[HSF] intraop TEE

Sat Feb 23 15:27:29 EST 2008

Dear forum members,
I have the privilege to hear your valuables opinion regarding the use of TEE in the operation room.Have been trying to convince the cardiolgists to educate the anasthesia people with little success, but they promised to give their support in all our cases. At the present time intraop TEE is an execption not a rule here.
BTW, is epicardial echo an approved modality and can it be considered as TTE in a very very thin patient! ( with the same rules and principles)
erdinc> Date: Wed, 20 Feb 2008 23:44:21 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] tricuspid noncoaptation> CC: > > I have learnt a lot , chnaged many a practice and had ability to> revise mistakes with TEE/Epicardial. Without echocardiographic> guidance , it is like navigating in the dark. You may get to your> destination by experience but you will get there consistently if you> navigate with the stars or better still use a GPS.> Prasanna> > On 2/20/08, Michael Firstenberg <msfirst at gmail.com> wrote:> > Hal> > Agree 110 percent - i have seen many bad outcomes avoided by having good intra-op pictures.> >> > Not having TEE is like doing cases without anesthesia.> >> > Michael Firstenberg <msfirst at gmail.com>> >> > -----Original Message-----> > From: hgrmd at aol.com> > To: OpenHeart-L at lists.hsforum.com> > Sent: 2/20/2008 5:56 AM> > Subject: Re: [HSF] tricuspid noncoaptation> >> > Michael,> > By having TEE, I've recognized inadequate repairs, SAM, paravalvular leaks, occult air, new segmental wall abnormalities, new severe TR. The list goes on and on. Thinking back to my days before TEE, over 10 years ago, I'm sure that some bad outcomes could have been avoided if I had TEE.> >> > Hal> >> >> > -----Original Message-----> > From: Michael Firstenberg <msfirst at gmail.com>> > To: OpenHeart-L at lists.hsforum.com> > Sent: Tue, 19 Feb 2008 8:57 pm> > Subject: Re: [HSF] tricuspid noncoaptation> >> >> > Intra-operative TEE should be standard of care for all heart surgery - provided you have the resources locally to support it. I am amazed at the number of things I find that need to be fix - not to mention the role in de-airing and sorting out problems (or making sure everything is ok) coming off pump.> >> > -michael> >> >> > On Feb 19, 2008, at 8:05 PM, hgrmd at aol.com wrote:> >> > >> > > Ani,> > >> > > Years ago, we used to wait for the cardiologist to do the before > and after TEE for a repair case. Lot's of wasted time. It's a > much better system now that the anesthesiologists do the TEE's. > Unlike the cardiologists, they often stick around to see the actual > pathology in order to correlate their preoperative findings. In > addition, the interpersonal dynamic is better. I can't very well > tell a cardiologist that he's getting lousy views. Because my > caseload is so different than the other cardiac surgeons, > anesthesiologists like doing my cases because I really emphasize > TEE. It's more interesting to them than an on pump quadruple > CABG. Though a few of them are certified in TEE, I think this will > eventually become a requirement. One thing I know for sure, the > routine use of TEE has helped me avoid a few deaths and suboptimal > results with my patients.> > >> > > Hal> > >> > >> > > -----Original Message-----> > > From: Ani Anyanwu <anianyanwu at hotmail.com>> > > To: openheart-l at lists.hsforum.com> > > Sent: Tue, 19 Feb 2008 10:42 am> > > Subject: RE: [HSF] tricuspid noncoaptation> > >> > >> > >> > >> > >> My Knowledge about echo of any type is provided by cardiologists >> ( the ones> > > ho are trained for it)> erdinc> But would we also say that because > radiologists> > > re the ones trained for radiology that they should interpret our > xrays and CT> > > cans? Particularly in valve reconstruction, the echo has a similar > weight with,> > > or instance, the CT scan for a lung cancer case - the surgeon > should not do a> > > alve reconstruction without a proper study (by the surgeon) and > understanding> > > f the lesions seen on the echocardiogram.> > >> > > ogistical and economic limitations as to whether such standards are > achievable> > > re another matter but I am sure most would agree with Hal's > statement that> > > ntraoperative echo done by those who make the intraoperative decisions> > > surgeons and anesthesiologists) provides the highest level of care > at the> > > resent time. (This may not necessarily be the standard of care as > Ben pointed> > > ut - however, the standard level of care is not necessarily, indeed > is often> > > ot, the best level of care).> > >> > > have worked in hospitals where cardiologists (who often will > simply report on> > > mages) provide this service and have found it less helpful that > those where> > > naesthesiologists do the echo (as they more often report on the > image in the> > > ontext of the patient and of what you as a surgeon have done, can > do or should> > > o). Of course there are notable exceptions where a cardiologist > works very> > > losely with a surgeon in the OR and so gives only surgically relevant> > > nterpretation (like in Carpentier's group) but i think the best > model has to> > > e that in which the surgeon and anaesthesiologist do the echo and> > > nterpretation.> > >> > > ni> > >> > >> > >> > >> From: enaseri at hotmail.com.tr> To: openheart-l at lists.hsforum.com> >> Subject: RE:> > > HSF] tricuspid noncoaptation> Date: Tue, 19 Feb 2008 07:56:12 > +0000> > > Hal, >> > > o disrespect intended. My Knowledge about echo of any type is > provided by> > > ardiologists ( the ones who are trained for it)> erdinc> To:> > > penHeart-L at lists.hsforum.com> Subject: Re: [HSF] tricuspid > noncoaptation> Date:> > > un, 17 Feb 2008 17:54:49 -0500> From: hgrmd at aol.com> CC: > > > Erdinc,> You can> > > oubt the validity of TEE with respect to the tricuspid valve all > you want, but> > > he overwhelming evidence supporting its use in evaluating the > tricuspid is> > > here if you want to believe it. In addition, I've got tons of > experience using> > > EE to evaluate the tricuspid. No question, it has helped me and my > patients.> >> > > al> > > -----Original Message-----> From: erdinç naseri > <enaseri at hotmail.com.tr>>> > > o: openheart-l at lists.hsforum.com> Sent: Sun, 17 Feb 2008 3:09 pm> > Subject: RE:> > > HSF] tricuspid noncoaptation> > > > > al,> .You are right. never > compared it to> > > ny other assessment method.> .I doubt the validity of TEE data wrt > tricuspid> > > alve.> rdinc> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] > tricuspid> > > oncoaptation> > ate: Fri, 15 Feb 2008 21:03:01 -0500> From: > hgrmd at aol.com> CC:> > >>> Nasser, > > rasanna, Erdinc,> > I've been reading this never >>> ending thread> > > ith a little > kepticism regarding the validity of finger palpation in> > > ssessing TR. How do > ou know this technique is any good? > Certainly, that was> > > he way I was taught > ver 20 years ago, but we didn't have routine > TEE. Have> > > ny of you done this > inger palpation, made an assessment, and then > compared it> > > o TEE? I would bet > ot.> > > > Hal> > > -----Original Message-----> > From:> > > asser F. Abou'Seada > nfaabouseada at gmail.com>> To: OpenHeart-> L at lists.hsforum.com>> > > ent: Fri, 15 Feb > 008 2:29 pm> Subject: Re: [HSF] tricuspid > noncoaptation> > >> > >> Dear erdinc> - > have no doubt of your judgement. I share with you >> the> > > ilemma of not> eing > e-imbursed for whatever you do in an > operation ........> > > elieve me> .. even > ith international insurrance > companies ......... I had> > > he> xperience of a big > uropean insurance company.... respectable > name ...> > > ot> aying me AFTER the > peration ... it is not only in a certain > > part of> > > he> orld .... it is > verywhere ........ the issue is .... we can > not just> > > top> here unable to do > omething ....... hence my advocation for a > no cost>> > > chnique ..... like a > eVega annuloplasty ........ especially in a> > heumatic> > > ibrosed annulus ...... > o in a case like yours .. -I have> > xperienced many- I> > > ould have trusted my > inger after all - sure I did> ithout TEE > many times- and> > > ould have performed a > uture annuloplasty based> n the SENSITIVE > and SPECIFIC> > > mpressions of my finger > ......... we> urgeons have our minds at > the tip of> > > ur fingers ... isn't it ??? > > ifference between a good anastomist > and another> > > ies in where the> upination > omes from .. the wrist?.. or the MCP > joints?- ..> > > ight ? .. ..> orry for the > xtension ...> 2 - that is another > reason that I> > > ould have advocated doing an > SI approach> .. especially that you > are aware of> > > he technique and its > mplications and> dvantages .... no much > difference in> > > ime .... in fact might > e less> ....> ut better exposure ...> 3 - > I totally> > > gree with you .... > onsensus is always changing .... I asked> arc > de Laval> > > nce about what he > hinks of the TCPC .... he answered ...that> E > did not know> > > .. !!!! .......... > now" he said ... consensus is that it> s a > good operation> > > ... in a few years > ime ... who knows .... might be> etter > improved ..> > > uperceeded by another > echnique .... might be otherwise> ... > consensus is> > > lways changing ... no dogma > hatsoever .... no technique> or > concept is> > > evelated no divine role .... it is > hat we infere from> > xperience .... whether> > > cientifically controlled with Stat > .. or just> nferences ...> 4- > as for> > > eVega .... I quiet agree ......... yet, > MHO .... we can not be> > ogmatic ..> > > hether with or against ..... certainly to > ondemn DeVega> > echnique ... is a> > > otal arrogance ...... and to presume it is > he best> echnique .... > is even> > > orse ... ignorance .... as we were taught in> > ementary ABC in > ENGLAND ....> > > it is ACCORDING > TO ...... according to the> ype > f patient, > pathological> > > rocess affecting the ventricle and valve ....> > ailable logistics -> rings e.g.-> > > ... consensus of opinion .... and above> ll ... > tate of funding and> > > e-imbursement .....> certainly it is a marvelous technique > hat > has saved a> > > ot .... and still> as got a place in our surgical > > rmamentarium .... at least> > > or me .....> according to the situation- ...!!!> > hank you for your> > > ommunication> Yours> NFA> > > On Fri, Feb 15, 2008 at 12:11 > M, > erdinç naseri> > > enaseri at hotmail.com.tr>> rote:> >> Dear Nasser,> 1. My > ingertip > data showed> > > rivial Tr at 1.st operation> 2.For me there is a > ifference of 10 > minutes> > > etween closing a L atriotomy> in single row and > losing LA roof and> > > nteratrial septum in 2 rows before> declamping.> 3.There is > ot > always a> > > oncensus in every situation between the 2> circles.e.g long chain > > f postings> > > n this forum about the treatment of> CAD by stents and surgery.> 4. > > here are> > > any studie> s which show no long term benefit of DeVega (> and many > > tudies on> > > he contrary)> erdinc> > > _______________________________________________> >> > > enHeart-L mailing list> > Send postings to:> OpenHeart-> L at lists.hsforum.com> > >> > > UNSUBSCRIBE, to CHANGE email address, or to view archives:> >> > > tp://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages > transmitted by >> > > e OpenHeart-L are subject to the policies> and> disclaimers posted > at:> >> > > tp://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > > _____________________________________________> penHeart-L mailing > list> Send >> > > stings to:> OpenHeart-L at lists.hsforum.com> To UNSUBSCRIBE, to > CHANGE email >> > > dress, or to view archives:> ttp://mmp.cjp.com/mailman/listinfo/> openheart-l> >> > > l messages transmitted by the OpenHeart-L are subject to the > policies and > >> > > claimers posted at:> ttp://www.hsforum.com/listdisclaim> > ---------------------------------------->> > >> ___________________________________________> >> _____________________________>> > > ore new features than ever. 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Check out the new AOL Mail ! - http://webmail.aol.com> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------