ObjectTo evaluate the feasibility of measuring the descending aortic blood flow using transesophageal ultrasound Doppler under cardiopulmonary bypass (CPB). MethodWe retrospectively analyzed the clinical data of 10 adult patients accepted elective cardiac surgery under CPB in March 2014 year. There were 4 males and 6 females with a mean age of 44.5±12.3 years ranging from 24.5-64.0 years. The descending aorta diameter and velocity time integral (VTI) of blood flow of middle esophageal and lower esophageal of these patients were detected by transesophageal echocardiography (TEE) under CPB. We took the formula of classic ultrasound texting the blood flow to calculate the descending aorta blood flow (DABF). At the same time, we recorded the data of CPB and index of hemodynamics. Compared with the flow of CPB pump, we analyzed the correlation between pump flow and the raliability of DABF texting value under CPB. ResultsTwo patients quit the trail for blurred imaging. The quality of blood flow spectrum images aquirded from the middle esophageal were inferior to those from the lower esophageal (P < 0.01) in the 10 patients. Among the patients 90% of DABF from the middle esophageal and 50% of DABF from the lower esophageal were more than pump flow. however, the texting value had an excellence correlation to PF (r=0.795, r=0.825). ConclusionThe classical TEE technique can not obtain accurate blood flow during CPB.
ObjectiveTo explore the safety and efficacy of transesophageal echocardiography (TEE)-guided percutaneous intervention for patent ductus arteriosus (PDA) in obese teenagers.MethodsFrom January 2018 to June 2019, 21 obese teenagers with PDA treated with femoral artery occlusion guided by TEE in the Department of Cardiac Surgery, Dalian Children's Hospital of Dalian Medical University were included in this study, including 13 males and 8 females aged 12.8-17.3 (15.1±1.7) years, with an average weight of 51.0-89.0 (73.4±10.1) kg. The operative effect was evaluated. ResultsAll patients successfully received the surgery, and none was changed to radiation-guided or thoracotomy ligation. The average operating time was 23.9±6.8 min, the average postoperative hospitalization time was 3.8±0.6 d. No peripheral vascular injury, intracardiac infection or pericardial effusion occurred. The mean follow-up time was 19.5±4.9 months, and the results of all reexaminations were good.ConclusionFor some PDA children with obesity, emphysema or thoracic malformation, it is difficult to block PDA by transthoracic ultrasound-guided percutaneous intervention, and TEE can avoid the interference of chest wall and lung qi, or other factors. It is an effective supplementary guidance method worthy of promotion.
ObjectiveTo evaluate the feasibility and safety of blocking congenital ventricular septal defect or congenital atrial septal defect through the small vertical incision of right subaxillary. MethodsWe retrospectively analyzed the clinical data of 38 patients underwent the surgery of blocking congenital ventricular septal defect or congenital atrial septal defect in our hospital from January to August 2015. There were 22 males and 16 females with a mean age of 10.3±5.2 months, weight of 8.2±3.5 kg. ResultsThere were 34 patients (89.5%) successfully blocked through the small vertical cut of right subaxillary. The average blood loss of those 34 patients was 19.5±13.4 ml and the mean time of surgery was 58.4±28.5 minutes. Four patients (10.5%) with ventricular septal defect failed to block because of aortic valve prolapse. Those patients underwent direct repair of ventricular septal defect under extracorporeal circulation while general anesthesia. There was no serious adverse event during the surgery. The extubation time was 3.9±1.6 hours, the ICU monitoring time was 1.8±0.8 days and the hospital stay time was 3.2±0.5 days. All patients discharged uneventfully. ConclusionBlocking congenital ventricular septal defect or congenital atrial septal defect through the cut of right subaxillary is a feasible, effective, safe, and minimally invasive method. The effect of early follow-up is well.
Objective To systematically evaluate the safety, efficacy, and economics of intracardiac echocardiography (ICE) versus transesophageal echocardiography (TEE) in left atrial appendage occlusion (LAAO). Methods PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Database were systematically searched to collect relevant studies on comparing ICE and TEE-guided LAAO from inception to June 15th, 2022. Two reviewers independently screened the literatures, extracted the data, and assessed the risk of bias of the included studies. Meta-analyses were performed using RevMan 5.3 and R 4.0.3. Retrospective cohort studies were excluded for sensitivity analysis. Subgroup analyses were performed based on the types of occluder and ICE catheter. Results A total of 14 studies with 6 599 patients were included. Meta-analyses showed no statistical differences in technical success rate, overall complications, device embolization, peri-device leakage, device-related thrombus, stroke, vascular complications, bleeding, operation time, fluoroscopy time, or contrast agent volume between the ICE and TEE-guided LAAO. The total in-room time (MD=–33.47 min, 95%CI –41.20 to –25.73, P<0.00001) and radiation dosage (MD=–170.20 mGy, 95%CI –309.79 to –30.62, P=0.02) were lower in the ICE group than those in the TEE group, whereas the incidence of pericardial effusion/tamponade was higher than the TEE group (RR=1.57, 95%CI 1.01 to 2.45, P=0.048). Except for pericardial effusion/tamponade, subgroup analyses and sensitivity analysis showed similar results. The analysis based on the cost data from the United States showed comparable or even lower total costs for ICE versus TEE, but comparative domestic cost studies were lacking. Conclusion Current evidence suggests that ICE-guided LAAO can reduce radiation dosage and total in-room time, and there is no statistical difference in the overall complication rate between the two groups. Owing to the limitations of sample size and quality of the included studies, the conclusion still needs to be verified by large sample size and high-quality randomized controlled trials.
ObjectiveTo share the experience of treating special cardiac malformations by applying minimally invasive techniques.MethodsEight children with special cardiac malformations admitted to our hospital from July 2014 to September 2020 were recruited, including 3 males and 5 females, aged 0.8-1.2 (1.1±0.4) years, and weighted 7.8-11.5 (9.6±2.9) kg. There were 2 patients of huge muscular ventricular septal defect (VSD), 3 perimembranous cribriform VSD, 1 right coronary-right atrial fistula, 1 right coronary-right ventricular fistula, and 1 young, low-weight child with large aortopulmonary. All were treated with minimally invasive techniques using transesophageal echocardiography (TEE) as a guiding tool. All children received intraoperative TEE immediately to evaluate the curative effect of the surgery, and all went to outpatient clinic for reexamination of echocardiography, electrocardiogram and chest X-ray after discharge.ResultsEight children underwent minimally invasive surgery successfully without any incision infection, intracardiac infection, arrhythmia or pericardial effusion. None of the 8 children were lost to follow-up, and the results of all reexaminations were satisfactory.ConclusionThe application of minimally invasive techniques is a bold and innovative attempt for the treatment of a few special types of cardiac malformations. It has significant advantages in reducing trauma and medical costs in some suitable patients, and has certain clinical reference values.
In recent years, transesophageal echocardiography has a trend toward miniaturization, so it has great clinical significance and broad clinical application prospect in the management of Cardiac Surgery ICU patient. This paper presents the characteristics of miniaturized transesophageal echocardiography and its clinical application. And we also focused on the contrast between miniaturized transesophageal echocardiography and standard transesophageal echocardiography and transthoracic echocardiography.
ObjectiveTo investigate clinical outcomes and safety of transesophageal echocardiography (TEE)-guided occlusion of infundibular ventricular septal defect (VSD) via minithoracotomy. MethodsClinical data of 21 pediatric patients with infundibular VSD who underwent TEE-guided occlusion via minithoracotomy in Children's Hospital of Hebei Province from January to June 2013 were retrospectively analyzed. There were 10 male and 11 female patients with their age of 8-24 (16±8) months and body weight of 9±3 kg. The size of VSD was 4.5±2.5 mm. TEE was used to evaluate the position of the occluder, its influence on the atrioventricular valves and aortic valve, and the presence of residual shunt. ResultsThere was no perioperative death or complication. VSD occlusion was successfully performed in 20 out of 21 patients (95.2%). One patient received conversion to open VSD repair under extracorporeal circulation because VSD size was too big. Mean time of delivery of occluders was 32±16 minutes, the size of the occluders was 5±3 mm, and length of hospital stay was 6-8 days. All the patients were followed up for 3-6 months after discharge. During follow-up, echocardiography showed clear echo and normal position of the occluders, and there was no mild or more severe residual shunt or valvular regurgitation. ConclusionTEE-guided occlusion of infundibular VSD via minithoracotomy is easy to perform and safe with satisfactory clinical outcomes.
We reported a 65-year-old female who was admitted to our institute with "recurrent subxiphoid pain accompanied by dyspnea for more than 10 days". Electrocardiogram examination suggested acute extensive anterior ST segment elevation myocardial infarction. Preoperative transthoracic echocardiography suggested ventricular septal rupture. The patient was planned for the repair of ventricular septal rupture with cardiopulmonary bypass. The formation of left ventricular aneurysm was diagnosed by intraoperative transesophageal echocardiography (TEE). The surgeon decided to abdopt the modified incision of left ventricular approach guided by TEE, which greatly improved the prognosis of the patient. The surgery duration was 197 min, aortic cross-clamping time was 56 min, cardiopulmonary bypass time was 69 min, and the patient was safely admitted to ICU after the surgery. Extubation was performed on the first day postoperatively, and the intra-aortic balloon pump support was retreated on the second day postoperatively. Postoperative echocardiography showed that no obvious residual shunt was observed after ventricular septal repairment and ventricular aneurysm resection. The patient was discharged on the 12th day after the surgery. Additionally, the mental condition was good and daily activities were not limited within 6 months postoperatively.