- Despite the valuable use of modern applications of perioperative ultrasound across multiple disciplines, there have been limitations to its implementation, restricting its impact on patient-based clinical outcomes. Point-of-care ultrasound evaluation of hypoxia and hypotension is an important tool to assess the underlying undifferentiated etiologies in a timely manner. However, there is a lack of consensus on the formal role of ultrasound during evaluation of perioperative hypoxia or hypotension.
- A 51-YEAR-OLD MAN (160 cm, 53 kg) with a known bicuspid aortic valve was scheduled to undergo an elective aortic valve replacement due to aortic valve stenosis. Preoperative transthoracic echocardiogram showed moderate-to-severe aortic valve stenosis (Vmax = 3.4 m/s, max gradient = 45.5 mmHg) and aortic insufficiency. Intraoperative transesophageal echocardiography revealed the following images (Figs 1 and 2, Videos 1 and 2). What is the diagnosis?
- A CHALLENGING CASE of intraoperative right ventricular (RV) failure and dynamic left ventricular outflow tract (LVOT) obstruction in a patient with takotsubo cardiomyopathy (CMP) and RV tear is presented. The major challenge of this case was the contradictory nature of therapy required for the biventricular support.
- THE QUALITY OF a 3-dimensional (3D) echocardiographic image is determined by the opposing requirements of spatial and temporal resolutions and the sector size.1 A simultaneous high level of temporal and spatial resolutions with the largest sector size only can be achieved with live R-wave gated reconstruction (Fig 1, Video 1).1 However, this is only possible in patients with stable cardiac rhythms and when there is no motion artifact. However, with arrhythmias, R-wave gating results in 3D images with stitching artifact that are qualitatively and quantitatively not interpretable and are unsuitable for decision-making.
- A 52-YEAR-OLD MAN was admitted to the authors’ hospital with a history of paroxysmal atrial fibrillation. He had undergone a pulmonary vein (PV) isolation procedure twice in the past, with the last procedure taking place in April 2016. Shortly after the last procedure the patient started experiencing progressive shortness of breath with accompanying dizziness and functional limitation. Computed tomographic scan demonstrated severe stenosis of all the PVs. Subsequently, he underwent balloon angioplasty of the left upper and lower PVs (LUPVs and LLPVs, respectively) and balloon angioplasty with stenting of the right upper pulmonary vein (RUPV).
- A 79-YEAR-OLD MAN experiencing shortness of breath was scheduled for transcatheter aortic valve replacement. He had a history of previous coronary artery bypass graft and congestive heart failure due to severe aortic valve stenosis (aortic valve area<1.0 cm2). The mitral valve was interrogated as part of the intraoperative transesophageal echocardiography examination with and without color-flow Doppler. The midesophageal views of the mitral valve with color-flow Doppler demonstrated a peculiar mitral regurgitation pattern with simultaneous anteriorly and posteriorly directed mitral regurgitation jets (Figs 1 and 2, Video 1A and 1B).
- To evaluate the feasibility of obtaining hemodynamic metrics of echocardiographically derived 3-dimensional printed mitral valve models deployed in a pulse-duplicator chamber.