Operative Surgical Procedures

ABCIC

Review Article

My Approach to VExUS Assessment Using Transesophageal Echocardiography: A Step-by-Step Performance Guide

Angelo Antunes Salgado et al. Marcos Paulo Lacerda Bernardo Marcelo Ramalho Fernandes

ABSTRACT

Monitoring systemic venous congestion has become essential in the management of critically ill patients, enabling accurate diagnosis, severity grading, and prognostic stratification. Literature shows that congestion is strongly associated with the development of acute kidney injury and increased mortality when compared with optimized volume states.

In this setting, intraoperative Transesophageal Echocardiography (TEE) has emerged as an advanced and versatile tool. In addition to allowing detailed assessment of cardiac function, TEE is effective in assessing intravascular volume status and predicting fluid responsiveness through dynamic measurement of stroke volume and the degree of systemic congestion. TEE also enables direct visualization of abdominal vessels, such as the hepatic, portal, and intrarenal veins, thereby facilitating the identification of pathological pulsatile flow patterns even in patients with limited transthoracic acoustic windows.

The integration of protocols such as VExUS (or its modified version, mVExUS) allows for a personalized approach focused on “perfusion without congestion.” This review outlines the practical application of VExUS assessment using TEE, its technical limitations, and how to use it to guide hemodynamic resuscitation, minimizing organ injury and optimizing clinical outcomes.

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ABCIC

Original Article

Comparison of Cardiac Structural Changes After Surgical and Transcatheter Atrial Septal Defect Closure With Color Doppler Echocardiography

Tuğçe Akın et al. Zeynep Bilge Yılmaz Dere Yılmaz Yozgat Halil Türkoğlu Murat Ugurlucan

ABSTRACT

Background:

Surgical and transcatheter techniques represent the two principal approaches for atrial septal defect (ASD) closure. Although both are widely used, comparative evidence regarding their mid-term effects on cardiac remodeling and right ventricular (RV) function remains limited.

Objectives:

To compare mid-term cardiac structural remodeling and right ventricular functional recovery after surgical versus transcatheter ASD closure in pediatric patients using serial color Doppler echocardiographic assessment. Additionally, to determine whether either technique leads to faster or greater improvement in right heart morphology and function.

Methods:

We retrospectively evaluated 69 pediatric patients who underwent ASD closure at a single center. A total of 39 patients underwent surgical repair (Group 1), and 30 patients underwent transcatheter closure (Group 2). Transthoracic color Doppler echocardiography was performed before the procedure and at 3 and 12 months after intervention. Measures of atrial and ventricular morphology and function were analyzed.

Results:

At 3 months, the surgical group showed significantly greater improvement in right atrium (RA) major axis, RA volume, interventricular septal thickness in diastole, interventricular septal thickness in systole, and RV end-diastolic diameter (RVEDd) compared with the transcatheter group (all p < 0.05). At 12 months, surgical repair remained superior regarding improvement in RA major axis, RA volume, and RVEDd (all p < 0.05). Residual shunt was identified in only one patient in each group at 12 months.

Conclusions:

urgical ASD closure was associated with earlier and more consistent recovery of right atrial and ventricular geometry and function compared with transcatheter closure. These findings indicate that surgical closure may offer advantages for selected patients, particularly in relation to right heart remodeling during the first postoperative year.

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IJCS

Case Report

Bentall-De Bono Reoperation Associated With Pseudoaneurysm and Infectious Endocarditis

Janayna Rabelato et al. Iuri Betuel Gomes Antonio Adnaldo da Silveira Maia Daniel Chagas Dantas … Antonio Flávio de Almeida Mario Issa

Abstract

We present the case of a 55-year-old patient who underwent the Bentall-De Bono procedure with mechanical prosthesis in 2005 and was admitted to the emergency department in July 2020 with mixed shock. Complementary exams showed an abscess involving the prosthetic tube, two thirds of the aortic valve circumference and the left ventricle, with a neocavity of about 45 mm in diameter from the aortic sinus to the ascending aorta. The patient underwent surgical repair, with a new procedure using the Bentall-De Bono technique, now associated with coronary artery bypass grafting with a great saphenous vein graft between the aorta and the anterior descending artery. Culture of samples collected intraoperatively showed Staphylococcus epidermidis. The patient received antibiotic therapy for 30 days, evolving favorably, and is under regular outpatient follow-up.

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My Approach to VExUS Assessment Using Transesophageal Echocardiography: A Step-by-Step Performance Guide

ABSTRACT

Comparison of Cardiac Structural Changes After Surgical and Transcatheter Atrial Septal Defect Closure With Color Doppler Echocardiography

ABSTRACT

Background:

Objectives:

Methods:

Results:

Conclusions:

Bentall-De Bono Reoperation Associated With Pseudoaneurysm and Infectious Endocarditis

Abstract

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