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Regional Ventricular Function

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Essential Echocardiography

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Abstract

One of the most useful applications of intra-operative 2D transesophageal echocardiography (TEE) in noncardiac surgery is qualitative assessment of myocardial function in acutely unstable patients. When hemodynamic instability occurs intraoperatively, TEE can serve as an adjunct to other modalities in diagnosing or ruling out an ischemic event. In fact, compared to other monitoring methods, regional wall motion abnormality (RWMA) observed on echocardiography is the most sensitive method for early detection of ischemic changes in the heart. In noncardiac surgery, this can be especially useful in patients with no existing invasive or detailed monitoring that shows a sudden change in clinical status. Knowledge of normal coronary anatomy and its myocardial distribution is key in determining the location of an ischemic event. Recognizing the attributes of a wall motion abnormality such as decreased wall excursion or decreased wall thickening is key in diagnosing ischemic events, while recognizing that not all wall motion abnormalities are ischemic events (e.g., pacing effect).

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Authors and Affiliations

  1. Department of Anesthesiology, University of California San Diego, 9300 Campus Pointe Drive, #7651, La Jolla, San Diego, CA, 92037-7651, USA

    Tariq Naseem MD & Timothy M. Maus MD, FASE

Authors
  1. Tariq Naseem MD
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  2. Timothy M. Maus MD, FASE
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Corresponding author

Correspondence to Tariq Naseem MD .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University of California San Diego, San Diego, California, USA

    Timothy M. Maus

  2. Division of Cardiovascular Anesthesiology and Critical Care , The Texas Heart Institute at Baylor St. Luke’s Medical Center, Houston, Texas, USA

    Sonia Nhieu

  3. Department of Anesthesiology, University of California San Diego, San Diego, California, USA

    Seth T. Herway

Electronic supplementary material

Below is the link to the electronic supplementary material.

Transgastric midpapillary short axis view in a patient with inferior wall hypokinesis (AVI 6,489 KB)

Transgastric midpapillary short axis view in a patient with anterior wall akinesis (AVI 7,373 KB)

Midesophageal four-chamber view in a patient with septal akinesis (AVI 2,808 KB)

Transgastric midpapillary short axis view in a patient with anterior dyskinesis (AVI 2,340 KB)

Midesophageal long axis view in a patient with prior anterior wall MI and a resulting anteroseptal left ventricular aneurysm (AVI 11,147 KB)

Midesophageal long axis view in a patient with ischemic mitral regurgitation. Note the akinetic anteroseptal wall (AVI 1,621 KB)

Transgastric midpapillary short axis view in a patient with an inferior wall myocardial infarction and inferior wall rupture. Color flow Doppler demonstrates flow through the large wall rupture (AVI 4,679 KB)

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Naseem, T., Maus, T.M. (2016). Regional Ventricular Function. In: Maus, T., Nhieu, S., Herway, S. (eds) Essential Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-319-34124-8_5

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  • DOI: https://doi.org/10.1007/978-3-319-34124-8_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-34122-4

  • Online ISBN: 978-3-319-34124-8

  • eBook Packages: MedicineMedicine (R0)

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