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Medical Applications of Ultrasonic Energy
Published in Dale Ensminger, Leonard J. Bond, Ultrasonics, 2011
Dale Ensminger, Leonard J. Bond
Echocardiography can be used at a patient’s bedside to diagnose pericardial effusion (escape of fluid through a rupture in the pericardium [108]). In such cases, the echo received from the posterior wall of the heart is split when the transducer is located on the anterior chest surface.
Cardiac
Published in Marsha A. Elkhunovich, Tarina L. Kang, Courtney Brennan, Kathryn Pade, Rashida Campwala, Jessica Rankin, Kristin Berona, Courtney Brennan, Pediatric Emergency Ultrasound, 2020
Marsha A. Elkhunovich, Tarina L. Kang, Courtney Brennan, Kathryn Pade, Rashida Campwala, Jessica Rankin, Kristin Berona, Courtney Brennan
Differentiate a pericardial effusion from a pleural effusion by looking at the descending aorta in the parasternal long view. A pleural effusion lies behind the aorta. If the fluid collection is anterior to the aorta, it is a pericardial effusion.
Update on the management and associated challenges of adult patients treated with veno-arterial extracorporeal membrane oxygenation
Published in Expert Review of Medical Devices, 2019
Yuichiro Kado, Takuma Miyamoto, Kiyotaka Fukamachi, Jamshid H. Karimov
Donker et al. [41] reported echocardiographic techniques and parameters that are required during VA ECMO. Before the initiation of VA ECMO, the authors reported that the following parameters needed to be assessed by echocardiography: LV morphology (left ventricular end diastolic diameter; LVEDD), LV function (LVEF), VTI, spectral tissue Doppler imaging mitral annulus peak systolic velocity (TDSa), RV failure, pericardial effusion, and atrial septal defect, whereas echocardiography was used to exclude the presence of aortic dissection, aortic valve regurgitation, papillary muscle rupture, interventricular septal rupture, large intracavitary or mural thrombi, and calcifications at the cannulation site. During VA ECMO support, echocardiography should be used to assess LV morphology (LVEDD), LV function (LVEF), VTI, TDSa, and intravascular volume status and to exclude pericardial effusion (tamponade), LV cavity dilatation, LV ejection (aortic valve opening), LV cavity thrombosis, aortic root thrombosis, and central venous thrombi. In addition, Doufle et al. [42] reported that the diastolic function of both the LV and RV, valvular assessment, and IVC/SVC size were important assessment parameters. Note that three-dimensional echocardiography has been widely used to evaluate RV function, as the volume and function of the RV are difficult to assess due to its unique configuration. Therefore, three-dimensional echocardiography aids in achieving a correct assessment and leads to an accurate prediction of patient outcome [34].
Appropriate use criteria of left atrial appendage closure devices: latest evidences
Published in Expert Review of Medical Devices, 2023
Fabrizio Guarracini, Eleonora Bonvicini, Alberto Preda, Marta Martin, Simone Muraglia, Giulia Casagranda, Marianna Mochen, Alessio Coser, Silvia Quintarelli, Stefano Branzoli, Roberto Bonmassari, Massimiliano Marini, Patrizio Mazzone
At the end of the procedure and before discharge, echocardiography assessment is used in order to point out major complication like pericardial effusion and tamponade or device dislodgment or embolization. After that usually at 45 day post intervention, a TEE is performed to check the position of the device and eventual thrombus or substantial leaks (>5 mm). CT controls are usually performed only after TEE assessment for better definition of already seen complications, because CT is more sensitive for intradevice leaks, minimal marginal leaks and defects of endothelization [61].
Lead choice in cardiac implantable electronic devices: an Italian survey promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing)
Published in Expert Review of Medical Devices, 2019
Matteo Ziacchi, Pietro Palmisano, Mauro Biffi, Federico Guerra, Giuseppe Stabile, Giovanni Battista Forleo, Gabriele Zanotto, Antonio D’Onofrio, Maurizio Landolina, Roberto De Ponti, Massimo Zoni Berisso, Renato Pietro Ricci, Giuseppe Boriani
The present survey is the first on this topic. Participation was fair and encompassed more than 1/3 of all Italian centers. The respondents reported favoring a passive atrial lead over an active lead because of the potential complications of the latter. It would be interesting to ascertain which complications are regarded as the most frequent (i.e. dislodgement, pericardial effusion, other) [9]. A large study on atrial lead implantation showed that active (compared with passive) lead fixation increased the risk of pericardial effusion requiring pericardiocentesis, without reducing the dislodgement rate. The same study also concluded that there was a clear association between low atrial septal lead position and lead dislodgement requiring lead revision [10]. As reported in our survey, an active atrial lead is used to pace outside the atrial appendage (e.g. septum or free wall), but in these sites dislocations are more frequent. On the basis of various European registers, it is possible to conclude that, after the left ventricular lead, the atrial lead is associated with the highest risk of complications (though the rates are comparable). It could therefore be concluded that the active-fixation atrial lead is more adaptable and should be used for ‘alternative’ site sensing/pacing. On the other hand, it is also at higher risk of dislodgement when compared to the passive lead. In conclusion, literature does not report a clear advantage of active or passive atrial leads in terms of long-term stability of electrical parameters or complication rates. However, it is fairly well established that an active fixation lead is better in the event of extraction for its structure which makes it more resistant [11]. Our survey revealed that the majority of ICD patients receive a screw-in atrial lead, while in PM patients, operators prefer a passive atrial lead. The reason for this choice is not completely clear, but the probable explanation is that PM patients are considered to be frailer. In conclusion, the respondents’ perception is that the passive atrial lead is safer but not suitable for placement in alternative sites, and more difficult to extract.