Lww Final The Echo Manual DIGITAL no offer

Chapter 12 Pericardial Diseases

CHAPTER 12 PERICARDIAL DISEASES

30

FIGURE 12-35 A: Transesophageal echocardiogram showing thickened peri- cardium ( arrows , P ). LA , left atrium; LV , left ventricle; RA , right atrium; RV , right ventricle. B: Electron beam computed tomographic scan of the pericar- dium of the same patient.

flow, with a simultaneous respirometer recording, to look for tamponade or constrictive physiology. TEE may be helpful in measuring pericardial thickness (8) (Fig. 12-35) and evaluating other abnormalities of pericardial anatomy (e.g., pericardial cyst; tumor). Occasionally, a patient with constrictive pericarditis presents with hypoxemia due to increased RA pressure and significant right-to-left shunt via a patent foramen ovale. This shunt phenomenon can be detected more reliably by TEE (Fig. 12-36).

and bacterial pericarditis is excluded, corticosteroids may be administered for 1 to 2 months (e.g., 60 mg daily for 1 week, then tapered over 6–8 weeks). With successful treatment, the inflamed pericardium returns to normal thickness, and con- strictive hemodynamic features resolve (53) (Fig. 12-34B). TRANSESOPHAGEAL ECHOCARDIOGRAPHY When TTE is inadequate for imaging the pericardium and assessing ventricular filling dynamics, TEE should be considered. A hemodynamically compromising loculated pericardial effusion may be difficult to detect with TTE. TEE has been especially helpful in postoperative cardiac surgical patients with tamponade due to loculated hemo- pericardium, especially over the right atrium. It can readily interrogate mitral, pulmonary venous, and hepatic venous

3D ECHOCARDIOGRAPHY IN PERICARDIAL DISEASE

To date, the utility of 3D imaging in pericardial disease has not been systematically assessed. Published anecdotes suggest that it may be useful in characterizing the parietal

:ROWHUV .OXZHU ,QF 8QDXWKRUL]HG UHSURGXFWLRQ RI WKH FRQWHQW LV SURKLELWHG

&RS\ULJKW ‹

FIGURE 12-36 Transesophageal echocardiography at zero degree ( left ) shows thick pericardium ( arrow ) with mild compression of the right ventricule ( RV ) in a patient with constriction and hypoxemia. Middle , Bicaval view shows pat- ent foramen ovale ( arrow ), and the administration of agitated saline indicates large right to left shunt ( right ). LA , left atrium; RA , right atrium; SVC , superior vena cava.

35