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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
A proposed method to visualize the ductus arteriosus on transesophageal echocardiography
Raviraj Gogia, Bhupesh Kumar, Aveek Jayant1
1Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
A simple maneuver improves visualization of the patent ductus arteriosus during transesophageal echocardiography. This technique enhances imaging without requiring additional tools, aiding in the management of congenital heart disease.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Pediatric Cardiology
Background:
- The patent ductus arteriosus (PDA) is crucial in congenital heart disease management.
- Transesophageal echocardiography (TEE) is valuable but often suboptimal for PDA imaging.
- The left main bronchus impedes PDA visualization during TEE.
Observation:
- Standard TEE views are often limited for optimal PDA assessment.
- Acoustic shadowing from the left main bronchus is a significant barrier.
- Previous adjunct techniques have been employed to overcome imaging limitations.
Findings:
- A novel, simple maneuver enables clear visualization of the PDA during TEE.
- This technique does not require any adjuncts or additional equipment.
- The maneuver effectively overcomes the acoustic impedance issue.
Implications:
- Improved TEE imaging of PDA can enhance diagnostic accuracy.
- This simple technique may refine interventional strategies for PDA.
- Facilitates better management of congenital heart conditions requiring PDA assessment.
Abstract:
The ductus arteriosus occupies a uniquely privileged position in the management of heart disease; it initiated not only the surgical management of congenital lesions but also the percutaneous management of this subset. During trans-thoracic echocardiography (TTE) the ductus is often visualized using 'high' parasternal (or the 'ductal' view) or suprasternal windows. It is generally agreed that imaging ductus during transesophageal echo (TEE) can be sub-optimal. During TEE imaging, visualization of the ductus arteriosus is obscured by the acoustic impedance offered by the left main bronchus; adjunct techniques such as insertion of a saline filled balloon in this airway have been used. We describe a simple maneuver that allows visualization of the patent ductus arteriosus during TEE imaging without the use of any adjuncts.
