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  1. Article ; Online: A systematic approach to performing a comprehensive transesophageal echocardiogram. A call to order.

    Kothavale, Avinash A / Yeon, Susan B / Manning, Warren J

    BMC cardiovascular disorders

    2009  Volume 9, Page(s) 18

    Abstract: Background: While the order for a clinical transthoracic examination is fairly standardized, there is considerable variability between laboratories and even among physicians in the same laboratory with regard to the order for transesophageal ... ...

    Abstract Background: While the order for a clinical transthoracic examination is fairly standardized, there is considerable variability between laboratories and even among physicians in the same laboratory with regard to the order for transesophageal echocardiograms (TEE). A systematic approach is desirable for more efficient use of physician and patient time, avoidance of inadvertent omission of important views, and to facilitate study review.
    Methods: We propose a standardized approach to TEE data acquisition in which cardiac structures are systematically identified and characterized at sequential positions and imaging planes to facilitate organized, efficient and comprehensive assessment.
    Results: Our approach to TEE study begins in the mid-esophagus with the imaging plane at 0 degrees. Based on the specific indication for the TEE, a cardiac structure (e.g., mitral valve, left atrial appendage, or interatrial septum) is chosen as the primary focal point for a comprehensive, multiplane analysis. This structure is assessed in 20 degrees-30 degrees increments as the imaging plane is advanced from 0 degrees to 165 degrees . Using the aortic valve as a reference point, pertinent cardiac structures are then assessed as the imaging plane is reduced to 135 degrees, to 90 degrees, to 40 - 60 degrees and then back to 0 degrees. The probe is then advanced into the stomach to obtain transgastric images at 0 degrees, 90 degrees, and 120 degrees. Finally, the thoracic aorta and pulmonary artery are assessed as the probe is withdrawn from the body. Using this method, an organized and comprehensive TEE can be performed in 10-15 minutes.
    Conclusion: A standardized and systematic TEE approach is described for efficient and comprehensive TEE study.
    MeSH term(s) Aorta, Thoracic/diagnostic imaging ; Cardiovascular Diseases/diagnostic imaging ; Echocardiography, Doppler ; Echocardiography, Transesophageal/methods ; Esophagus/anatomy & histology ; Heart/anatomy & histology ; Humans ; Practice Guidelines as Topic ; Pulmonary Artery/diagnostic imaging
    Language English
    Publishing date 2009-05-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 2059859-2
    ISSN 1471-2261 ; 1471-2261
    ISSN (online) 1471-2261
    ISSN 1471-2261
    DOI 10.1186/1471-2261-9-18
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A systematic approach to performing a comprehensive transesophageal echocardiogram. A call to order

    Manning Warren J / Yeon Susan B / Kothavale Avinash A

    BMC Cardiovascular Disorders, Vol 9, Iss 1, p

    2009  Volume 18

    Abstract: Abstract Background While the order for a clinical transthoracic examination is fairly standardized, there is considerable variability between laboratories and even among physicians in the same laboratory with regard to the order for transesophageal ... ...

    Abstract Abstract Background While the order for a clinical transthoracic examination is fairly standardized, there is considerable variability between laboratories and even among physicians in the same laboratory with regard to the order for transesophageal echocardiograms (TEE). A systematic approach is desirable for more efficient use of physician and patient time, avoidance of inadvertent omission of important views, and to facilitate study review. Methods We propose a standardized approach to TEE data acquisition in which cardiac structures are systematically identified and characterized at sequential positions and imaging planes to facilitate organized, efficient and comprehensive assessment. Results Our approach to TEE study begins in the mid-esophagus with the imaging plane at 0°. Based on the specific indication for the TEE, a cardiac structure (e.g., mitral valve, left atrial appendage, or interatrial septum) is chosen as the primary focal point for a comprehensive, multiplane analysis. This structure is assessed in 20° – 30° increments as the imaging plane is advanced from 0° to 165°. Using the aortic valve as a reference point, pertinent cardiac structures are then assessed as the imaging plane is reduced to 135°, to 90°, to 40 – 60° and then back to 0°. The probe is then advanced into the stomach to obtain transgastric images at 0°, 90°, and 120°. Finally, the thoracic aorta and pulmonary artery are assessed as the probe is withdrawn from the body. Using this method, an organized and comprehensive TEE can be performed in 10 – 15 minutes. Conclusion A standardized and systematic TEE approach is described for efficient and comprehensive TEE study.
    Keywords Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language English
    Publishing date 2009-05-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article: Predictors of left ventricular regional wall motion abnormalities after subarachnoid hemorrhage.

    Kothavale, Avinash / Banki, Nader M / Kopelnik, Alexander / Yarlagadda, Sirisha / Lawton, Michael T / Ko, Nerissa / Smith, Wade S / Drew, Barbara / Foster, Elyse / Zaroff, Jonathan G

    Neurocritical care

    2006  Volume 4, Issue 3, Page(s) 199–205

    Abstract: Introduction: Cardiac abnormalities that have been reported after subarachnoid hemorrhage (SAH) include the release of cardiac biomarkers, electrocardiographic changes, and left ventricular (LV) systolic dysfunction. The mechanisms of cardiac ... ...

    Abstract Introduction: Cardiac abnormalities that have been reported after subarachnoid hemorrhage (SAH) include the release of cardiac biomarkers, electrocardiographic changes, and left ventricular (LV) systolic dysfunction. The mechanisms of cardiac dysfunction after SAH remain controversial. The aim of this study was to determine the prevalence of LV regional wall motion abnormalities (RWMA) after SAH and to quantify the independent effects of specific demographic and clinical variables in predicting the development of RWMA.
    Methods: Three hundred patients hospitalized with SAH were prospectively studied with serial echocardiography. The primary outcome measure was the presence of RWMA. The predictor variables included the admission Hunt & Hess grade, age, gender, cardiac risk factors, aneurysm location, plasma catecholamine levels, cardiac troponin I (cTi) level, heart rate (HR), blood pressure, and phenylephrine dose. Univariate and multivariate logistic regression was performed with adjustment for serial measurements, reporting odds ratios (OR) and 95% confidence intervals (CI).
    Results: In this study, 817 echocardiograms were analysed. RWMA were detected in 18% of those studied. The prevalence of RWMA in patients with Hunt & Hess grades 3 - 5 was 35%. Among patients with a peak cTi level greater than 1.0 m g/L, 65% had RWMA. Multivariate analysis demonstrated that high Hunt & Hess grade (OR 4.22 for grade 3 - 5 versus grade 1 - 2, p = 0.046), a cTi level greater than 1.0 microg/L (OR 10.47, p = 0.001), a history of prior cocaine or amphetamine use (OR 5.50, p = 0.037), and higher HR (OR 1.34 per 10 bpm increase, p = 0.024) were predictive of RWMA.
    Conclusions: RWMA were frequent after SAH. High-grade SAH, an elevation in cTi levels, a history of prior stimulant drug use, and tachycardia are independent predictors of RWMA.
    MeSH term(s) Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Risk Factors ; Severity of Illness Index ; Subarachnoid Hemorrhage/blood ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/therapy ; Troponin I/blood ; Ultrasonography ; Ventricular Dysfunction, Left/blood ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/etiology
    Chemical Substances Troponin I
    Language English
    Publishing date 2006
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2381896-7
    ISSN 1556-0961 ; 1541-6933
    ISSN (online) 1556-0961
    ISSN 1541-6933
    DOI 10.1385/NCC:4:3:199
    Database MEDical Literature Analysis and Retrieval System OnLINE

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