N. Kolev, G. Huemer, M. Zimpfer Transesophageal Echocardiography A New Monitoring Technique Springer-Verlag Wien New York
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. 1995 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), 1942-. Transesophageal echocardiography: a new monitoring technique / N. Kolev, G. Huemer, M. Zimpfer. p. cm. ISBN-13: 978-3-211-82650-8 e-isbn-13: 978-3-7091-7676-4 DOl: 10.1007/978-3-7091-7676-4 1. Transesophageal echocardiography. I. Huemer G. (Gunter). II. Zimpfer, M. (Michael), 1951-. III. Title. [DNLM: 1. Echocardiography, Transesophageal. WG 141.5.E2 K81t 1994]. RC683.5.T83K651994. 616.1'20754-dc20. DNLM/DLC. 94-42060 CIP. ISBN-I3: 978-3-211-82650-8
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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... 10 Digital cine loop technology... 15 History and development of transesophageal echocardiography........... 17 Characteristics of transesophageal systems... 18 References... 21 Chapter 3 Standard transesophageal imaging and planes 24 General considerations.......................................... 24 Cardiac examination........................................... 24 Transgastric views... 24 Midesophageal views............................................ 28 Basal esophageal views... 30 References... 34 Chapter 4 On-line and off-line determinations of ventricular preloads and volumes...... 36 Preload - clinical relevance......................................... 36 Off-line echocardiographic estimations of preload...................... 38 Prolate ellipse method, area-length approach... 40 Simpson's rule method.......................... 41 On-line assessment of preload: acoustic quantification technique... 45 References... 47 Chapter 5 Assessment of afterload 50 Clinical relevance................................................. 50 Echocardiographic estimation of afterload... 54 References... 56
VIII Contents Chapter 6 Contractility........................................................ 58 Contractility indices revisited... 58 Cardiac output... 59 Two-dimensional method... 61 Doppler echocardiographic method... 62 Theory... 62 Cardiac output by sampling the aortic valve... 63 Cardiac output by sampling the pulmonic valve...................... 64 Fundamental sources of error... 65 Comparison with other methods of cardiac measurement... 67 Uses of Doppler cardiac output in anesthesiology... 67 Ejection fraction.................................................. 67 Mean velocity of circumferential fiber shortening (Vcf).................. 71 Two-dimensional Doppler echocardiographic estimation of isovolurnic phase indexes... 72 Peak rate of change ofleft ventricular pressure (dp / dt)... 72 Isovolumic contraction time (NCT)... 74 Frank-Starling principle and end-systolic performance curves............. 75 References... 82 Chapter 7 Perioperative myocardial ischemia... 86 Cardiac risk...................................................... 86 References... 89 Myocardial ischemia: pathophysiology and effects of the inhalational anesthetics... 91 References... _... 94 Left ventricular segmental wall motion analysis......................... 97 Experimental and clinical studies... 97 Standard TEE monitoring position... 99 General considerations.......................................... 104 Reference systems... 105 Methods for calculating the central reference (centroid) for an individual frame... 108 Systolic wall thickening analysis... 110 Biplane and multiplane TEE imaging... 113 Cine loop and SWMA... 114 Methodological problems........................................ 116 References... 117 Automated on-line wall motion analysis... 121 Introduction... 121 Principles of border identification... 121 Principles of the internal "centroid" reference systems... 122 Wall motion versus wall thickening... 124 Conclusion.................................................... 124 References... 125 Myocardial ischemia and Doppler transmitral diastolic flow... '..... 126 Recording techniques and parameters of Doppler transmitral inflow.. '.. 127 Practical remarks on measurement of Doppler transmitral parameters... 131
Contents IX Relation between mitral flow characteristic and hemodynamics......... 132 Doppler transmitral flow for intraoperative diagnosis of acute myocardial ischemia... 133 References... 136 Myocardial perfusion by contrast echocardiography: new trend in ischemia detection (scenario of the year 2000)... 138 Principles of contrast echocardiography......................... 138 Quantitative analysis of myocardial contrast two-dimensional echocardiography... 140 a) Assessment of the perfusion territory of regional myocardial perfusion mapping... 141 b) Qualification of regional myocardial blood flow... 145 Conclusion..., 147 References... 147 Subject index....................................................... 151