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Atrial Fibrillation
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Rong Bai, Mohamed Salim, Luigi Di Biase, Robert Schweikert, Walid Saliba
May be guided by transesophageal echocardiography. It can help rule out left atrial clot and expedite cardioversion in patients who are tolerating AF poorly. In this strategy, anticoagulation should be started with unfractionated heparin or low molecular weight heparin before cardioversion and continued until a therapeutic international normalized ratio (INR) is achieved with warfarin therapy.
Predicting the Biomechanics of the Aorta Using Ultrasound
Published in Ayman El-Baz, Jasjit S. Suri, Cardiovascular Imaging and Image Analysis, 2018
Mansour AlOmran, Alexander Emmott, Richard L. Leask, Kevin Lachapelle
However, the quality of the images obtained are patient and operator dependent [51]. Ultrasound images inherently provide poor lateral spatial resolution, and limited precision, as it's based on video-image analysis, that is, high-quality images involving the whole structure of interest are required for accurate assessment [51–53]. Additionally, most of the analysis is performed on two-dimensional images, which might present some limitations in fully assessing a three-dimensional structure. Another inherent limitation is that blind spots cause local anatomic constraints, such as structures behind ribs, the aortic arch, and the distal ascending aorta [54]. However, the use of transesophageal echocardiography to complement transthoracic echocardiography alleviates most of the aforementioned anatomical limitations with the added risk (albeit low) of sedation and the invasive probe introduction [55, 56].
Single-lung transplantation: Technical aspects
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
Christopher Wigfield, Wickii T. Vigneswaran
Once a donor has been verified and a lung has been deemed suitable for transplantation, the recipient is brought into the operating room for transplantation. We prefer to place a thoracic epidural before the transplantation procedure unless cardiopulmonary bypass and full systemic anticoagulation are expected. General anesthesia is provided, and the patient is ventilated with a double-lumen endotracheal tube. The tube’s position is verified by fiberoptic bronchoscopy. Arterial and venous access lines, including a Swan-Ganz catheter, are placed. At this stage we also insert a transesophageal echocardiography (TEE) probe. The patient is placed in a lateral decubitus position for an anterolateral thoracotomy or in a semilateral position if a limited submammary incision is planned. An axillary roll should be placed under the axilla of the dependent arm to prevent injuries to the brachial plexus. A body-warming device (Bair Hugger) is used for the lower part of the body. The chest, abdomen, and groin are exposed, and the field is prepared with antiseptic solution and draped in sterile fashion (in case cardiopulmonary bypass via femoral access is needed). It is helpful to insert a femoral arterial line for a later Seldinger approach in this position if the need for extracorporeal support appears to be likely.
Infective endocarditis by Actinomyces species: a systematic review
Published in Journal of Chemotherapy, 2023
Petros Ioannou, Stella Baliou, Ioanna Papakitsou, Diamantis P. Kofteridis
The most common site of infection was the aortic valve in 46.7% (14 out of 30 patients with available data), the mitral valve in 43.3% (13 patients), the tricuspid valve in 16.7% (5 patients), and the pulmonary valve and the eustachian valve in 3.3% (1 patient) each. In 10% (3 patients), multiple valves were infected. Lead infection was noted in 3.3% (1 patient), where the tricuspid valve was also infected. Diagnosis was facilitated by transesophageal echocardiography in 38.7% (12 out of 31 patients), and transthoracic echocardiography in 35.5% (11 patients), while diagnosis was set at autopsy in 16.1% (5 patients). In 9.7% (3 patients) the diagnosis was set empirically, with the Dukes criteria by the studies’ authors. In all cases presented herein, diagnosis was confirmed with the current modified Dukes’ diagnostic criteria by this study’s investigators.
Combined liver transplantation and off-pump coronary artery bypass grafting: a report of two cases
Published in Acta Chirurgica Belgica, 2022
Tumay Uludag Yanaral, Gokhan Ertugrul, Mustafa Ozer Ulukan, Pelin Karaaslan, Ibrahim Oguz Karaca, Murat Dayangac
The critical issue in this type of highly specified procedure involving two major surgical operations concerns the optimization of the patient preoperatively and reducing the duration of the operation and amount of transfusion. The preoperative optimization of the patient should include correcting coagulopathy, managing encephalopathy, preventing sepsis, and improving respiratory and renal function. The PiCCO system enables the continuous monitoring of the stroke volume, continuous cardiac output, systemic vascular resistance, intrathoracic blood volume, and extravascular lung water throughout the operations. It aids critical decisions to restore hemodynamic stability during LT. We adjusted the inotropic support and fluid requirements through PiCCO parameters in our patients. Transesophageal echocardiography is also very important during such procedures since they allow monitoring myocardial functions, regional wall motion abnormalities, and volume status inside the heart [11]. As expected, our second patient had significantly higher blood loss during surgery due to her significantly higher MELD score and more severe portal hypertension. However, despite high blood loss during surgery and the presence of hepatorenal syndrome, she had a significant improvement in kidney function on day 1 after the transplant as a result of the use of terlipressin and more importantly the successful transplant procedure.
Pulmonary embolism and primary cardiac lymphoma
Published in Acta Cardiologica, 2020
Siddharth Jogani, Florentijn Risseeuw, Michael Janssens, Bernard Paelinck
A 60-year old male patient was admitted because of right sided heart failure due to extensive bilateral obstructive pulmonary embolism (PE) (Figure 1, panel A). On admission, the patient was hemodynamically stable. Transthoracic echocardiography confirmed right sided heart failure including visualisation of a large intracardiac mass in the right ventricle and right atrium. Transesophageal echocardiography confirmed the presence of this mass expanding through the atrioventricular groove and intramurally in the right ventricle (Figure 1, panel B). An echo-guided right heart catheter biopsy was performed. Histologically medium size monomorphic cells with irregular nuclei were seen together with strong positivity for CD45 and CD20, diagnosing diffuse large B-cell lymphoma. Further disease staging was done with PET-CT and MRI-scan. PET-CT scan showed a large fluor-18-deoxyglucose avid tumour in the right heart expanding into the mediastinum with aortic invasion (Figure 1, panel C).