Transcript Three-dimensional transoesophageal echocardiography is

Perioperative three-dimensional transoesophageal echocardiography
in patients receiving a Heartmate II LVAD.
#
MD ,
S. Bouchez, MD°, S. Jacobs, MD°, I Herck,
F. De Somer, PhD*, Y. Van Belleghem, MD*.
° Department of Anaesthesiology, University of Ghent, Belgium
* Department of Cardiac Surgery, University of Ghent, Belgium
# Department of Intensive Care, University of Ghent, Belgium
Aim of the abstract:
Abstract:
Introduction : Perioperative
transoesophageal echocardiography is an
important tool in the management of
patients receiving a Heartmate II
(Thoratec Corporation, Pleasanton, CA,
USA) left ventricular assist device (LVAD)
and almost obligatory for surgical and
anaesthetic decision making. We
evaluated whether three-dimensional
echocardiography offers incremental
value in this setting.
The aim was to evaluate three dimensional transoesophageal echocardiography in addition to the standard
two-dimensional examination for the assessment of proper placement and function of the LVAD in the surgical and early
postoperative period.
Methods : A Three dimensional
transoesophageal echocardiography
(Philips IE33 – intraoperative transducer
X7-2t ; Philips, Andover, MA, USA ) was
used in addition to standard twodimensional imaging for the assessment
of proper placement and function of the
LVAD in the surgical and early
postoperative period. three successive
patients presenting for implantation of a
Heartmate II LVAD (Thoratec Corporation,
Pleasanton, CA, USA) were evaluated.
Results : All assessors agreed that threedimensional echocardiographic
examination provided more accurate
information for 1.correct cannula
alignment, 2.unloading of the left ventricle
, 3. presence of spontaneous contrast and
the formation of thrombi in the left
ventricle and aorta , and 4. the effect of
the LVAD-device settings on global heart
function. three dimensional information on
‘ventricular-assist’ functioning was a better
guide to optimize pump performance.
Images were easier to interprete by
professionals with limited experience in
echocardiography.
Doppler flow measurements for the
evaluation of cannula flow velocities as
well as color flow imaging for the
evaluation of valvular regurgitation still
need to be assessed with two-dimensional
echocardiography.
Conclusion : Three-dimensional
transoesophageal echocardiography is
complementary to two-dimensional
echocardiography for the evaluation of
the Heartmate II LVAD during the
perioperative period.
Methods:
LV apical inflow cannula in apex.
No deviation to septum or lateral side.
Perfect alignment towards mitral valve.
Three-dimensional and two-dimensional
Echocardiography was performed in three
patients receiving a Heartmate II LVAD
( Philips IE33 Intraoperative transducer X7-2t, Philips
Andover, MA, USA).
Assessment by 2D and 3D TEE :
1. Placement and alignment of cannulas
2. Unloading of the left ventricle
3. Presence of spontaneous contrast, thrombi
in left ventricle and aorta.
4. Septal deviation
5. Right ventricular function
LV apical inflow cannula in apex
Viewed from mitral valve
towards apex. Position of cannula
in apex.
Assessment by 2D-doppler and Color flow doppler :
1. Cannula flow velocities ( only 2D TEE )
a/ LV apical inflow cannula
b/ Aortic outflow cannula
2. Valvular regurgitation ( 2D and 3D TEE )
a/ Tricuspid regurgitation
b/ Mitral regurgitation
c/ Aortic regurgitation
Aortic outflow cannula in aorta.
Aortic valve remains closed.
The acquired images were assessed and interpreted both
by experts in echocardiography and by physicians with
limited experience in echocardiography.
Results:
Left atrial view: ellipsoïd appearance
of mitral valve annulus, mitral valve
remains open due to excessive
LVAD suction.
More accurate assesment when using 3D in evaluating :
- Geometric position of inflow cannula in left ventricle
- Septal deviation
- Position of aortic outflow cannula
- Presence of spontaneous contrast in aorta
- The effect of the LVAD-device on global heart function
2D-color flow was the preferred method for the evaluation of
valvular regurgitation. Images were easier to interprete by
professionals with limited experience in echocardiography.
Conclusions:
Three-dimensional transoesophageal echocardiography is complementary to twodimensional echocardiography for the evaluation of the Heartmate II LVAD during the
perioperative period.