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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Perioperative echocardiography in minimally invasive surgery for hypertrophic obstructive cardiomyopathy
Ceng Wang1, Zhenzhen Wang1, Yi Zheng2
1Cardiovascular Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China.
Insights
Transesophageal echocardiography (TEE) is crucial for guiding minimally invasive surgery in hypertrophic obstructive cardiomyopathy (HOCM) patients. This technique effectively assesses obstruction and guides mitral valve repair, improving outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents significant risks, including arrhythmias and sudden cardiac death (SCD).
- Surgical septal myectomy is the primary treatment for HOCM, aiming to relieve left ventricular outflow tract (LVOT) obstruction.
- Minimally invasive approaches, such as right infra-axillary thoracotomy, are increasingly used for septal myectomy.
Purpose of the Study:
- To evaluate the role of perioperative transesophageal echocardiography (TEE) in minimally invasive transaortic septal myectomy for HOCM.
- To explore how TEE aids in assessing obstruction severity and guiding surgical decisions.
- To determine the effectiveness of TEE in managing mitral valve abnormalities during the procedure.
Main Methods:
- A cohort of 27 HOCM patients underwent minimally invasive septal myectomy via right infra-axillary thoracotomy.
- Perioperative TEE was utilized to assess ventricular wall thickness, LVOT obstruction, and mitral regurgitation.
- TEE guided the extent of septal resection and the necessity of mitral valve repair.
Main Results:
- TEE provided detailed insights into the LV cavity structure and the causes of obstruction.
- All patients achieved resolution of LVOT obstruction and systolic anterior motion of the mitral valve.
- Mitral regurgitation was significantly reduced following the surgical intervention.
Conclusions:
- Perioperative TEE is invaluable for complex LVOT obstruction in HOCM.
- TEE facilitates precise septal resection and assessment for mitral valve repair during minimally invasive surgery.
- This imaging modality enhances the efficacy of transaortic septal myectomy for HOCM.
Background:
Hypertrophic obstructive cardiomyopathy (HOCM) is clinically symptomatic and prone to malignant arrhythmias and sudden cardiac death (SCD). Currently, an effective treatment is surgical resection of the hypertrophic ventricular septum to relieve the left ventricular outflow tract (LVOT) obstruction and mitral insufficiency. Our center performs an innovative, minimally invasive right infra-axillary thoracotomy for transaortic septal myectomy. Minimally invasive procedures rely more on perioperative transesophageal echocardiography (TEE). This study aimed to explore the use of echocardiography during the perioperative period of surgical intervention for HOCM.
Methods:
Between August 2021 and April 2022, 27 patients with HOCM underwent cardiac surgery at our hospital. Minimally invasive transaortic septal resection (Morrow myectomy) was performed from the right axilla. The extent of myectomy and need for mitral valve repair were based on perioperative TEE assessment and surgical findings. The demographic parameters and clinical data of patients were recorded. The cardiopulmonary bypass time, aortic cross-clamp, and mechanical ventilation times were calculated. TEE was used to assess ventricular wall thickening and anatomical abnormalities of mitral regurgitation, assist in intravenous catheterization, and assess the postoperative gradients of the LVOT.
Results:
Among the 27 patients with HOCM who underwent transaortic septal myectomy by minimally invasive right infra-axillary thoracotomy, 16 had LVOT obstruction, 2 had mid-LV obstruction, and 9 had both LVOT and mid-LV involvement. TEE provides information about the fine structure of the LV cavity and the etiology of the obstruction. In all cases, LVOT obstruction and mitral valve systolic anterior motion were resolved postoperatively, and the degree of mitral regurgitation was significantly reduced.
Conclusion:
Perioperative echocardiography provides valuable information regarding the complex etiology of LVOT obstruction during minimally invasive right infra-axillary thoracotomy for transaortic septal myectomy. It helps determine the extent of septal resection and assess the need for concomitant mitral valve repair.
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