By Annette Vegas MD, FRCPC, FASE (auth.)
Transesophageal echocardiography (TEE) is a useful diagnostic modality now oftentimes used in the course of cardiac surgical procedure and within the in depth care unit. more and more, anesthesiologists proficient in TEE give you the provider in either settings the place they face the problem of integrating quite a few present TEE guidance into daily perform. Perioperative Two-Dimensional Transesophageal Echocardiography: A sensible Handbook has been designed to be a concise, transportable advisor for utilizing TEE to acknowledge cardiac pathology in the course of the perioperative interval.
This compact advisor has a various charm for anesthesiologists, cardiac surgeons, and cardiologists needing accomplished updated echocardiographic details at their fingertips.
- More than 450 full-color, top of the range medical photographs and illustrations
- Synopsis of cardiac pathology as a rule encountered in cardiac surgical procedure patients
- Convenient spiral binding
- On-the-spot reference for echocardiographers with quite a lot of adventure, from beginner to expert
Read or Download Perioperative Two-Dimensional Transesophageal Echocardiography: A Practical Handbook PDF
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Additional resources for Perioperative Two-Dimensional Transesophageal Echocardiography: A Practical Handbook
Imaged Structures Diagnostic Issues Right atrium (RA), appendage (RAA) Right ventricle (RV) Tricuspid valve (TV): Anterior + posterior leaflets Color/CW or PW Doppler Coronary sinus (CS) Superior vena cava (SVC) TV pathology CW Doppler tricuspid regurgitation CS color flow SVC color flow Inter-atrial septum flow 29 2 Doppler and Hemodynamics Color Doppler ........................................................................................... Spectral Doppler .........................................................................................
Velocity black line towards Time 0 away At each time point, the spectral display shows: • Blood flow direction (toward or away from the transducer) • Velocity (frequency shift) • Signal magnitudes (greyness) • Timing with ECG (systole or diastole) Black line: absence of Doppler information as 2D image is updated Parameters that can be adjusted in spectral Doppler mode include: • Scale: adjusts the range of velocities displayed • Baseline: adjusts the zero baseline velocity up or down • Doppler gain: alters the overall strength of returning signals • Grey scale: alters the various ranges of grey displayed • Wall filter: sets the threshold below which low frequency signals are removed from the display (preset at 500 Hz) • Sweep speed: changes in ECG rate (25, 50, 100, 150 mm/s) affect Doppler display 34 Spectral Doppler Pulsed Wave Doppler Continuous Wave Doppler • Uses one crystal in transducer to intermittently send + receive signals • Allows sampling of blood velocity at specific depth (range resolution) • Limit on the maximum velocity seen (aliasing) due to the Nyquist limit (PRF = 2 x transmitted frequency) • Uses two crystals in transducer to continuously send + receive signals • Sampling occurs along the entire Doppler beam (range ambiguity) • Unlimited maximum velocity displayed (no aliasing), not Nyquist limited Source: Quinones MA, et al.
This view is also obtained from the ME Ascending Aortic LAX (120°) by decreasing the omniplane angle to 0°–10° to image SVC (SAX), ascending aorta (SAX), and RPA (LAX). Color Doppler box is positioned over the PA and aorta with Nyquist 50–70cm/s to show laminar antegrade systolic flow. The color Doppler box can be separately positioned over the SVC with a lower Nyquist of 30cm/s. Shown above is flow acceleration in the main PA and turbulent flow in the ascending aorta. Imaged Structures Diagnostic Issues Ascending (Asc) aorta Main pulmonary artery Right pulmonary artery (RPA) Superior vena cava (SVC) Aorta atherosclerosis Aorta dissection Aorta aneurysm Pulmonary embolism Swan–Ganz catheter position 24 Mid-esophageal Ascending Aortic Long-Axis (LAX) PA Asc aorta ME Asc aortic LAX The ME Ascending Aortic (LAX) view may be visualized from the ME AV LAX (120°), by withdrawing the probe to image the right pulmonary artery (RPA) in SAX, and decreasing the omniplane angle slightly (100°–110°).