Transesophageal Echocardiography

Transcription

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2 N. Kolev, G. Huemer, M. Zimpfer Transesophageal Echocardiography A New Monitoring Technique Springer-Verlag Wien New York

3 Nikolai Kolev, MD, FACC Research Cardiologist Associate in Anesthesia and Consultant Echocardiographer, Firma Hewlett Packard Department of Anesthesiology and General Intensive Care, University of Vienna, Austria Gunter Huemer, MD Staff Anesthesiologist Department of Anesthesiology and General Intensive Care, University of Vienna, Austria Michael Zimpfer, MD Professor of Anesthesia Chairman of the Department of Anesthesiology and General Intensive Care, University of Vienna, Austria This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machines or similar means, and storage in data banks Springer-Verlag/Wi en Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Typesetting and Data-conversion: Thomson Press, India Printed on acid-free and chlorine-free bleached paper With 77 partly coloured Figures Library of Congress Cataloging-in-Publication Data. Kolev, N. (Nikolai), Transesophageal echocardiography: a new monitoring technique / N. Kolev, G. Huemer, M. Zimpfer. p. cm. ISBN-13: e-isbn-13: DOl: / Transesophageal echocardiography. I. Huemer G. (Gunter). II. Zimpfer, M. (Michael), III. Title. [DNLM: 1. Echocardiography, Transesophageal. WG E2 K81t 1994]. RC683.5.T83K '20754-dc20. DNLM/DLC CIP. ISBN-I3:

4 This book is dedicated to our children

5 Contents Chapter 1 Introduction References 1 4 Chapter 2 General theory, history and development 5 Principles of two-dimensional echocardiography... 5 Principles of Dopper echocardiography Digital cine loop technology History and development of transesophageal echocardiography Characteristics of transesophageal systems References Chapter 3 Standard transesophageal imaging and planes 24 General considerations Cardiac examination Transgastric views Midesophageal views Basal esophageal views References Chapter 4 On-line and off-line determinations of ventricular preloads and volumes Preload - clinical relevance Off-line echocardiographic estimations of preload Prolate ellipse method, area-length approach Simpson's rule method On-line assessment of preload: acoustic quantification technique References Chapter 5 Assessment of afterload 50 Clinical relevance Echocardiographic estimation of afterload References... 56

6 VIII Contents Chapter 6 Contractility Contractility indices revisited Cardiac output Two-dimensional method Doppler echocardiographic method Theory Cardiac output by sampling the aortic valve Cardiac output by sampling the pulmonic valve Fundamental sources of error Comparison with other methods of cardiac measurement Uses of Doppler cardiac output in anesthesiology Ejection fraction Mean velocity of circumferential fiber shortening (Vcf) Two-dimensional Doppler echocardiographic estimation of isovolurnic phase indexes Peak rate of change ofleft ventricular pressure (dp / dt) Isovolumic contraction time (NCT) Frank-Starling principle and end-systolic performance curves References Chapter 7 Perioperative myocardial ischemia Cardiac risk References Myocardial ischemia: pathophysiology and effects of the inhalational anesthetics References... _ Left ventricular segmental wall motion analysis Experimental and clinical studies Standard TEE monitoring position General considerations Reference systems Methods for calculating the central reference (centroid) for an individual frame Systolic wall thickening analysis Biplane and multiplane TEE imaging Cine loop and SWMA Methodological problems References Automated on-line wall motion analysis Introduction Principles of border identification Principles of the internal "centroid" reference systems Wall motion versus wall thickening Conclusion References Myocardial ischemia and Doppler transmitral diastolic flow... ' Recording techniques and parameters of Doppler transmitral inflow.. ' Practical remarks on measurement of Doppler transmitral parameters

7 Contents IX Relation between mitral flow characteristic and hemodynamics Doppler transmitral flow for intraoperative diagnosis of acute myocardial ischemia References Myocardial perfusion by contrast echocardiography: new trend in ischemia detection (scenario of the year 2000) Principles of contrast echocardiography Quantitative analysis of myocardial contrast two-dimensional echocardiography a) Assessment of the perfusion territory of regional myocardial perfusion mapping b) Qualification of regional myocardial blood flow Conclusion..., 147 References Subject index