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Posts Tagged ‘transesophageal echo’

Mitral valve can be termed as  the most important valve of heart . The reason  for this  : It is the only valve that is dependent on the  Left ventricular function (The  parameter  which   determines the  ultimate outcome in any form CAD ! )

So , indirectly mitral valve function will invariably be affected by some degree  at least in  most  patients with LV dysfunction. (After all LV free wall , is a component of mitral valve apparatus.)

While , we have numerous modalities to assess mitral valve function  ,  the one that has fascinated the surgeons during  mitral  valve surgery is the intra operative TEE.

Many believe TEE provides live  images  of mitral valve   which are not possible  even under  direct vision ! The eye of the  TEE sees the mitral valve  from a  posterior location , (of -course It can see at any angle !)   while surgeon can see in one angle . The  types of repair , the adequacy  of repair, the annulus status,  even a trial mitral run ,  can be done with the help of TEE.

The TEE probe silently does  this job sitting inside the esophagus   , without  obstructing the surgeon’s operative field .

The success of TEE as an investigative tool did not come easy.Decades of  observation , innovation and learning( Especially from  department of cardiac science  Mayo clinic USA , where they standardized the views. )  are involved .

Now we have omni plane, real time 3D TEE probes .

The books  which are  considered the best for  TEE aspects of mitral valve  and it’s  repair are

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Internet is  a  wonderful gift for  for mankind   but  only  occasionally we find great resources .

Hats off to Dr .Pybus from Australia for his efforts

A must read for  all cardiologists rather  everyone involved with echocardiography

Click on the Image to reach the site

http://www.manbit.com/ERS/ERSAZ.asp

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Logic would suggest  any two structures  in close proximity can have  some sort of anatomical , physiological or sometimes pathological relationship .Esophagus and heart  share a strategic  anatomical  space within the mediastinum  . The left atrial wall  is abetting the esophagus with only few millimeters separating the two. Trans esophageal  echocardiography has utilised this proximity for it’s  advantage . With the probe in esophagus we can get a  100%  interior view of left atrium . Both these structures can mutually compress one another at times of pathology . ( LA compression on esophagus in mitral stenosis , Esophageal compression of LA in hiatus hernia or esophageal growths) . Now ,  we also  realise , esophagus  a   functionally unrelated structure  to  cardiovascular system  can have a impact on cardiac functioning.

Hiatus hernia of gastroesophageal junction can mechanically compress the posterior aspect of heart and result in atrial  arrhythmias and pericarditis  ?

Reference

1 Duygu H, Ozerkan F, Saygi S, et al. Persistent atrial fibrillation associated with
gastroesophageal refl ux accompanied by hiatal hernia. Anadolu Kardiyol Derg
2008; 8(2):164-165.

A case report from South africa

http://www.saheart.org/journal/index.php?journal=SAHJ&page=article&op=view&path[]=115&path[]=109

Read further for esophagus- heart  stories.

  • Esophageal ulcers , spasm can trigger electrical activity that can mimic cardiac event  or rarely precipitate a real angina  , what is often referred to as  linked angina .
  • A rare case of pneumopericardium due to rupture of esophagus into pericardial space
  • ST elevation in ECG due to esophageal spasm

http://www.drsvenkatesan.com

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