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Transesophageal Echocardiography 2nd Edition診断と治療社 | 書籍詳細:Transesophageal Echocardiography 2nd Edition


尾本 良三(おもと りょうぞう) 編集

Maimonides Medical Center

Steven N. Konstadt 編集


渡橋 和政(おりはし かずまさ) 編集

改訂第2版 A4変形 並製(4色) 466頁 2012年11月30日発行



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Chapter 1  Instrumentation
Kiyoshi Tamura and Ryozo Omoto
 Kinds of TEE
 What Makes Image Quality
 Safety Considerations
 Current and Future Technologies

Chapter 2  How to Insert Transesophageal Echocardiography Probe: Awake and Intraoperative Cases
Makoto Matsumura
 Anatomy of Pharynx and Esophagus
 Influence on the Cardiac Function and Hemodynamics
 Influence on Respiration

Chapter 3 Anatomical Orientation and Transesophageal Echocardiography Views
Kazumasa Orihashi and Yasu Oka
 Manipulation of the Probe and Scanning Plane
 Anatomical Aspects of Probe Manipulation
 20 Basic Views for Intraoperative TEE and Practical Approaches
 Beyond the Basic Views and Solutions for Blind Zones
 Longitudinal Scan and Multiplane Scan

Chapter 4 Clinical Significance of Real-time 3D Transesophageal Echocardiography
Takahiro Shiota
 Clinical Applications of the Live 3D TEE

Chapter 5 Monitoring Left Ventricular Performance
Zak Hillel and Daniel Thys
 Right Ventricular Performance
 3-Dimensional Echocardiography
 Conclusions and the Future

Chapter 6 Measurement of Left Ventricular Diastolic Function
Tatsuya Yamada, Shiro Iwanaga and Yasu Oka
 Phases of Diastole
 Left Ventricular Diastolic Function
 Clinical Implications of Diastolic Function
 Echocardiographic Evaluation of Left Ventricular Filling:Transmitral Inflow
 Echocardiographic Evaluation of Left Atrial Filling:Pulmonary Venous Flow
 Clinical Application of Echocardiographic Assessment
 Pericardial Diseases
 Newer Techniques

Chapter 7 Acquired Valvular Heart Diseases
7-1 Degenerative and Rheumatic Valvular Disease
Yoshie Nakajima, Makoto Matsumura and Ryozo Omoto
7-2 Infective Endocarditis (Native Heart Valve Endocarditis)
Yoshie Nakajima, Makoto Matsumura and Ryozo Omoto
 Identification of vegetation
7-3 Prosthetic Heart Valve
Yoshie Nakajima, Makoto Matsumura and Ryozo Omoto

Chapter 8  Mitral Valve Repair
Ellen Mayer Sabik and William J. Stewart
 Methods of Intraoperative TEE
 Mitral Regurgitation
 Mitral Stenosis
 Methods of Grading Severity of Mitral Regurgitation in the Operating Room
 Post-Pump Intraoperative Echo
 Complications Seen After Mitral Valve Repair
 Results of Mitral Repair at the Cleveland Clinic

Chapter 9  Transesophageal Echocardiography in Transcatheter Valve Repair and Replacement
William J. Stewart
 Transcatheter Aortic Valve Implantaion
 Transcatheter Edge-to-Edge Repair of Mitral Regurgitation
 Transcatherter Closure of Peri-prosthetic Regurgitation

Chapter 10 Ischemic Heart Disease
10-1 Echocardiographic Diagnosis of Ischemic Heart Disease
Nobuhide Kin
 Coronary Artery Supply
 Segments of Myocardium
 Pathophysiology of Myocardial Ischemia
 Myocardial Stunning and Hibernation
 Detection of Wall Motion Abnormalities
 Tissue Doppler Imaging
 Tissue Deformation Imaging
 Complications of Acute Myocardial Infarction
10-2  Part I
Transesophageal Echocardiographic Monitoring During Off Pump Coronary Bypass Grafting (OPCAB)
Komarakshi Balakrishnan and Suresh Rao
 Intraoperative Monitoring of Cardiac Function
 Technical Considerations in OPCAB
 Exposure of the Coronary Arteries  
 Causes of Hemodynamic Instability During OPCAB
 Intramyocardial LAD  
    Part II
Transesophageal Echocardiography Monitoring During Coronary Bypass Surgery Using Cardiopulmonary Bypass
Komarakshi Balakrishnan
 Management of Aortic Stenosis During CABG
 Management of Mitral Regurgitation During CABG
 Evolving Myocardial Infarction with Cardiogenic Shock
 Assessment of Myocardial Viability in Poor Ventricular Function
 Hemodynamics and Volume Status
 Management of an Intraoperatively Diagnosed Patent Foramen Ovale During Coronary Artery Bypass Surgery

Chapter 11  Cardiomyopathies
Yasuhiro Koide
 Physiologic Classification
 Hypertrophic Cardiomyopathy (HCM)
 Dilated Cardiomyopathy (DCM)
 TEE Application for Patients with DCM
 Restrictive Cardiomyopathy (RCM)
 Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)  
 LV Non-compaction  
 Stress (Tako-Tsubo) Cardiomyopathy  

Chapter 12 Aortic Diseases
12-1 Aortic Diseases with Special Reference to Acute Aortic Dissection
Ryozo Omoto and Kazumasa Orihashi
 Introduction: Diagnostic and Therapeutic Implications of Transesophageal Echocardiography in Acute Aortic Dissection 213
Anatomical Classifications
 Location of Entry Site
 Transesophageal Echocardiographic Findings in Type A and Type B Acute Aortic Dissection
 Intramural Hematoma
 Coronary Artery Involvement
 Three-Dimensional Understanding of Dissection
 Other Aortic Lesions
12-2 Assessment of Aortic Dissection Including Malperfusion
Kazumasa Orihashi
 Malperfusion:General Principles
 Measures to Detect Malperfusion by TEE
 Malperfusion:Specific Organs
 False Lumen Perfusion and Arterial Route
 Another Scenario Behind the Stage

Chapter 13 Use of TEE for Retained Intracardiac Air
Kazumasa Orihashi and Yasu Oka
 Forms of Retained Air and TEE Findings 250
 TEE Findings of Retained Air at Each Site 253
 Quantitative Analysis of Retained Air 258
 A Pitfall of Retained Air 259
 Removal of Air 260

Chapter 14 Cerebral Stroke
Kazuya Murata, Nobuaki Tanaka and Masunori Matsuzaki
 Left atrial Thrombi
 Spontaneous Echo Contrast
 Left atrial appendage Flow Velocity
 Complex Aortic Atheroma
 Valvular Vegetation
 Prosthetic Valve Endcarditis
 Cardiac Tumors
 Patent Foramen ovale
 Atrial Septal Aneurysm

Chapter 15 Assist Circulation
Yoshihiko Ohnishi
 Ventricular Assist Devices
 LVAD devices and insertion surgery
 Echocardiographic Examination Before LVAD Insertion
 TEE Observation After LVAD Insertion
 Percutaneous Cardiopulmonary Support (PCPS)

Chapter 16 Percutaneous Transvenous Mitral Commissurotomy
Li-xue Yin
 Pre-PTMC Evaluation
 TEE Navigation and Monitoring During PTMC
 Post-PTMC Evaluation
 Future of PTMC with New Echocardiographic Thchnologies

Chapter 17 Tumors in the Cardiovascular System and Thorax
Kazumasa Orihashi
 General Principles
 Cardiac Tumors
 Mediastinal Tumors
 TEE-Guided Resection of Tumors
 Intimal Sarcoma
 Lung Cancer
 Renal Cell Carcinoma

Chapter 18 Chest Trauma and Other TEE Applications in the ER or ICU
Benjamin A. Kohl and Albert T. Cheung
 Safety of TEE in the ICU or ER
 Indications and Feasibility for ICU/ER Echocardiography
 TEE Examination in the ER/ICU:Limited or Comprehensive

Chapter 19 Echocardiography and Measurement of Aortic Plaque
Jonathan Leff and Linda Shore-Lesserson
 Clinical Significance
 Risk Factors
 Anatomy and TEE Techniques
 Techniques for Assessment of Plaque Burden
 Transcranial Doppler
 Treatment Strategies

Chapter 20 Intraoperative Hypotension
Eugene A. Rapaport and Steven N. Konstadt
 Left Ventricular Systolic Dysfunction
 Aortic Valvular Disease
 Mitral Valvular Dysfunction
 Right Ventricular Systolic Dysfunction
 Extracardiac Causes

Chapter 21 Contrast Echo Method
Hiroshi Kitahata and Shinji Kawahito
 Physical Principle
 Imaging Methods
 Contrast Agents
 Clinical Applications

Chapter 22 Role of TEE in Minimally Invasive Cardiovascular Surgery
Kazumasa Orihashi
 Visualization of Catheters and Devices
 General Rules of Visualization
 Guiding Placement and Monitoring (MAL) Function of Cannulae
 Detection of Pleural Hemorrhage and Extravasation
 Detection and Removal of Air
 Endovascular Stent Graft Implantation

Chapter 23 Liver Transplantation
Andre M. De Wolf
 Hemodynamics in Patients with End-stage Liver Disease
 Intraoperative TEE Monitoring of Uncomplicated Liver Transplantation
 Monitoring and Detection of Intraoperative Complications Using TEE
 Unrelated Cardiopulmonary Disease
 Related Cardiopulmonary Disease
 Evaluation of Vessels

Chapter 24 Adult Orthotopic Heart Transplantation
Lech Paluszkiewicz, Heinrich Kortke, Gero Tenderich and Reiner Korfer
 Assessment of the Donor Heart
 Assessment of Recipient Heart in the Pretransplantation Period
 Assessment of the Recipient Heart in the Operating Theater in the Early Posttransplantation Period
 Assessment of the Recipient Heart in the Intensive Care Unit Early After Transplantation
 Assessment of the Recipient Heart in Long Term Follow Up

Chapter 25 Congenital Heart Disease
25-1  Techniques and Methods of Transesophageal Echocardiography for Children and Neonates
Keith DesRochers and David J. Sahn
 Visualizing Congenital Heart Disease  
 Special Considerations in the Pediatric Patient  
 Complications and Contraindications  
 Development of Three-Dimensional TEE  
25-2 Congenital and Pediatric TEE with Clinical Decision Making
Minoru Nomura and Satoshi Kurokawa
 Atrial Septal Defect, Patent Foramen Ovale  
 Ventricular Septal Defect with Tetralogy of Fallot and Double Outlet Right Ventricle  
 Pulmonary Artery Banding (VSD and ASD with Coarctation)  
 Bland-White-Garland Syndrome  
 Persistent Left Superior Vena Cava  
 Ross Procedure  
 Patent Ductus Arteriosuss  
 Jatene Procedure  
 Future Pediatric TEE  
25-3 Catheter Intervension in Pediatric Cardiology
Shen-Kou Tsai
 Atrial Septal Defects
 The role of TEE
 Patent Foramen Ovale
 Patent Ductus Arteriosus
 Closure of Intracardiac Fontan Fenestration
 Ruptured Sinus of Valsalva Aneurysm
 Aortico-Left Ventricular Tunnel
 Ventricular Septal Defect
 Percutaneous Transvenous Mitral Commissurotomy
 Electrophysiological Studies and Ablation Procedure for Right Atrium Diverticulum
 Aorta To Right Atrial Tunnel
 Hybrid Procedure for Hypoplastic Left Heart Syndrome



Preface (2nd Edition) Since “Transesophageal Echocardiography” was published in 2000, tremendous progress has been made in the quality, efficacy, and safety of cardiovascular disease treatment. Cardiovascular surgical procedures that are less invasive and more tissue-preserving have gained popularity, such as off-pump coronary artery bypass, robotic or non-robotic mitral valve repair, and aortic valve-preserving procedures. In addition, the use of percutaneous catheter treatment has increased, including device closure for atrial septal defect, patent foramen ovale, or patent ductus arteriosus, as well as transcatheter aortic valve implantation, mitral valve clip device implantation for mitral regurgitation, and percutaneous transvenous mitral commissurotomy. Further, more patients who undergo cardiovascular treatments are now of more advanced age and/or have a higher surgical risk due to comorbid diseases. In these circumstances, the role of transesophageal echocardiography (TEE) has become more important.
The greatest advancement in TEE in this decade has been real-time three-dimensional imaging, which provides a new vision. The “en face view” facilitates comprehension of the morphology of cardiac structures, such as the mitral valve, as well as the ability to guide procedures in the beating heart. TEE is now utilized in various ways: for intraoperative monitoring, evaluating surgical procedures, diagnosing newly developed events, and guiding intracardiac treatment.
On the other hand, the performance of computed tomography has improved drastically, enabling the investigator to scan the whole body within seconds and providing high-resolution images with prompt reconstruction in any plane or three-dimensional rendering images. It has enabled the non-invasive diagnosis of acute aortic dissection and aortic rupture with abundant information. At this time, preoperative computed tomography and intra- and immediately postoperative TEE should achieve the best role-sharing to generate the best outcomes.
These changes have demanded cardiovascular anesthesiologists to have more skills in TEE and to utilize TEE more than ever. A certification system was first established in the United States as the Examination of Special Competence in Perioperative TEE (PTEeXAM) of the National Board of Echocardiography (NBE). In Japan, the Japanese Board of Perioperative TEE (JB-POT) was started in 2004, and the certificate of the JB-POT has become one of the requisites for certified cardiovascular anesthesiologists.
Considering the need to follow these advancements and to cover these expanding applications, a revision of “Transesophageal Echocardiography” was proposed in 2008. Thankfully, a number of distinguished authors have contributed to the new edition. It is regretful that Dr. Yasu Oka, one of the editors of the first edition, declined the editorship of this version. Instead, Dr. Steven N. Konstadt joined as the editor, later assisted by Dr. Kazumasa Orihashi. The editors asked each contributing author to submit a manuscript that provides the most up-to-date information on a specific topic and that is useful for clinical practice, containing comprehensive images and illustrations. Although it took nearly 4 years to complete the revision process, the manuscripts have been meticulously updated. We editors would like to express our sincere gratitude to each author for his or her generous and excellent contribution, as well as to the publisher, SHINDAN TO CHIRYO SHA, Inc. for such persevering and elaborate work. Due to the expanded application of TEE and the increased content, this revised edition is approximately 100 pages longer than the previous version. Thanks to the publisher, however, the purchase price has remained the same. The editors are proud that this book covers all areas of TEE application at the highest level and hope that this book will stimulate readers to take full advantage of TEE and provide their patients with the best possible treatment.
October, 2012
Ryozo Omoto
Steven N. Konstadt
Kazumasa Orihashi

Preface (1st Edition) Despite its semi-invasive nature, transesophageal echocardiography (TEE) is now an established and standard diagnostic technique in the clinical disciplines of cardiology, cardiac surgery and anesthesiology. Interestingly, we can trace the roots of transesophageal echocardiography for greater than 20 years. Frazin first reported the clinical use of TEE in 1976 after using M-mode echocardiographs taken from within the esophagus. Oka’s group subsequently reported the use of this technique in 1980 for use in the continuous intraoperative monitoring of left ventricular performance. Important studies illustrating the significant clinical applications of TEE and improvements in related technologies followed rapidly in the United States, Europe and Japan. The present general acceptance of transesophageal echocardiography can be attributed to the unique and extremely valuable information provided by utilizing the combination of color Doppler and TEE, which began around 1986. Remarkable progress in TEE probe technology has been advanced during these ten years, producing a wide variety of probes including pediatric probes, biplane probes, matrix array probes, multiplane probes, and panoramic probes.
From the initial introduction of the transesophageal echocardiographic technique, TEE’s major role has been to manage patients promptly on the basis of significant and clear clinical findings. This may be the reason why many anesthesiologists and cardiovascular surgeons, as well as cardiologists, have enthusiastically accepted the clinical use of transesophageal echocardiography. In mitral valve repair or the management of acute aortic dissection, for example, transesophageal echocardiography is indispensable for the evaluation of the surgical procedure before the chest closure, or patient management decision-making.
During these ten years, many celebrated textbooks illustrating and describing Transesophageal Echocardiography have been published. A listing of the major and pivotal publications follows : Erbel. Khandheria et al (eds.) in 1989, Sutherland, Roelandt et al (eds.) in 1991, Oka, Goldiner (eds.) in 1992, Maurer (ed. )in 1994, Oka, Konstadt (eds.) in 1996, Roelandt, Pandian et al (eds.) in 1996, and so on. These publications have contributed significantly to the education, standardization, and the expanding use of transesophageal echocardiography. The technologies related to transesophageal echocardiographic techniques are still expanding and these technologies are emerging and growing in large steps. The list of clinical applications for transesophageal echocardiography is also growing resulting from the introduction of new and innovative medical and surgical treatments. For example, minimally invasive cardiac surgery or implantation of left ventricular assist devices usually requires monitoring utilizing transesophageal echocardiography.
The primary purpose of this textbook, “Transesophageal Echocardiography”, is to present the reader with the current state of the art in Transesophageal Echocardiography techniques and clinical application. This textbook is also aimed at providing fundamental and comprehensive knowledge in Transesophageal Echocardiography including practical techniques on how to utilize TEE, diagnostic interpretation of images obtained using TEE and the impact on patient management resulting from TEE findings.
This book contains three major parts. Part I contains information on basic and technical considerations. Part II contains information and analysis of cardiovascular diseases. Part III contains information on specialized applications utilizing TEE. All of the chapters provide easy-to-understand explanations along with many relevant diagrams intended to assist the reader in a comprehensive and current understanding of transesophageal echocardiography and its clinical utility.
I strongly wish that this new textbook “Transesophageal Echocardiography” will offer and provide an up-to-date, practical and useful reference source for cardiologists, cardiac surgeons, anesthesiologists, and also sonographers who are involved or interested in transesophageal echocardiography.
Finally, I would like to express my indebtedness to Dr.Y. Oka, for without her invaluable co-editorship this new issue “Transesophageal Echocardiography” could not have been realized.
May, 2000
Ryozo Omoto, MD
Saitama Medical School Hospital