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Abstracts
 
ID Journal Abstract
#1: ANA
Educational program for intraoperative transesophageal echocardiography
Title: Educational program for intraoperative transesophageal echocardiography
Authors: RM Savage, MG Licina, CG Koch, CJ Hearn, JD Thomas, NJ Starr, and WJ Stewart
Citation: Anesth Analg 1995 81: 399-403
Abstract: Educational program for intraoperative transesophageal echocardiography
#2: ANA
Acute hypovolemia may cause segmental wall motion abnormalities in the absence of myocardial ischemia
Title: Acute hypovolemia may cause segmental wall motion abnormalities in the absence of myocardial ischemia
Authors: MD Seeberger, MK Cahalan, K Rouine-Rapp, E Foster, P Ionescu, M Balea, S Merrick and NB Schiller
Citation: Anesthesia & Analgesia, Vol 85, 1252-1257
Abstract: New segmental wall motion abnormalities (SWMA) detected by echocardiography are considered sensitive and specific markers of myocardial ischemia. However, we have observed new SWMA during pacing- induced reductions in left ventricular filling, which resolved immediately with cessation of the atrial pacing and simultaneous restoration of filling. Therefore, we designed this study to determine whether acute reduction in filling can induce new SWMA in the absence of ischemia. Institution of cardiopulmonary bypass was used as a clinical model of acute reduction in filling, and a beat-by-beat analysis of left ventricular contraction, filling, blood pressures, and electrocardiogram was performed when the drainage of blood to the cardiopulmonary bypass machine rapidly emptied the heart. Acute reduction in filling induced new SWMA in 4 of 38 study patients. All 4 patients had preexisting abnormalities of left ventricular contraction, but translocation of these preexisting SWMA did not explain the new SWMA, nor did myocardial ischemia. We conclude that acute reduction in left ventricular filling can cause new SWMA in the absence of ischemia. This finding limits the usefulness of new SWMA as a marker of ischemia in the presence of acute reduction in filling, such as that secondary to severe hypovolemia. Implications: This study documented that acute reduction in cardiac filling can be associated with new systolic wall motion abnormalities detected by transesophageal echocardiography in the absence of documented myocardial ischemia. These findings indicate that segmental wall motion may not be a valid marker for ischemia in the setting of acute hypovolemia
#3: ANA
Improved Evaluation of the Location and Mechanism of Mitral Valve Regurgitation with a Systematic Transesophageal Echocardiography Examination
Title: Improved Evaluation of the Location and Mechanism of Mitral Valve Regurgitation with a Systematic Transesophageal Echocardiography Examination
Authors: A.-Stephane Lambert, MD, FRCPC*, Joseph P. Miller, MD*, Scot H. Merrick, MD, FACS, Nelson B. Schiller, MD, FACC, Elyse Foster, MD, FACC, Isobel Muhiudeen-Russell, MD*, and Michael K. Cahalan, MD*
Citation: Anesth Analg 1999;88:1205
Abstract: Mitral regurgitation (MR) is a major determinant of outcome in cardiac surgery. The location and mechanism of mitral lesions determine the approach to various repairs and their feasibility. Because of incomplete evaluations or change in patient condition, detailed intra- operative transesophageal echocardiography (TEE) examination of the mitral valve may be required. We hypothesized that a systematic TEE mitral valve examination would allow precise identification of the anatomic location and mechanism of MR in patients undergoing mitral surgery. We designed a systematic mitral valve examination consisting of six views: five-chamber, four-chamber, two-chamber anterior, two-chamber mid, two-chamber posterior and short-axis. We used this examination prospectively in 13 patients undergoing mitral valve surgery for severe MR and compared the results with the surgical findings. We then retrospectively interpreted 11 similar patients who had undergone intraoperative TEE studies before this examination. TEE correctly diagnosed the mechanism and precise location of pathology in 12 of 13 patients in the prospective group, but in only 6 of 10 patients in the retrospective group. TEE also correctly identified 75 of 78 mitral segments (96%) as being normal or abnormal. In the retrospective group, only 42 of 60 segments (70%) were correctly identified (P < 0.001). We conclude that this systematic TEE mitral valve examination improves identification of mitral segments and precise localization of pathologies and may also improve the diagnosis of the mechanism of MR.
#4: ANA
Transesophageal Echocardiography Interpretation: A Comparative Analysis Between Cardiac Anesthesiologists and Primary Echocardiographers
Title: Transesophageal Echocardiography Interpretation: A Comparative Analysis Between Cardiac Anesthesiologists and Primary Echocardiographers
Authors: Joseph P. Mathew, MD, Manuel L. Fontes, MD, Susan Garwood, MD, Elizabeth Davis, LPN, RDCS, William D. White, MPH, Gerard McCloskey, MD, Jane C.K. Fitch, MD, Sherif Afifi, MD, David L. Lee, MD, Phillip Kraker, DO, Terence D. Rafferty, MD, Paul G. Barash, M
Citation: Anesth Analg 2002;94:302-309
Abstract: Diagnostic interpretation of intraoperative transesophageal echocardiography (TEE) examinations may vary, particularly when the echocardiographer is also the anesthesiologist. We therefore evaluated the concordance of TEE interpretation as part of a process of continuous quality improvement (CQI). Ten cardiac anesthesiologists participating in a CQI program conducted 154 comprehensive TEE examinations, each consisting of 16 major fields describing cardiac anatomy and function. These examinations were subsequently interpreted off-line by two primary echocardiographers (a radiologist and a cardiologist). Agreement was assessed using the coefficient and percent agreement. Overall and percent agreement were 0.58 and 83% for anesthesiologists versus radiologist, 0.57 and 80% for anesthesiologists versus cardiologist, and 0.60 and 82% for radiologist versus cardiologist. Anesthesiologists with longer than 5 yr of TEE experience had higher levels of agreement with the radiologist when assessing the aorta, right atrium, pulmonary vein flow, transmitral flow, and fractional area change. Cardiac anesthesiologists supported by a CQI program interpret TEE examinations at a level comparable with physicians whose primary practice is echocardiography. Thus, the anesthesiologist and the intraoperative echocardiographer need not be mutually exclusive.
#5: ANA
The Adequacy of Basic Intraoperative Transesophageal Echocardiography Performed by Experienced Anesthesiologists
Title: The Adequacy of Basic Intraoperative Transesophageal Echocardiography Performed by Experienced Anesthesiologists
Authors: Joseph P. Miller, MD*, A.-Stephane Lambert, MD, William A. Shapiro, MD, Isobel A. Russell, MD, Nelson B. Schiller, MD, and Michael K. Cahalan, MD
Citation: Anesth Analg 2001;92:1103-1110
Abstract: Transesophageal echocardiography (TEE) may improve intraoperative decision-making and patient outcome if it is performed and interpreted correctly. After revising our TEE examination to fulfill the published guidelines for basic TEE practitioners, we prospectively evaluated the ability of our cardiac anesthesiologists (all very experienced with TEE) to record and interpret this revised examination. Educational aids and regular TEE performance feedback were provided to the anesthesiologists. Their interpretations were compared with the independently determined results of experts. Compared with their own historical controls (42% recording rate), all anesthesiologists showed significant improvement in their ability to record a basic intraoperative TEE examination resulting in 81% (P < 0.0001) of all required images being recorded: 88% before cardiopulmonary bypass, 77% immediately after bypass, and 64% after chest closure. Seventy-nine percent of the images recorded at baseline were correctly interpreted, 6% were incorrectly interpreted, and 15% were not evaluated. Our attempt to assess compliance with published guidelines for basic intraoperative TEE resulted in a marked improvement in our intraoperative TEE practice. Most, but not all, standard cross-sections are recorded or interpreted correctly, even by highly experienced and motivated practitioners.
#6: JASE
American Society of Echocardiography and Society of Cardiovascular Anesthesiologists task force guidelines for training in perioperative echocardiography.
Title: American Society of Echocardiography and Society of Cardiovascular Anesthesiologists task force guidelines for training in perioperative echocardiography.
Authors: Cahalan MK, Stewart W, Pearlman A, Goldman M, Sears-Rogan P, Abel M, Russell I, Shanewise J, Troianos C; Society of Cardiovascular Anesthesiologists; American Society of Echocardiography Task Force.
Citation: J Am Soc Echocardiogr. 2002 Jun;15(6):647-52.
Abstract: Society of Cardiovascular Anesthesiologists task force guidelines for training in perioperative echocardiography.
#7: JASE
ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography
Title: ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography
Authors: Shanewise JS, Cheung AT, Aronson S, Stewart WJ, Weiss RL, Mark JB, Savage RM, Sears-Rogan P, Mathew JP, Quinones MA, Cahalan MK, Savino JS.
Citation: J Am Soc Echocardiogr 1999 Oct;12(10):884-900.
Abstract: ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography.
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#8: ANA
ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography.
Title: ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography.
Authors: Shanewise JS, Cheung AT, Aronson S, Stewart WJ, Weiss RL, Mark JB, Savage RM, Sears-Rogan P, Mathew JP, Quinones MA, Cahalan MK, Savino JS.
Citation: Anesth Analg. 2000 May;90(5):1248-9.
Abstract: American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography.
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