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Ossenkoppele BW, Luijten B, Bera D, de Jong N, Verweij MD, van Sloun RJG. Improving Lateral Resolution in 3-D Imaging With Micro-beamforming Through Adaptive Beamforming by Deep Learning. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:237-255. [PMID: 36253231 DOI: 10.1016/j.ultrasmedbio.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/26/2022] [Accepted: 08/28/2022] [Indexed: 06/16/2023]
Abstract
There is an increased desire for miniature ultrasound probes with small apertures to provide volumetric images at high frame rates for in-body applications. Satisfying these increased requirements makes simultaneous achievement of a good lateral resolution a challenge. As micro-beamforming is often employed to reduce data rate and cable count to acceptable levels, receive processing methods that try to improve spatial resolution will have to compensate the introduced reduction in focusing. Existing beamformers do not realize sufficient improvement and/or have a computational cost that prohibits their use. Here we propose the use of adaptive beamforming by deep learning (ABLE) in combination with training targets generated by a large aperture array, which inherently has better lateral resolution. In addition, we modify ABLE to extend its receptive field across multiple voxels. We illustrate that this method improves lateral resolution both quantitatively and qualitatively, such that image quality is improved compared with that achieved by existing delay-and-sum, coherence factor, filtered-delay-multiplication-and-sum and Eigen-based minimum variance beamformers. We found that only in silica data are required to train the network, making the method easily implementable in practice.
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Affiliation(s)
| | - Ben Luijten
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Nico de Jong
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands; Department of Cardiology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - Martin D Verweij
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands; Department of Cardiology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - Ruud J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Philips Research, Eindhoven, The Netherlands
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Reply. Ann Thorac Surg 2020; 109:1309. [DOI: 10.1016/j.athoracsur.2019.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 11/21/2022]
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Hastie J, Panzer OPF, Weyker P, Flynn BC. Miniaturized Echocardiography in the Cardiac Intensive Care Unit. J Cardiothorac Vasc Anesth 2018; 33:1540-1547. [PMID: 30243874 DOI: 10.1053/j.jvca.2018.08.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 11/11/2022]
Abstract
Miniaturized transesophageal echocardiography has become more common in cardiac intensive care units. There are potential benefits to this mode of technology, many of which have been described in the literature. However, image acquisition and quality have been cited as being less optimal when compared to traditional transesophageal echocardiography. This review will discuss the current options available for miniaturized transesophageal echocardiography along with a literature review of this emerging assessment modality.
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Affiliation(s)
- Jonathan Hastie
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Oliver P F Panzer
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Brigid C Flynn
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS.
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Wang L, Zhang J, Zheng SP, He L, Wang J, Wang XF, Xie MX. Research and application of transnasal transesophageal echocardiography probe. Curr Med Sci 2017; 37:782-786. [PMID: 29058296 DOI: 10.1007/s11596-017-1805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/16/2017] [Indexed: 11/26/2022]
Abstract
The intubation of conventional transesophageal echocardiography (TEE) probes into patients causes serious esophagus irritation, and thus the use of TEE probes in pediatric practice is limited. In this study, we aimed at the development of a special probe which could be inserted through the nasopharyngeal cavity into the esophagus to obtain the same high-quality echocardiography images as those obtained by conventional TEE and improve patients' experience. During the examination, the patients felt relaxed for a longer time and cooperated with the sonographers in the process of cardiac catheterization conducted in the surgery room or the intensive care unit (ICU), resulting in improved accuracy of the diagnosis and timely administration of appropriate treatment. Two years ago, Prof. Xin-fang WANG put theories into practice by inserting the probe through the nasal cavity and pharynx into the esophagus of volunteers to successfully detect the heart and great vessels at the retrocardiac space. Later, Prof. Ming-xing XIE performed the transnasal TEE examination in 12 atrial septal defect (ASD) patients and proved the safety and reliability of this method, which could become a new way for clinical diagnosis and treatment.
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Affiliation(s)
- Lei Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shao-Ping Zheng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lin He
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xin-Fang Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ming-Xing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Monitorage hémodynamique par échocardiographie des patients en état de choc. MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hemodynamic Transesophageal Echocardiography-Guided Venous-Arterial Extracorporeal Membrane Oxygenation Support in a Case of Giant Cell Myocarditis. Case Rep Crit Care 2016; 2016:5407597. [PMID: 27648312 PMCID: PMC5014940 DOI: 10.1155/2016/5407597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/03/2016] [Indexed: 11/22/2022] Open
Abstract
Giant cell myocarditis (GCM) is a rare and commonly fatal form of fulminant myocarditis. During the acute phase, while immunosuppressive therapy is initiated, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is commonly used as a bridge to heart transplantation or recovery. Until recently, conventional transesophageal echocardiography and transthoracic echocardiography were the tools available for hemodynamic assessment of patients on this form of mechanical circulatory support. Nevertheless, both techniques have their limitations. We present a case of a 54-year-old man diagnosed with GCM requiring VA-ECMO support that was monitored under a novel miniaturized transesophageal echocardiography (hTEE) probe recently approved for 72 hours of continuous hemodynamic monitoring. Our case highlights the value of this novel, flexible, and disposable device for hemodynamic monitoring, accurate therapy guidance, and potential VA-ECMO weaning process of patients with this form of severe myocarditis.
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Begot E, Dalmay F, Etchecopar C, Clavel M, Pichon N, Francois B, Lang R, Vignon P. Hemodynamic assessment of ventilated ICU patients with cardiorespiratory failure using a miniaturized multiplane transesophageal echocardiography probe. Intensive Care Med 2015; 41:1886-94. [PMID: 26254013 DOI: 10.1007/s00134-015-3998-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/16/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the feasibility, image quality, diagnostic accuracy, therapeutic impact and tolerance of diagnostic and hemodynamic assessment using a novel miniaturized multiplane transesophageal echocardiography (TEE) probe in ventilated ICU patients with cardiopulmonary compromise. STUDY DESIGN Prospective, descriptive, single-center study. METHODS Fifty-seven ventilated patients with acute circulatory or respiratory failure were assessed, using a miniaturized multiplane TEE probe and a standard TEE probe used as reference, randomly by two independent experienced operators. Measurements of hemodynamic parameters were independently performed off-line by a third expert. Diagnostic groups of acute circulatory failure (n = 5) and of acute respiratory failure (n = 3) were distinguished. Hemodynamic monitoring was performed in 9 patients using the miniaturized TEE probe. TEE tolerance and therapeutic impact were reported. RESULTS The miniaturized TEE probe was easier to insert than the standard TEE probe. Despite lower imaging quality of the miniaturized TEE probe, the two probes had excellent diagnostic agreement in patients with acute circulatory failure (Kappa: 0.95; 95% CI: 0.85-1) and with acute respiratory failure (Kappa: 1; 95% CI: 1.0-1.0). Accordingly, therapeutic strategies derived from both TEE examinations were concordant (Kappa: 0.82; 95% CI: 0.66-0.97). The concordance between quantitative hemodynamic parameters obtained with both TEE probes was also excellent. No relevant complication secondary to TEE probes insertion occurred. CONCLUSIONS Hemodynamic assessment of ventilated ICU patients with cardiopulmonary compromise using a miniaturized multiplane TEE probe appears feasible, well-tolerated, and relevant in terms of diagnostic information and potential therapeutic impact. Further larger-scale studies are needed to confirm these preliminary results.
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Affiliation(s)
- Emmanuelle Begot
- Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
- Faculty of Medicine, University of Limoges, Limoges, France
- Inserm CIC1435, Limoges, France
| | - François Dalmay
- Department of Biostatistics, INSERM UMR1094, Limoges, France
| | | | - Marc Clavel
- Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
- Inserm CIC1435, Limoges, France
| | - Nicolas Pichon
- Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
- Inserm CIC1435, Limoges, France
| | - Bruno Francois
- Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France
- Inserm CIC1435, Limoges, France
| | - Roberto Lang
- Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL, USA
| | - Philippe Vignon
- Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.
- Faculty of Medicine, University of Limoges, Limoges, France.
- Inserm CIC1435, Limoges, France.
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Fletcher N, Geisen M, Meeran H, Spray D, Cecconi M. Initial clinical experience with a miniaturized transesophageal echocardiography probe in a cardiac intensive care unit. J Cardiothorac Vasc Anesth 2015; 29:582-7. [PMID: 25575411 DOI: 10.1053/j.jvca.2014.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the safety of a novel, miniaturized, monoplane transesophageal echocardiography probe (mTEE) and its potential as a hemodynamic monitoring tool. DESIGN This was a retrospective analysis of the clinical evaluation of a disposable mTEE in ventilated patients with severe cardiogenic shock requiring hemodynamic support. mTEE assessment was performed by operators with mixed levels of TEE training. Information on hemodynamic interventions based on mTEE findings was recorded. SETTING A tertiary university cardiac critical care unit. PARTICIPANTS Male and female critical care patients admitted to the unit with severe hemodynamic instability. INTERVENTIONS Insertion of miniaturized disposable TEE probe and hemodynamic and other critical care interventions based on this and conventional monitoring. MEASUREMENTS AND MAIN RESULTS In 41 patients (51.2% female, 73.2% after cardiac surgery), hemodynamic support probe insertion was accomplished without major complications. A total of 195 mTEE studies were performed, resulting in changes in therapy in 37 (90.2%) patients based on mTEE findings, leading to an improvement in hemodynamic parameters in 33 (80.5%) patients. Right ventricular (RV) failure was diagnosed in 25 patients (67.6%) and mTEE had a direct therapeutic impact on management of RV failure in 17 patients (68 %). CONCLUSIONS Insertion and operation of a novel, miniaturized transoesophageal echocardiography probe can be performed for up to 72 hours without major complications. Repeated assessment using this device provides complementary information to invasive monitoring in the majority of patients and has an impact on hemodynamic management.
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Affiliation(s)
- Nick Fletcher
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom.
| | - Martin Geisen
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom
| | - Hanif Meeran
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom
| | - Dominic Spray
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom
| | - Maurizio Cecconi
- Department of Intensive Care Medicine, St. Georges Healthcare NHS Trust, London, United Kingdom; Department of Anaesthesia, St. Georges Healthcare NHS Trust, London, United Kingdom
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Smith LA, Monaghan MJ. Monitoring of procedures: peri-interventional echo assessment for transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2013; 14:840-50. [DOI: 10.1093/ehjci/jet042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Vieillard-Baron A, Slama M, Mayo P, Charron C, Amiel JB, Esterez C, Leleu F, Repesse X, Vignon P. A pilot study on safety and clinical utility of a single-use 72-hour indwelling transesophageal echocardiography probe. Intensive Care Med 2013; 39:629-35. [PMID: 23287876 DOI: 10.1007/s00134-012-2797-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 10/12/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the hemodynamic monitoring capability and safety of a single-use miniaturized transesophageal echocardiography (TEE) probe left in place in ventilated critically ill patients. METHODS The probe was inserted in 94 patients and designed to be left in place for up to 72 h. Three views were obtained: the superior vena caval transverse, the mid-esophageal four-chamber, and the transgastric mid-papillary short-axis views. Observational data on the feasibility of insertion, complications, image quality, and influence on management were recorded and analyzed. RESULTS No failure of probe insertion was observed. The nasogastric tube had to be removed in 17 % of cases. Image quality was judged as adequate or optimal in 91/94 (97 %) of cases in the superior vena caval view, 89/94 (95 %) of cases in the four-chamber view, and 86/94 (91 %) of cases in the short-axis view. The duration of monitoring was 32 ± 23 h, allowing 2.8 ± 1.6 hemodynamic evaluations per patient that led to a mean of 1.4 ± 1.5 therapeutic changes per patient. Among the 263 hemodynamic assessments, 132 (50 %) had a direct therapeutic impact in 62 patients (66 %). Two patients developed lip ulceration from the probe, and two patients had self-limited gastric bleeding. CONCLUSION The single-use miniaturized probe could be inserted in all patients. Image quality was acceptable in the majority of cases, and the information derived from the device was useful in making management decisions in patients with hemodynamic failure on ventilatory support. Further studies are needed to confirm the good tolerance and to compare the new device with other hemodynamic monitoring techniques.
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Affiliation(s)
- Antoine Vieillard-Baron
- Intensive Care Unit, Section Thorax-Vascular Diseases-Abdomen-Metabolism, University Hospital Ambroise Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92104, Boulogne, France.
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Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD. EAE/ASE Recommendations for the Use of Echocardiography in New Transcatheter Interventions for Valvular Heart Disease. J Am Soc Echocardiogr 2011; 24:937-65. [DOI: 10.1016/j.echo.2011.07.003] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. Eur Heart J 2011; 32:2189-214. [PMID: 21885465 DOI: 10.1093/eurheartj/ehr259] [Citation(s) in RCA: 245] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zamorano JL, Badano LP, Bruce C, Chan KL, Goncalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P, Silvestry FE, Vanoverschelde JL, Gillam LD, Vahanian A, Di Bello V, Buck T. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:557-84. [DOI: 10.1093/ejechocard/jer086] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fitzsimons MG, Kamdar B, Eyvazzadeh J, Heidi B. Transnasal TOE: An alternate approach in the setting of difficult probe placement for seated spinal surgery. Indian J Anaesth 2011; 54:65-7. [PMID: 20532078 PMCID: PMC2876908 DOI: 10.4103/0019-5049.60503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Transnasal transoesophageal echocardiography may be an effective alternative approach when difficulty is encountered while placing a probe for patients with severe kyphoscoliosis. We describe a successful approach in a patient presenting for orthopaedic fixation and review the current literature.
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Affiliation(s)
- Michael G Fitzsimons
- Harvard Medical School, Division of Cardiac Anesthesia, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Bosten, USA
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Fukuda S, Shimada K, Kawasaki T, Taguchi H, Maeda K, Fujimoto H, Inanami H, Yoshida K, Jissho S, Yoshiyama M, Yoshikawa J. Transnasal transesophageal echocardiography in the detection of left atrial thrombus. J Cardiol 2009; 54:425-31. [PMID: 19944318 DOI: 10.1016/j.jjcc.2009.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/16/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The widespread use of transesophageal echocardiography (TEE) is limited by disadvantages, including patient intolerance and increased medical costs. We aimed to investigate the feasibility and safety of transnasal TEE in the detection of possible embolic sources in patients with atrial fibrillation (AF) and/or stroke, using an ultrathin TEE probe. METHODS Sixty-two patients with AF and/or stroke underwent transnasal TEE without conscious sedation. The presence or the absence of the following parameters was evaluated: left atrial (LA) thrombus; LA spontaneous echocardiographic contrast; intraatrial shunts; and aortic plaque. RESULTS The insertion of a TEE probe was successful in 52 (84%) patients. TEE found LA thrombus in 10 (19%) patients and other embolic sources in 4 (8%) patients. Two (4%) patients had mild epistaxis. CONCLUSIONS This study demonstrated that the use of transnasal TEE was feasible and safe in the detection of LA thrombus in patients with AF and/or stroke.
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Affiliation(s)
- Shota Fukuda
- Department of Medicine, Cardiovascular Division, Osaka Ekisaikai Hospital, 2-1-10 Honden, Nishi-ku, Osaka 550-0022, Japan.
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Côté G, Denault A. Transesophageal echocardiography-related complications. Can J Anaesth 2008; 55:622-47. [DOI: 10.1007/bf03021437] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Over the last three decades, the continuing development of transesophageal echocardiography (TEE) has represented a major advance in our ability to visualize cardiovascular structures with ultrasound. TEE serves as a valuable complement to transthoracic echocardiography (TTE) by allowing: images to be obtained with less attenuation from structures such as the lung, muscle, bone, and soft tissue; high resolution visualization of structures not well seen by TTE, such as left atrial appendage, descending thoracic aorta, and prosthetic heart valves; and assessment of hemodynamics and flow disorders in greater detail. This article provides a brief overview of current as well as emerging clinical applications of transesophageal echocardiography.
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Affiliation(s)
- R Parker Ward
- Noninvasive Cardiac Imaging Laboratories, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
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Zimmermann P, Greim C, Trautner H, Sagmeister U, Kraemer K, Roewer N. Echocardiographic monitoring during induction of general anesthesia with a miniaturized esophageal probe. Anesth Analg 2003; 96:21-7, table of contents. [PMID: 12505917 DOI: 10.1097/00000539-200301000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Standard transesophageal echocardiography (TEE) does not allow cardiac monitoring during the induction of anesthesia because standard probes would limit the oropharyngeal space and impair mask ventilation and tracheal intubation. We hypothesized that a prototype, miniaturized TEE probe could be safely introduced transnasally in awake patients and that mask ventilation and orotracheal intubation could be performed while continuously monitoring left ventricular (LV) function during the induction of anesthesia. Forty-five patients were studied prospectively. The transnasal TEE probe was introduced through one of the nares and advanced until a transverse plane image of the LV at the level of the papillary muscles was seen. Anesthesia was induced, and the patients were ventilated with a mask that had previously been threaded over the TEE probe via a central perforation. Probe insertion was successful in 12 patients under local anesthesia alone and in an additional 31 patients with a combination of local anesthesia and mild sedation. In two cases, probe placement was unsuccessful. Overall, hemodynamic variables did not change significantly during insertion. No case of significant mucosal bleeding was seen. In one patient, regurgitation of gastric contents occurred without affecting the perioperative outcome. The two-dimensional echocardiogram image quality of the LV during the induction of anesthesia was good or acceptable in 95% of patients. We conclude that transnasal TEE can effectively be used for cardiac monitoring during the induction of general anesthesia. IMPLICATIONS This study demonstrates that it is feasible and generally safe to introduce a miniaturized transesophageal echocardiography probe transnasally in awake cardiac risk patients to monitor cardiac performance during the induction of general anesthesia.
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Affiliation(s)
- Peter Zimmermann
- Department of Anesthesiology, University of Würzburg Medical Center, Germany.
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Echocardiographic Monitoring During Induction of General Anesthesia with a Miniaturized Esophageal Probe. Anesth Analg 2003. [DOI: 10.1213/00000539-200301000-00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Maslow A, Bert A, Schwartz C, Mackinnon S. Transesophageal Echocardiography in the noncardiac surgical patient. Int Anesthesiol Clin 2002; 40:73-132. [PMID: 11910251 DOI: 10.1097/00004311-200201000-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew Maslow
- Rhode Island Hospital, Brown University Medical Center, Providence 02903, USA
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Greim CA, Trautner H, Krämer K, Zimmermann P, Apfel CC, Roewer N. The detection of interatrial flow patency in awake and anesthetized patients: a comparative study using transnasal transesophageal echocardiography. Anesth Analg 2001; 92:1111-6. [PMID: 11323330 DOI: 10.1097/00000539-200105000-00006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED The Valsalva maneuver in the awake patient and the ventilation maneuver in the tracheally intubated anesthetized patient are two provocation methods to detect a patent foramen ovale (PFO) by means of contrast transesophageal echocardiography. In 60 patients undergoing posterior fossa surgery, a contrast agent was administered via a peripheral vein during a Valsalva maneuver immediately before anesthesia induction, followed by central venous administration during a ventilation maneuver in the same patients when anesthetized and endotracheally intubated. We evaluated both maneuvers with a 32-element monoplane transnasal transesophageal echocardiography probe to trace the atrial flow of the contrast agent in a 90 degrees bicaval view. A maneuver was rated positive when more than four bubbles appeared in the left atrium during the first three cardiac cycles after intrathoracic pressure release. The right atrial cross-sectional area before pressure release, and the peak septal excursion during atrial contrast opacification, were measured. McNemar's test was used to assess a paired dichotomous response on the two maneuvers for a significant difference. In 56 patients, the ventilation maneuver was significantly (P < 0.037) more often positive for PFO (n = 14) than the Valsalva maneuver (n = 7). Although there was no difference in the methods regarding the peak septal excursion, the mean right atrial area before pressure release was significantly smaller during the ventilation maneuver than during the Valsalva maneuver (11.2 +/- 3.1 cm(2) vs 14.4 +/- 3.3 cm(2), n = 42, P < 0.05). In the patients with a positive ventilation, but a negative Valsalva maneuver, the discrepancy was even larger (10.9 +/- 4.4 cm(2) vs 16.3 +/- 4.2 cm(2), n = 7, P < 0.001). We conclude that the ventilation maneuver is superior to the Valsalva maneuver in detecting PFO. Our data suggest that a peak pressure of 30 cm H(2)O during the ventilation maneuver achieves a more pronounced reduction in right atrial load and allows right atrial pressure to exceed left atrial pressure when intrathoracic pressure is released. IMPLICATIONS A controlled ventilation maneuver in anesthetized patients immediately before posterior fossa surgery may be superior to the preoperative Valsalva maneuver in detecting a patent foramen ovale by contrast transesophageal echocardiography. This approach identifies patients at high risk for paradoxic embolism, but it is not practical for preoperative identification of patients who might benefit from patent foramen ovale closure before surgery.
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Affiliation(s)
- C A Greim
- Department of Anesthesiology, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany.
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Abstract
Critically ill patients often pose special diagnostic problems to the clinician, intensified by limited physical examination findings and difficulty in transportation to imaging suites. Mechanical ventilation and the limited ability to position the patient make transthoracic echocardiography difficult. Transesophageal echocardiographic (TEE) imaging, however, is well suited to the critical care patient and is frequently used to evaluate hemodynamic status, the presence of vegetations, a cardioembolic source, and an intracardiac cause of hypoxemia. Using proper precautions, TEE can be performed safely in unstable patients and frequently leads to important changes in management.
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Affiliation(s)
- P A Heidenreich
- Department of Medicine, Stanford University, Stanford, CA, USA
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24
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Abstract
Transesophageal echocardiography (TEE) provides excellent delineation of ventricular function in the ambulatory and critical settings. Major indications include the acutely ill patient with suboptimal images with other techniques and the intraoperative assessment of patients undergoing cardiac surgery and of cardiac patients undergoing noncardiac surgery. The methodology of quantification of ventricular function is quite accurate, though it has inherent limitations. Newer technologies, such as edge enhancement techniques, three-dimensional acquisition, and contrast agents, all have the potential to improve evaluation of ventricular function with TEE. Stress imaging with TEE is possible with dobutamine and with pacing techniques. This is sage and accurate, and it is indicated in patients, such as the morbidly obese, who are impossible to image by other methods.
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Affiliation(s)
- J A Skiles
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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25
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Gunasegaran K, Yao J, De Castro S, Nesser HJ, Pandian NG. Three-dimensional transesophageal echocardiography (TEE) and other future directions. Cardiol Clin 2000; 18:893-910. [PMID: 11236172 DOI: 10.1016/s0733-8651(05)70186-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As faster imaging systems enter the market, three-dimensional echocardiography is gearing up to become a useful tool in assisting the clinician to image the heart in many innovative projections. What started out as a novel idea of displaying a three-dimensional anatomic picture of the heart now provides a multitude of views of the heart and its structures. Information gained from anatomic and dynamic data has helped clinicians and surgeons in making clinical decisions. In the future, this imaging modality may become a routine imaging modality for assessing cardiac pathology and may serve to increase understanding of the dynamics of the heart.
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Affiliation(s)
- K Gunasegaran
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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26
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Abstract
Today's intensivists are provided with more information than ever before, yet current monitors present data from multiple sources in a relatively raw form with virtually no intelligent data integration and processing. In the next century, technological advances in miniaturization, biosensors and computer processing, coupled with an improved understanding of critical illnesses at the molecular level, will lead to the development of a new generation of monitors. Monitoring will move from the traditional macroscopic invasive approach to a noninvasive, molecular analysis of evolving critical disease processes. It is likely that disturbances in homeostasis will become known immediately or before they would otherwise be manifest clinically. Nanotechnology will permit monitoring of critical changes in the intracellular environment or the by-products of cellular metabolism and signal messaging. This article discusses monitoring technologies that hold promise for further development in the next century and point out techniques likely to be abandoned.
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Affiliation(s)
- R Kohli-Seth
- Department of Surgery, Mount Sinai Medical Center, City University of New York, New York, USA
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27
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28
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Spencer KT, Goldman M, Cholley B, Hultman J, Benjamin E, Oropello J, Harris KM, Bednarz J, Manasia A, Leibowitz A, Connor B, Lang RM. Multicenter Experience Using a New Prototype Transnasal Transesophageal Echocardiography Probe. Echocardiography 1999; 16:811-817. [PMID: 11175225 DOI: 10.1111/j.1540-8175.1999.tb00133.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Transesophageal echocardiography (TEE) is an invaluable diagnostic tool, particularly in patients with inadequate transthoracic echocardiographic examinations. In addition, continuous TEE has been used to monitor ventricular and valvular performance in the intensive care unit and the operating room. However, current generation transesophageal probes have limitations in the critical care setting due to their size. Recently, a prototype miniaturized transesophageal probe was developed to overcome these limitations. This probe was used by five medical centers for 194 examinations. A large proportion of these patients were in the intensive care unit (43%), as well as mechanically ventilated (39%). Seventy percent (70%) of the subjects in this study were intubated nasally with the prototype probe, with a success rate of 88.5%. Oral intubation was successful in every case. Subject tolerance was good, and 25% of the patients were intubated for > 1 h. Nasal intubation with the probe was more likely in intensive care patients, ventilated subjects, and patients who were intubated for > 1 hour. TEE with this miniaturized probe is feasible and safe even in multi-instrumented critical care patients. This probe provides adequate diagnostic imaging capabilities and may allow imaging over prolonged periods of time, making it suitable for the serial monitoring of ventricular performance.
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Affiliation(s)
- Kirk T. Spencer
- The University of Chicago, Department of Medicine, Section of Cardiology, 5841 South Maryland Avenue, MC 5084, Chicago, IL 60637
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29
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Greim CA, Brederlau J, Kraus I, Apfel C, Thiel H, Roewer N. Transnasal Transesophageal Echocardiography. Anesth Analg 1999. [DOI: 10.1213/00000539-199902000-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Greim CA, Brederlau J, Kraus I, Apfel C, Thiel H, Roewer N. Transnasal transesophageal echocardiography: a modified application mode for cardiac examination in ventilated patients. Anesth Analg 1999; 88:306-11. [PMID: 9972746 DOI: 10.1097/00000539-199902000-00015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED In 42 endotracheally intubated patients, we examined the utility of a miniaturized monoplane probe for transnasal transesophageal echocardiography (TEE). Transnasal TEE was prospectively evaluated in 26 deeply and 16 mildly sedated patients receiving topical anesthesia with lidocaine jelly 2%. The patients with deep sedation were additionally examined with transoral monoplane and multiplane TEE. Transnasal esophageal insertion of the TEE probe was successfully performed in 90% of patients. Endotracheal malpositioning was corrected in two patients. Nasal bleeding required treatment in another patient. Topical anesthesia was adequate in 82% of mildly sedated patients. Left ventricular short- and four-chamber long-axis views of good quality were obtained with transnasal (transoral) monoplane TEE in 76% (81%) and 92% (96%) of patients (differences not significant). Compared with conventional multiplane TEE, transnasal monoplane TEE missed diagnoses in 19% of patients. The relative error (mean +/- SEM) of quantification with transnasal TEE was <9% +/- 2% for ventricular diameters and <7% +/- 2% for cross-sectional area measurements, with a bias of 0.5 +/- 3.8 cm2 and 0.1 +/- 2.4 cm2 (mean +/- 2 SD) for left ventricular end-diastolic and end-systolic short-axis areas. The relative error in measuring intracardiac flow velocities was >40%, but systolic to diastolic peak velocity ratios at the valvular site were determined with an error <4% +/- 3%. Transnasal monoplane TEE can be performed even in mildly sedated patients with an endotracheal tube without further need for analgesia or sedation. The technique is as useful as conventional transoral TEE to image standard tomographic planes for quantification, but it is less suited for comprehensive echocardiographic diagnosing. IMPLICATIONS Transnasal insertion of a miniaturized monoplane transesophageal echocardiography (TEE) probe was studied in endotracheally intubated patients. Nasal passage was well tolerated even by patients with only mild sedation. Imaging quality was similar to conventional transoral monoplane TEE with larger transducers, but technical restraints cause a deficit in complete cardiac diagnosing obtained with multiplane TEE.
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MESH Headings
- Anatomy, Cross-Sectional
- Anesthesia, Intravenous
- Anesthesia, Local
- Anesthetics, Local/administration & dosage
- Bias
- Blood Flow Velocity/physiology
- Cardiac Output/physiology
- Echocardiography
- Echocardiography, Transesophageal/adverse effects
- Echocardiography, Transesophageal/instrumentation
- Echocardiography, Transesophageal/methods
- Epistaxis/etiology
- Equipment Design
- Female
- Heart Valves/diagnostic imaging
- Humans
- Hypnotics and Sedatives/administration & dosage
- Intubation, Intratracheal
- Lidocaine/administration & dosage
- Male
- Middle Aged
- Miniaturization
- Nose
- Prospective Studies
- Respiration, Artificial
- Sensitivity and Specificity
- Transducers
- Ventricular Function, Left
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Affiliation(s)
- C A Greim
- Department of Anesthesiology, Julius-Maximilians-Universität, Würzburg, Germany.
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31
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Shiota T, Lewandowski R, Piel JE, Smith LS, Lancée C, Djoa K, Bom N, Cobanoglu A, Rice MJ, Sahn DJ. Micromultiplane transesophageal echocardiographic probe for intraoperative study of congenital heart disease repair in neonates, infants, children, and adults. Am J Cardiol 1999; 83:292-5, A7. [PMID: 10073843 DOI: 10.1016/s0002-9149(98)00845-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study reports the development of a micromultiplane 8.2-mm transesophageal echocardiographic probe. The probe is applicable to newborn infants and can deliver diagnostic images in adults.
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Affiliation(s)
- T Shiota
- The Clinical Care Center for Congenital Heart Disease, Oregon Health Sciences University, Portland 97201, USA
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32
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Vignon P, Spencer KT, Mor-Avi V, Weinert L, Lang RM. Evaluation of Global and Regional Right Ventricular Function Using Automated Border Detection Techniques. Echocardiography 1999; 16:105-116. [PMID: 11175128 DOI: 10.1111/j.1540-8175.1999.tb00791.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Quantitative evaluation of right ventricular (RV) function remains challenging due to the complex geometry of this chamber, which precludes the use of simple geometric assumptions. Automated border detection (ABD) techniques, which provide online changes in cardiac chamber dimensions, have been predominantly used for quantitative assessment of global as well as regional left ventricular function. Recently, acoustic quantification has been validated for quantitative evaluation of global RV function, and color kinesis has been used to objectively assess systolic and diastolic regional RV function. In this article, the main studies validating ABD for the objective assessment of global RV function and the current clinical uses of this technique are reviewed. In addition, technical guidelines and limitations of ABD techniques are described, and potential applications of color kinesis for quantitative assessment of regional systolic and diastolic RV performance are detailed. ABD techniques provide new insights into right atrial and RV systolic and diastolic properties. The clinical value of these techniques in the diagnosis, prognosis, and potential guidance of therapeutic management of RV dysfunction remains to be determined.
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Affiliation(s)
- Philip Vignon
- The University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637
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33
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Mueller HS, Chatterjee K, Davis KB, Fifer MA, Franklin C, Greenberg MA, Labovitz AJ, Shah PK, Tuman KJ, Weil MH, Weintraub WS. ACC expert consensus document. Present use of bedside right heart catheterization in patients with cardiac disease. American College of Cardiology. J Am Coll Cardiol 1998; 32:840-64. [PMID: 9741535 DOI: 10.1016/s0735-1097(98)00327-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Weil MH. The assault on the Swan-Ganz catheter: a case history of constrained technology, constrained bedside clinicians, and constrained monetary expenditures. Chest 1998; 113:1379-86. [PMID: 9596322 DOI: 10.1378/chest.113.5.1379] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- M H Weil
- Institute of Critical Care Medicine, Palm Springs, Calif 92262-6167, USA
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