世界のTEE専門医が執筆．基本原則から先進のアプリケーションを含む最新技術と臨床応用まで，TEEに関するすべての領域を網羅した渾身の一冊．心臓専門医，麻酔医，心臓血管外科医をはじめあらゆるフィールドの読者に向けた渾身の一冊．
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目次
CONTENTS
Chapter 1 Instrumentation
Kiyoshi Tamura and Ryozo Omoto
Kinds of TEE
What Makes Image Quality
Artifacts
Safety Considerations
Current and Future Technologies
Chapter 2 How to Insert Transesophageal Echocardiography Probe: Awake and Intraoperative Cases
Makoto Matsumura
Introduction
Anatomy of Pharynx and Esophagus
Techniques
Influence on the Cardiac Function and Hemodynamics
Influence on Respiration
Complications
Chapter 3 Anatomical Orientation and Transesophageal Echocardiography Views
Kazumasa Orihashi and Yasu Oka
Introduction
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
Sammary
Chapter 5 Monitoring Left Ventricular Performance
Zak Hillel and Daniel Thys
Introduction
Techniques
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
Introduction
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
Introduction
Techniques
7-2 Infective Endocarditis (Native Heart Valve Endocarditis)
Yoshie Nakajima, Makoto Matsumura and Ryozo Omoto
Introduction
Techniques
Identification of vegetation
7-3 Prosthetic Heart Valve
Yoshie Nakajima, Makoto Matsumura and Ryozo Omoto
Introduction
Technique
Chapter 8 Mitral Valve Repair
Ellen Mayer Sabik and William J. Stewart
Introduction
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
Introduction
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
Conclusion
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
Conclusions
Chapter 11 Cardiomyopathies
Yasuhiro Koide
Introduction
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
Malperfusion
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
Introduction
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
Introduction
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
Summary
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
Introduction
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
Mesothelioma
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
Introduction
Safety of TEE in the ICU or ER
Indications and Feasibility for ICU/ER Echocardiography
TEE Examination in the ER/ICU:Limited or Comprehensive
Conclusion
Chapter 19 Echocardiography and Measurement of Aortic Plaque
Jonathan Leff and Linda Shore-Lesserson
Introduction
Clinical Significance
Risk Factors
Pathogenesis
Anatomy and TEE Techniques
Cost
Techniques for Assessment of Plaque Burden
Transcranial Doppler
Treatment Strategies
Conclusion
Chapter 20 Intraoperative Hypotension
Eugene A. Rapaport and Steven N. Konstadt
Introduction
Approach
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
Introduction
Physical Principle
Imaging Methods
Contrast Agents
Logistics
Clinical Applications
Summary
Chapter 22 Role of TEE in Minimally Invasive Cardiovascular Surgery
Kazumasa Orihashi
Introduction
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
Summary
Chapter 23 Liver Transplantation
Andre M. De Wolf
Introduction
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
Introduction
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
Introduction
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
Norwood
Patent Ductus Arteriosuss
Jatene Procedure
Cost
Future Pediatric TEE
25-3 Catheter Intervension in Pediatric Cardiology
Shen-Kou Tsai
Introduction
TEE
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
Conclusion
Index
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序文
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
Director
Saitama Medical School Hospital
