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INTRODUCTION

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As we have explored in this atlas, echocardiography has assumed a primary role in the evaluation and management of patients with known or suspected cardiac disease.1,2 Up until now, we have emphasized its role principally as a diagnostic test. Transesophageal echocardiography (TEE) has become an integral tool in the operating room for assessing and monitoring patients undergoing cardiac surgery. Its role in that setting is beyond the scope of this atlas. As new technologies and therapies have evolved, however, echocardiography is playing an increasingly important role in interventional procedures.3,4 Echocardiography has demonstrated utility in a variety of such procedures, including

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pericardiocentesis, endomyocardial biopsy, transatrial septal catheterization, transcatheter closure of patent foramen ovale (PFO) and atrial septal defects (ASDs), percutaneous mitral and aortic balloon valvuloplasty, alcohol septal ablation for hypertrophic cardiomyopathy, some electrophysiologic procedures, as well as transcatheter mitral valve repair, left atrial appendage (LAA) occlusion procedures, and transcatheter aortic valve replacement procedures.3,4 Many of these procedures have been described in prior chapters.

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In this chapter, we will highlight the role of echocardiography, primarily TEE, as a tool to help guide interventional procedures performed in the cardiac catheterization lab and the operating room in several clinical settings from our institution that have not been addressed previously in this atlas.

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SECTION 1: ECHO-GUIDED PERICARDIOCENTESIS

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CASE PRESENTATION

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A 57-year-old man with a history of lung cancer and severe COPD presented to our institution with progressive dyspnea and dizziness. He denied any chest pain, recent febrile illness, cough or other constitutional symptoms other than anorexia. On arrival to the ED, he was noted to be tachypneic and tachycardic. His BP was 90/60 mm Hg. His lung exam revealed decreased breath sounds bilaterally, more prominent on the right. His neck veins were elevated. Cardiac exam revealed no murmurs; however, his heart sounds were distant. He had no edema. A chest x-ray revealed cardiomegaly and a right-sided pleural effusion. A stat bedside TTE revealed a large pericardial effusion with evidence of cardiac tamponade. He was taken to the cardiac catheterization lab where he underwent an echo-guided pericardiocentesis (Figures 13-1-1, 13-1-2, 13-1-3). Postprocedure echocardiography revealed resolution of the effusion. He was admitted to the oncology service. The pericardial drain was removed 2 days later after a limited echo revealed no reaccumulation of the fluid. He underwent further treatment of his lung cancer.

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Figure 13-1-1

Initial echocardiogram in the catheterization lab which confirmed the presence of a large pericardial effusion ▶ (see Video 13-1-1).

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Video 13-1-1: Initial echocardiogram in the catheterization lab which confirmed the presence of a large pericardial effusion.
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Figure 13-1-2

Apical 4 chamber view from the procedure. ...

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