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15 results

Core Topics in Transesophageal Echocardiography
  • Edited by Robert Feneck, John Kneeshaw, Marco Ranucci
  • Published online:
    10 May 2010
    Print publication:
    15 April 2010
  • Core Topics in Transesophageal Echocardiography is a highly illustrated, full color, comprehensive clinical text reviewing all aspects of TEE. The text has been written particularly for those who are seeking accreditation in TEE. Section 1 includes chapters on first principles including cardiovascular anatomy, safety issues, indications and contraindications for use, US technology and physics and the details of image acquisition and interpretation in a variety of routine pathologies. Section 2 chapters discuss the use of TEE in a variety of more demanding clinical conditions including valve disease, complex ischaemic heart disease, the use of TEE in critical care and emergency settings, new echocardiography technologies, and TEE reporting. An outstanding free companion website (www.cambridge.org/feneck) contains numerous TEE video clips showing both normal and pathological states. Written by leading TEE experts from EACTA and EAE, this is an invaluable practical resource for all clinicians involved in the care of cardiac patients.

  • 14 - Ischemic heart disease

  • from Section 2 - Practical issues in transesophageal echocardiography
  • Edited by Robert Feneck, John Kneeshaw, Marco Ranucci
  • Book:
    Core Topics in Transesophageal Echocardiography
    Published online:
    10 May 2010
    Print publication:
    15 April 2010, pp 225-246

  • Summary

    Aortic valve (AV) disease is very common in Western populations. Aortic sclerosis is diagnosed when there is an ejection systolic murmur present in the AV region due to calcification in the ascending aorta, with associated turbulent flow. Aortic stenosis (AS) is differentiated from sclerosis when significant restriction of cusp movement and a raised transaortic peak velocity is seen on echocardiography. Transesophageal echocardiography (TEE) evaluation of AS starts with a 2D examination of the mid-esophageal short-axis (ME SAX) and long-axis (LAX) views of the valve. Continuous-wave Doppler (CWD) is applied to measure flow velocity across the valve and then calculate a pressure gradient using the Bernoulli equation. Aortic regurgitation (AR) results from a primary valve lesion, an abnormal aortic root and/or ascending aorta, or a combination of both. TEE is valuable in revealing important aspects of AV disease.

  • 1 - Introduction: indications, training, and accreditation in transesophageal echocardiography

  • from Section 1 - Fundamentals of transesophageal echocardiography
  • Edited by Robert Feneck, John Kneeshaw, Marco Ranucci
  • Book:
    Core Topics in Transesophageal Echocardiography
    Published online:
    10 May 2010
    Print publication:
    15 April 2010, pp 3-12

  • Summary

    Transesophageal echocardiography (TEE) is a relatively recent development in imaging. In 1997 the American College of Cardiology (ACC) and the American Heart Association (AHA) published guidelines for the clinical application of echocardiography. Routine intraoperative use of TEE has been shown to lead to an improvement in both surgical and anesthetic management, which presumably is translated into better and more consistent outcomes for patients. The use of TEE as a diagnostic tool in the echo lab, and as a diagnostic and monitoring tool during and after cardiac or other major operations, has increased significantly. In Europe, the problem of training and accreditation in perioperative TEE has been addressed, during the last decade, by the European Association of Echocardiography (EAE), which is a formal association of the European Society of Cardiology (ESC), and the European Association of Cardiothoracic Anaesthesiologists (EACTA).

  • 13 - Hemodynamic assessment

  • from Section 1 - Fundamentals of transesophageal echocardiography
  • Edited by Robert Feneck, John Kneeshaw, Marco Ranucci
  • Book:
    Core Topics in Transesophageal Echocardiography
    Published online:
    10 May 2010
    Print publication:
    15 April 2010, pp 205-222

  • Summary

    This chapter presents a standardized approach to assess the four valves of the heart: the mitral valve (MV); aortic valve; tricuspid valve; pulmonary valve. The MV is examined through four mid-esophageal and two transgastric views. The aortic valve is a semilunar valve with three cusps of similar size. The aortic root is usually easy to visualize with transesophageal echocardiography (TEE) and needs three cross-sections for a complete evaluation. The tricuspid valve consists of three leaflets, attached via multiple chordae tendineae to three small papillary muscles, a supporting annular ring, and a portion of the myocardium of the right ventricular (RV) free wall. The pulmonary valve and the main pulmonary artery can be assessed with TEE in the basal view. The standardized approach outlined in the chapter provides a useful framework for a TEE assessment of the cardiac valves.

  • 17 - Aortic valve surgery

  • from Section 2 - Practical issues in transesophageal echocardiography
  • Edited by Robert Feneck, John Kneeshaw, Marco Ranucci
  • Book:
    Core Topics in Transesophageal Echocardiography
    Published online:
    10 May 2010
    Print publication:
    15 April 2010, pp 275-293

  • Summary

    Ejection fraction (EF) is a well accepted and useful index of quantitative left ventricular (LV) function, but it is influenced by changes in preload, afterload, and contractility. Stroke volume (SV) can be obtained with 2D transesophageal echocardiography (TEE) by measuring LV end-systolic and end-diastolic volumes for measuring EF. TEE evaluation of LV systolic function, both global and regional, provides insight into hemodynamic impairment in a variety of situations. Doppler echocardiography is the principal diagnostic tool to assess LV diastolic function non-invasively. TEE facilitates a complete evaluation of diastolic LV function by assessing diastolic phases and elucidating structural causes of altered diastole. The use of this tool has relevant implications in the management of hemodynamic derangement due to impaired diastolic function, in vasoactive drugs titration, in the detection of myocardial ischemia, and in performing prognostic stratification.