Role of Perioperative Transesophageal Echocardiography in Left Ventricular Apical Pseudoaneurysm Surgery

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Left ventricular apical pseudoaneurysm following myocardial infarction (n=1). Intervention: Perioperative transesophageal echocardiography (2D and 3D TEE) guided surgical repair (Dor procedure) vs. Preoperative transthoracic echocardiography (TTE). Primary outcome: Accurate diagnosis and surgical repair of left ventricular apical pseudoaneurysm with postoperative LVEF assessment.

Q: What does this research mean for the field?

Perioperative 2D and 3D transesophageal echocardiography accurately differentiates left ventricular apical pseudoaneurysm from true aneurysm and effectively guides surgical repair. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sunder Negi; Ganesh Kumar Munirathinam; Imran Bhat; Goverdhan D Puri; Shyam KS Thingnam; Srinath Damodaran; Krishna Prasad Gourav; Virendra K. Arya

doi:10.5005/jp-journals-10034-1082

January 1, 2018Journal of Perioperative EchocardiographyOpen Access

Role of Perioperative Transesophageal Echocardiography in Left Ventricular Apical Pseudoaneurysm Surgery

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Key Points

To describe the perioperative role and utility of transesophageal echocardiography in the surgical management of a left ventricular apical pseudoaneurysm following myocardial infarction.
Case report of a patient in his 6th decade of life undergoing urgent Dor procedure repair of a left ventricular apical pseudoaneurysm following acute myocardial infarction.
Cardiopulmonary bypass was initiated after exposing and cannulating femoral vessels prior to sternotomy, with transesophageal echocardiography guiding aortic cannulation by identifying grade III and grade II aortic atheromas.
Intraoperative transesophageal echocardiography was used to visualize the narrow aneurysmal neck, exclude the pseudoaneurysm from the left ventricle, and assess hemodynamics.
The pseudoaneurysm neck was closed with pericardium and thrombotic necrotic tissue was excised, requiring an aortic cross-clamp time of 48 minutes.
Post-cardiopulmonary bypass transesophageal echocardiography demonstrated an improved left ventricular ejection fraction of 50% and trivial mitral regurgitation following milrinone administration.
The patient was extubated after 5 hours of mechanical ventilation, transferred to the ward on postoperative day 3, and discharged on postoperative day 5.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient aged 52 years with hypertension, type II diabetes, and a left ventricular apical pseudoaneurysm 2 months post-myocardial infarction, followed through hospital discharge on postoperative day 5.

I

Intervention

Perioperative transesophageal echocardiography (TEE)

Main Result

Absolute Event Rate: 50% vs 45%

Perioperative transesophageal echocardiography is a critical imaging modality for guiding urgent surgical repair of post-myocardial infarction left ventricular apical pseudoaneurysms.

Limitations

Single-patient case report design limits generalizability
Poor transthoracic echocardiography acoustic window due to patient obesity and smoking history
Planned coronary artery bypass grafting to the left anterior descending artery was abandoned due to a poor target vessel

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Implication

May support selective perioperative TEE when TTE is inconclusive; hypothesis-generating and should not yet change practice.

Abstract

Left ventricular apical pseudoaneurysm following myocardial infarction is a rare entity and often fatal due to rupture of free wall, thus warranting an urgent surgery. Although transthoracic echocardiography (TTE) plays a significant role in the diagnosis of pseudoaneurysm, transesophageal echocardiography (TEE) remains an indispensable tool during perioperative period. In this report, we are describing a case of left ventricular apical pseudoaneurysm planned for an urgent surgery.

Discussion

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Cite This Study

Negi et al. (2018) conducted a case report in Left ventricular apical pseudoaneurysm following myocardial infarction (n=1). Perioperative transesophageal echocardiography (2D and 3D TEE) guided surgical repair (Dor procedure) vs. Preoperative transthoracic echocardiography (TTE) was evaluated on Accurate diagnosis and surgical repair of left ventricular apical pseudoaneurysm with postoperative LVEF assessment.

synapsesocial.com/papers/6a9480e3f7624a8005c52c07 https://doi.org/10.5005/jp-journals-10034-1082

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Role of Perioperative Transesophageal Echocardiography in Left Ventricular Apical Pseudoaneurysm Surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Role of Perioperative Transesophageal Echocardiography in Left Ventricular Apical Pseudoaneurysm Surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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