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.
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.
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.
目的探讨在经食管超声心动图（TEE）引导下经胸封堵室间隔缺损（VSD）的临床经验。 方法回顾性分析2013年7月至2014年7月高州市人民医院23例先天性心脏病患儿的临床资料，其中男9例、女14例，年龄4个月至1岁。胸骨下段小切口暴露右心室前壁，在TEE引导和实时监测下，穿刺右心室前壁，建立轨道，通过短输送装置直接将封堵器安放在VSD部位。 结果23例患者全都封堵成功，置入封堵器直径6～10 mm，术后5～11 d出院，随访3～24个月，无残余分流、主动脉瓣反流以及心律失常等并发症。 结论TEE引导下经胸微创封堵婴儿室间隔缺损是一种简单安全的治疗方法。
Objective To analyze the efficacy and safety of closure of patent foramen ovale (PFO) guided by transesophageal echocardiography (TEE), and summarize the experience of some difficult cases. MethodsThe patients who underwent the percutaneous PFO occlusion in our hospital from January 2020 to May 2023 were retrospectively enrolled. Dynamic monitoring data of TEE before, during, and after the operation were recorded. Results A total of 68 patients including 30 males and 38 females at an average age of (45.6±16.3) years were included. There were 7 patients with complex PFO. Under TEE guidance, 65 patients successfully completed the occlusion treatment, with an average operation time of (55.6±26.2) min and hospital stay time of (4.2±1.1) d, and 3 patients failed to close. During the operation, the two-dimensional TEE images of the patients were clear, which fully and clearly showed the process of the sheath canal passing through the foramen ovale and the continuous observation of the occlusive umbrella after releasing the occlusive umbrella. The position of the umbrella was secure and the shape of the umbrella was satisfactory. No blood shunt or pericardial effusion was found at 6-month and 1-year follow-up. The heart structure and heart rhythm were improved, the atrioventricular valve function was normal, the blocking umbrella was firm and stable, and there was no shedding or displacement. ConclusionThe percutaneous PFO occlusion guided by TEE is safe and effective, and has fewer side effects on patients compared with traditional interventional methods, but the complex PFO occlusion surgery is still challenging.
Echocardiography is an important imaging technique in mithal valve transcatheter edge-to-edge repair (TEER). During the operation, mitral leaflets capture and clamping have the highest requirements for ultrasound image quality and should be performed under the guidance of high-quality commissural view. However, standard commissural view cannot be obtained in some patients due to cardiac enlargement, transposition or limited esophageal acoustic window. In this condition, the optimal view can be obtained by Multivue technology. This paper reports a male patient aged 67 years with successful mitral valve TEER under the real-time guidance of Multivue technology, and summarizes the key points of this technology.
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.
Aortic stenosis accounts for a large proportion of valvular heart disease in China. This article described an unusual case of severe aortic stenosis with severe cardiopulmonary decompensation treated by emergency transcatheter aortic valve replacement. Preoperative assessment was performed by transesophageal echocardiography. The extracorporeal membrane oxygenation team was informed to be ready. During the operation, no obvious perivalve leakage was observed after valve released. The transvalvular pressure gradient decreased to 7 mm Hg (1 mm Hg=0.133 kPa).The patient’s symptoms were completely relieved after the operation, and no adverse events occurred during the hospitalization. After discharge, color Doppler echocardiography showed that stenosis was eliminated, cardiac function was improved, no significant perivalvular leakage was observed, and pulmonary hypertension reduced to moderate. The success of this operation confirmed the efficacy of emergency transcatheter aortic valve replacement, and showed that after a rigorous evaluation, emergency transcatheter aortic valve replacement may be a reasonable choice for patients with severe aortic valve stenosis.