists' Armamentarium: A Core Review. [Review]
Anesthesia & Analgesia. 108(1):48-66, January 2009.
Abstract
Endocardial motion and surface/volume changes during the cardiac cycle are echocardiographic methods for regional (analysis of wall motion) and global (fractional area change, stroke volume, and ejection fraction) evaluation of cardiac function. These conventional methods can be subjective, and/or time consuming and, depending upon circumstances, may divert the anesthesiologist's attention from intraoperative activities. Doppler tissue imaging (DTI) is a novel echocardiographic technique, which displays and measures systolic and diastolic velocity from a myocardial region. DTI is simple to perform and independent of adequate endocardial imaging. The numeric information (velocity or time intervals) is easily obtained and measured. Assessment of systolic and diastolic function on regional (detection of ischemia) as well as global level (ejection fraction, grading of diastolic dysfunction) and evaluation of filling pressure can be derived from DTI signals and used by any practicing cardiac anesthesiologist. This review describes the principles, imaging modalities, and clinical applications of DTI.(C) 2009 by International Anesthesia Research Society.

Tousignant, Claude
CON: Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists' Armamentarium. [Editorial]
Source
Anesthesia & Analgesia. 108(1):41-47, January 2009.

Kronzon, Itzhak MD

PRO: Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists' Armamentarium. [Editorial]
Source
Anesthesia & Analgesia. 108(1):37-40, January 2009.

Hilberath, Jan N. ; Shernan, Stanton K. ; Segal, Scott ; Smith, Brian et al

The Feasibility of Epicardial Echocardiography for Measuring Aortic Valve Area by the Continuity Equation

Anesthesia & Analgesia. 108(1):17-22, January 2009.
Abstract
BACKGROUND: Measuring the aortic valve area (AVA) remains an important component of a comprehensive intraoperative echocardiographic examination in patients undergoing aortic valve surgery. Epicardial echocardiography (EE) represents an accessible alternative to transesophageal echocardiography (TEE), however, its agreement and correlation with other imaging modalities for measuring AVA has not been systematically validated.METHODS: EE was used in 85 patients undergoing cardiac surgery to measure AVA (AVA-EE) using the continuity equation. AVA-EE was compared to measurements obtained by intraoperative transesophageal echocardiography (AVA-TEE) in the same population. In a subset of patients, AVA-EE was also compared to AVA measurements from either preoperative transthoracic echocardiography (AVA-TTE) (n = 65) or cardiac catheterization (AVA-Cath) (n = 35) that were acquired within 4 wk before the date of surgery.RESULTS: Adequate trans-AV Doppler recordings were obtained in 94% of patients for AVA-TEE and 100% of patients for AVA-EE. EE measurements of AVA showed close agreement with TEE measurements (mean difference [bias] +/- 95% CI = -0.09 cm2 +/- 0.18 cm2, r2 = 0.83, P < ci =" -0.03" r2 =" 0.87," ci =" -0.06" r2 =" 0.81,">

Clinical Physiology and Functional Imaging Volume 28 Issue 6 2008

Clinical Physiology and Functional Imaging
Volume 28, Issue 6, 2008.
Pages: 409-416
Comparison of different views with three-dimensional echocardiography: apical views offer superior visualization compared with parasternal and subcostal views
Ellen Ostenfeld, Kambiz Shahgaldi, Reidar Winter, Ronnie Willenheimer, Johan Holm

Superior Vena Cava Mass Missed on Transesophageal Echocardiography

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Mizuguchi, K Annette ; Fox, Amanda A. ; Burch, Thomas M.
Incidental Finding of Superior Vena Cava Mass Missed on Transesophageal Echocardiography but Seen on Epiaortic Imaging
Anesthesia & Analgesia. 107(3):788-790, September 2008.

BMJ Learning module - Transoesophageal echocardiography

Transoesophageal echocardiography
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Author: Partho P Sengupta and Bijoy K Khandheria

Circulation. 117(14) April 8, 2008.

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Yang, Hyun Suk MD; Srivathsan, Komandoor MD; Wissner, Eric et al
Real-Time 3-Dimensional Transesophageal Echocardiography: Novel Utility in Atrial Fibrillation Ablation With a Prosthetic Mitral Valve
pages e304-e305

Soriano, Brian D. MD; Hoch, Martin MD; Ithuralde, Alejandro MD; Geva, Tal MD et al
Matrix-Array 3-Dimensional Echocardiographic Assessment of Volumes, Mass, and Ejection Fraction in Young Pediatric Patients With a Functional Single Ventricle: A Comparison Study With Cardiac Magnetic Resonance
p.1842-1848
Abstract
Background-: Quantitative assessment of ventricular volumes and mass in pediatric patients with single-ventricle physiology would aid clinical management, but it is difficult to obtain with 2-dimensional echocardiography. The purpose of the present study was to compare matrix-array 3-dimensional echocardiography (3DE) measurements of single-ventricle volumes, mass, and ejection fraction with those measured by cardiac magnetic resonance (CMR) in young patients.Methods and Results-: Twenty-nine patients (median age, 7 months) with a functional single ventricle undergoing CMR under general anesthesia were prospectively enrolled. The 3DE images were acquired at the conclusion of the CMR. Twenty-seven of 29 3DE data sets (93%) were optimal for 3DE assessment. Two blinded and independent observers performed 3DE measurements of volume, mass, and ejection fraction. The 3DE end-diastolic volume correlated well (r=0.96) but was smaller than CMR by 9% (P<0.01), and 3DE ejection fraction was smaller than CMR by 11% (P<0.01). There was no significant difference in measurements of end-systolic volume and mass. The 3DE interobserver differences for mass and volumes were not significant except for ejection fraction (8% difference; P<0.05). Intraobserver differences were not significant.Conclusions-: In young pediatric patients with a functional single ventricle, matrix-array 3DE measurements of mass and volumes compare well with those obtained by CMR. 3DE will provide an important modality for the serial analysis of ventricular size and performance in young patients with functional single ventricles.

Clinical Physiology and Functional Imaging Vol 28, Issue 3, May 2008

N.B. We do not have access to the full text of this journal

Review Articles
Assessment of coronary blood flow and the reactivity of the microcirculation non-invasively with transthoracic echocardiography
Tuomas Kiviniemi
pages 145–155

Original Articles
Transoesophageal echocardiography should be considered in patients with ischaemic stroke or transient ischaemic attack
Marjatta Strandberg, Reijo J Marttila, Hans Helenius and Jaakko Hartiala
pages 156–160

Normal limits for left ventricular ejection fraction and volumes determined by gated single photon emission computed tomography a comparison between two quantification methods
Milan Lomsky, Lena Johansson, Peter Gjertsson, Jonas Björk and Lars Edenbrandt
pages 169–173