- Email: [email protected]
Performing transesophageal echocardiography in infants remains a challenge
57
Archives of Cardiovascular Diseases Supplements (2017) 9 46-58
extract local deformation. Data were temporally realigned to allow intersubject pattern comparison. Spatial correspondences were obtained from the software, and allowed statistical computation in 8 standard zones of the RV. The highest deformation was found at the RV lateral and inferior walls. In PH patients, regional motion and deformation and global volume patterns were affected in all segments. Over a median follow-up of 6.7 months [5.8-7.2], 16 (15.4%) patients died from cardio-pulmonary causes. Right atrial pressure, global RV area strain, TAPSE, 3D RV ejection fraction and end-diastolic volume were independent predictors of survival. Global RV area strain > -18% was the most powerful RV function parameter, identifying patients with a 48%-increased risk of death.
Micro-TEE introduction failed in 3 patients<4 kg because of hemodynamic compromise. Longitudinal 2D image quality was quoted 1.5 with ICE and 2.5 with micro-TEE. Color, pulsed and continuous Doppler qualities were quoted 2.5 with ICE and 2 with micro-TEE. Horizontal plan images could not be obtained using ICE which performed complete diagnoses in only 60% of cases. No complication related to probe manipulation was observed with both probes. ICE compared to the micro-TEE probe was judged thinner, less flexible and more fragile (image degradation during the exams).
Conclusion RV strain patterns are reduced in PH patients and provide independent prognostic information in this population.
Conclusion TEE is feasible using ICE probe in low weight infants after cardiac surgery. However, the absence of multiplane imaging and the low spatial resolution are major limitations. Industry has to develop adapted matrix TEE probe for infant performing both 2D multiplane and 3D images.
Abstract 611 – Figure: Global RV area strain relates to NYHA class and survival
Abstract 344 – Figure 1 Comparison between micro-TEE (top) and ICE (bottom) probes.
The authors hereby declare no conflict of interest
The authors hereby declare no conflict of interest
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614
Performing transesophageal echocardiography in infants remains a challenge K. Hadeed* (1), R. Amadieu (2), N. Tahhan (1), Y. Dulac (1), G. Chausseray (3), R. Fesseau (3), P. Cuttone (4), X. Alacoque (3), B. Leobon (4), P. Acar (1) (1) Children’s Hospital, Pediatric cardiology, Toulouse, France – (2) Children’s Hospital, Intensive care, Toulouse, France – (3) Children’s Hospital, Pediatric anesthesia, Toulouse, France – (4) Children’s Hospital, Pediatric cardiac surgery, Toulouse, France *Corresponding author: [email protected] Background Transesophageal echocardiography (TEE) has an important role after surgical repair of congenital heart disease. The currently available size of probes limits their application in in low weight children. A miniaturized ultrasound transducer-tipped catheter, designed for Intracardiac Echocardiography (ICE) is now available. Its use through transesophageal route in small children is not yet reported. Purpose (1) Determine the feasibility of ICE probe through transesophageal route, in children with low weight undergoing surgical repair for congenital heart disease (2) compare this new imaging with the available commercialized pediatric TEE probe. Methods TEE was performed in operating room and/or pediatric intensive care unit, using both ICE and Micro-TEE probes successively for each patient (Figure 1). 2D and Doppler image qualities were compared and quoted (1 poor, 2 medium, 3 high). Results 10 patients were included: 2 TGA, 5 AVSD, 2 VSD and 1 TOF. Median weight was 4 kg (1.7-7 kg). ICE probe insertion was easy in all patients without hemodynamic compromise or increase airway resistance.
Effect of changing the preload on speckle-tracking-derived left ventricular contractility indexes in middle-aged ultra-trailers F. Chagué* (1)(2), A. Gudjoncik (1)(2), C. Richard (1), F. Compagnon (3)(2), O. Ganansia (4)(2), V. Pasquereau (5)(2), Y. Cottin (1) (1) CHU Dijon, Cardiologie, Dijon, France – (2) Doctrotter Medical Consulting Assistance, Paris, France – (3) CH Coulommiers, Urgences, Coulommiers, France – (4) Hôpital Saint-Joseph, Urgences, Paris, France – (5) CH Mantes, Réanimation, Mantes, France *Corresponding author: [email protected] Background preload is prone to vary during ultra-long duration exercise (ULDE) and this can complicate the analysis of LV function under such conditions. Purpose we studied LV contractility indexes while preload conditions were changed. Methods 22 healthy male amateur ultra-trailers (mean age 47) underwent serial echocardiographic assessments in three positions at rest: left side decubitus in the standard position (P1), head-up and legs-down (P2) then the Trendelenburg position (P3). Heart rate (HR) and systolic blood pressure (SBP) were monitored; preload was estimated by the biplane LV end diastolic volume (LVEDV). Results HR and SBP did not vary. LVEDV was significantly greater in P3 than in P2 (p=0.004) and in P1 (p=0.010). Radial (R) Peak Strain (PS) and Circumferential (C) PS did not change but Longitudinal (L) PS was greater in P3 than in P2 (p<0.001) and in P1 (p<0.001). The L Strain Rate (SR), CSR and Torsion Cadence (TC) were not modified by the change of body position. Time to peak (TTP) corrected by the Bazett formula changed: LPS (p=0.005), LSR (p 0.001), CSR (p=0.016). (Table 1).
© Elsevier Masson SAS. All rights reserved.
Archives of Cardiovascular Diseases Supplements (2017) 9 46-58
extract local deformation. Data were temporally realigned to allow intersubject pattern comparison. Spatial correspondences were obtained from the software, and allowed statistical computation in 8 standard zones of the RV. The highest deformation was found at the RV lateral and inferior walls. In PH patients, regional motion and deformation and global volume patterns were affected in all segments. Over a median follow-up of 6.7 months [5.8-7.2], 16 (15.4%) patients died from cardio-pulmonary causes. Right atrial pressure, global RV area strain, TAPSE, 3D RV ejection fraction and end-diastolic volume were independent predictors of survival. Global RV area strain > -18% was the most powerful RV function parameter, identifying patients with a 48%-increased risk of death.
Micro-TEE introduction failed in 3 patients<4 kg because of hemodynamic compromise. Longitudinal 2D image quality was quoted 1.5 with ICE and 2.5 with micro-TEE. Color, pulsed and continuous Doppler qualities were quoted 2.5 with ICE and 2 with micro-TEE. Horizontal plan images could not be obtained using ICE which performed complete diagnoses in only 60% of cases. No complication related to probe manipulation was observed with both probes. ICE compared to the micro-TEE probe was judged thinner, less flexible and more fragile (image degradation during the exams).
Conclusion RV strain patterns are reduced in PH patients and provide independent prognostic information in this population.
Conclusion TEE is feasible using ICE probe in low weight infants after cardiac surgery. However, the absence of multiplane imaging and the low spatial resolution are major limitations. Industry has to develop adapted matrix TEE probe for infant performing both 2D multiplane and 3D images.
Abstract 611 – Figure: Global RV area strain relates to NYHA class and survival
Abstract 344 – Figure 1 Comparison between micro-TEE (top) and ICE (bottom) probes.
The authors hereby declare no conflict of interest
The authors hereby declare no conflict of interest
344
614
Performing transesophageal echocardiography in infants remains a challenge K. Hadeed* (1), R. Amadieu (2), N. Tahhan (1), Y. Dulac (1), G. Chausseray (3), R. Fesseau (3), P. Cuttone (4), X. Alacoque (3), B. Leobon (4), P. Acar (1) (1) Children’s Hospital, Pediatric cardiology, Toulouse, France – (2) Children’s Hospital, Intensive care, Toulouse, France – (3) Children’s Hospital, Pediatric anesthesia, Toulouse, France – (4) Children’s Hospital, Pediatric cardiac surgery, Toulouse, France *Corresponding author: [email protected] Background Transesophageal echocardiography (TEE) has an important role after surgical repair of congenital heart disease. The currently available size of probes limits their application in in low weight children. A miniaturized ultrasound transducer-tipped catheter, designed for Intracardiac Echocardiography (ICE) is now available. Its use through transesophageal route in small children is not yet reported. Purpose (1) Determine the feasibility of ICE probe through transesophageal route, in children with low weight undergoing surgical repair for congenital heart disease (2) compare this new imaging with the available commercialized pediatric TEE probe. Methods TEE was performed in operating room and/or pediatric intensive care unit, using both ICE and Micro-TEE probes successively for each patient (Figure 1). 2D and Doppler image qualities were compared and quoted (1 poor, 2 medium, 3 high). Results 10 patients were included: 2 TGA, 5 AVSD, 2 VSD and 1 TOF. Median weight was 4 kg (1.7-7 kg). ICE probe insertion was easy in all patients without hemodynamic compromise or increase airway resistance.
Effect of changing the preload on speckle-tracking-derived left ventricular contractility indexes in middle-aged ultra-trailers F. Chagué* (1)(2), A. Gudjoncik (1)(2), C. Richard (1), F. Compagnon (3)(2), O. Ganansia (4)(2), V. Pasquereau (5)(2), Y. Cottin (1) (1) CHU Dijon, Cardiologie, Dijon, France – (2) Doctrotter Medical Consulting Assistance, Paris, France – (3) CH Coulommiers, Urgences, Coulommiers, France – (4) Hôpital Saint-Joseph, Urgences, Paris, France – (5) CH Mantes, Réanimation, Mantes, France *Corresponding author: [email protected] Background preload is prone to vary during ultra-long duration exercise (ULDE) and this can complicate the analysis of LV function under such conditions. Purpose we studied LV contractility indexes while preload conditions were changed. Methods 22 healthy male amateur ultra-trailers (mean age 47) underwent serial echocardiographic assessments in three positions at rest: left side decubitus in the standard position (P1), head-up and legs-down (P2) then the Trendelenburg position (P3). Heart rate (HR) and systolic blood pressure (SBP) were monitored; preload was estimated by the biplane LV end diastolic volume (LVEDV). Results HR and SBP did not vary. LVEDV was significantly greater in P3 than in P2 (p=0.004) and in P1 (p=0.010). Radial (R) Peak Strain (PS) and Circumferential (C) PS did not change but Longitudinal (L) PS was greater in P3 than in P2 (p<0.001) and in P1 (p<0.001). The L Strain Rate (SR), CSR and Torsion Cadence (TC) were not modified by the change of body position. Time to peak (TTP) corrected by the Bazett formula changed: LPS (p=0.005), LSR (p 0.001), CSR (p=0.016). (Table 1).
© Elsevier Masson SAS. All rights reserved.