Tissue deformation imaging enables the objective assessment of regional myocardial deformation assessed by ultrasound-based strain and strain rate. There are two ways to compute myocardial deformation (strain) using echocardiography: One-dimensional tissue Doppler (DTI)-derived strain and two-dimensional (2D) strain derived from B-mode images (speckle tracking, 2D-ST). This study compares the myocardial deformation parameter (i.e., strain) by these two techniques in the perioperative period using transesophageal echocardiography (TEE) in patients undergoing surgery for coronary artery bypass graft (CABG).

We performed preoperative global longitudinal strain (GLS) of left ventricle (LV) using 2D-ST and DTI, three-dimensional (3D) left ventricular ejection fraction (LVEF) and 2D LVEF in a consecutive series of 50 adult patients scheduled for on-pump CABG.

There was no difference between 2D and 3D LVEF (p < 0.0001), GLS using 2D-ST and DTI (p-value = 0.0005). The 3D LVEF correlated well with GLS using 2D-ST (r = 0.54, p < 0.0001) and less with tissue Doppler-derived GLS (r = 0.35, p-value = 0.0131).

The LV GLS calculated using 2D-ST correlates well with LV GLS derived from DTI using TEE. The LV GLS also correlated well with the 3D LVEF.

Kumar A, Mandal B, Raj R, Bhat I. Comparison of Two Different Methods of obtaining Strain by Perioperative Transesophageal Echocardiography in Patients undergoing Coronary Artery Bypass Graft Surgery: A Prospective Observational Study. J Perioper Echocardiogr 2016;4(2):37-44.

Incidence of right ventricular (RV) dysfunction in early postoperative period after Tetralogy of Fallot (TOF) repair ranges from 28 to 63%. Echocardiography is the first-line tool for the assessment of RV function in early postoperative period. As speckle tracking echocardiography (STE) has emerged as a new promising tool for assessing myocardial performance and is independent of geometric assumptions and angle dependence, it is more sensitive for detecting changes in myocardial performance than conventional echocardiographic parameters of RV function. The current study demonstrates echocardiographic parameters assessed by conventional two-dimensional (2D) echocardiography and STE in patients before and after TOF repair.

Fifty-nine consecutive patients planned for complete intracardiac repair for TOF were enrolled in this prospective cohort study. The 2D echocardiography and STE were performed a day prior to TOF repair, in the early postoperative period between days 3 and 7 and after discharge at 3 months.

The median age of patients was 6 years, with 57.6% males (34/59). Baseline hemoglobin and room air oxygen saturation were 17.7 ± 3.7 gm% and 79.4% ± 8% respectively. Two patients did not survive the procedure (3.4%). Right ventricular longitudinal peak systolic strain (RV LPSS) in early postoperative period was significantly decreased in all segments of both septal and lateral wall. However, RV LPSS assessed at midterm follow-up at 3 months postoperatively significantly improved in all segments of RV compared with assessment done in the early postoperative period, and was significantly better than preoperative values in all three segments of the septal wall.

Our study shows that the use of 2D strain or speckle tracking is a feasible and easy-to-implement technique for the evaluation of RV function after TOF repair.

Negi SL, Puri K, Mandal B, Rana SS, Barwad P. Right Ventricle Segmental Strain Trends in Patients undergoing Tetralogy of Fallot Repair: An Observational Study. J Perioper Echocardiogr 2016;4(2):45-50.

Kumar A, Dutta V, Puri GD, Barwad P. Perioperative Echocardiographic Features of Total Anomalous Pulmonary Venous Connection. J Perioper Echocardiogr 2016;4(2):51-58.

Sinus of Valsalva aneurysm (SOVA) may have associated infective endocarditis in which case single aneurysm may drain into adjacent chamber of heart via multiple openings. We report a rare case of congenital SOVA with associated infective endocarditis where intraoperative transesophageal echocardiogram (TEE) helped in localizing two separate openings in the SOVA draining into right ventricle and an associated perforation in the larger rightward cusp of bicuspid aortic valve (BAV) causing severe aortic regurgitation.

A 28-year-old male presented with grade III to IV dyspnea with previous history of infective endocarditis. Preoperative transthoracic echocardiogram (TTE) showed calcified BAV with severe aortic valve regurgitation and stenosis, severe tricuspid regurgitation, and pulmonary artery hypertension along with ruptured SOVA arising from right coronary sinus and draining into the right ventricle. Intraoperative TEE confirmed the TTE findings and in addition showed the presence of two jets arising from the SOVA draining into right ventricle, a subaortic membrane, and a perforation in the aortic cusp opening into left ventricle. The ruptured SOVA was repaired using single patch technique and aortic valve was replaced. The completeness of the repair was checked using TEE to exclude failure of closure of additional opening if any and the patient was discharged from hospital after 7 days of uneventful postoperative course.

Sinus of Valsalva aneurysm may have multiple openings draining into adjacent chamber, particularly if associated with infective endocarditis. Intraoperative TEE plays a crucial role in identification of multiple opening, involvement of adjacent structure, and assessment of completeness of repair.

Kumar B, Munirathinam GK, Sharma P, Puri GD, Singh H. Role of Transesophageal Echocardiography in Rupture of Sinus of Valsalva Aneurysm with Associated Infective Endocarditis. J Perioper Echocardiogr 2016;4(2):59-63.

Kunju SAM, Rapchuk IL. The Value of a Systematic Transesophageal Echocardiography Examination: An Isolated Finding mimicking a Pleural Effusion. J Perioper Echocardiogr 2016;4(2):64-66.

Kumar S, Kumar A, Dutta V. Unusual Embolization of Atrial Septal Defect Device in Left Ventricle and its Successful Retrieval. J Perioper Echocardiogr 2016;4(2):67-69.

Boisen ML, McHugh SM, Boretsky RH, Phillips DP, Meng L, Caldwell MW, Kaynar AM, Subramaniam K. Perioperative Echocardiographic Diagnosis of Regional Wall Motion Abnormalities: Not All of Them are Ischemic! J Perioper Echocardiogr 2016;4(2):70-73.

Ungerman E, Haft W. Giant Right Atrial Myxoma: The Importance of Transesophageal Echocardiography during Diagnosis, Evaluation, and Resection. J Perioper Echocardiogr 2016;4(2):74-78.