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2 results

  • 12 - The thoracic aorta

  • from Section 1 - Fundamentals of transesophageal echocardiography
  • Edited by Robert Feneck, John Kneeshaw, Marco Ranucci
  • Book:
    Core Topics in Transesophageal Echocardiography
    Published online:
    10 May 2010
    Print publication:
    15 April 2010, pp 193-204

  • Summary

    Intraoperative transesophageal echocardiography (TEE) is increasingly being used to assess ventricular function in patients about to undergo coronary revascularization, and it should always be used to assess the result of surgery and cardiac function both following bypass and/or at the time of chest closure. The development of standard chocardiographic views, coupled with agreed terminology for describing manipulation of the TEE probe, has been essential for the development of TEE into an effective imaging modality. Th e 20 standard views described in 1999 form the basis of the TEE study. Echocardiographic examination of left ventricular function can reveal useful information when the heart is at rest or under stress with a pharmacological agent such as dobutamine. In order to evaluate each part accurately, the left ventricle has been divided into a number of segments. TEE is particularly useful for examining the mitral valve.

  • EFFECT OF PHYSICIAN SPECIALTY ON TREATMENT RECOMMENDATION TO PATIENTS WITH CORONARY ARTERY DISEASE

  • Joseph McDonnell, Annejet P. Meijler, James P. Kahan, Henk Rigter, Steven J. Bernstein
  • Journal:
    International Journal of Technology Assessment in Health Care / Volume 16 / Issue 1 / January 2000
    Published online by Cambridge University Press:
    04 May 2001, pp. 190-198

  • Objective: To assess the influence of physician specialty and the way in which patient data are presented in the treatment recommended for patients with coronary artery disease.

    Methods: In a prospective study, 3,628 patients with significant coronary artery disease who had been referred to 1 of 10 heart centers in the Netherlands as possible candidates for either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG) were recruited. Within each center, the recommended treatment is determined by a team consisting of cardiologists only, cardiovascular surgeons only, or cardiologists and cardiovascular surgeons (i.e., composite teams). The main outcome measures are the proportions of patients for whom PTCA, CABG, or noninvasive (medical) therapy was recommended.

    Results: Composite teams made 71% of recommendations, surgeon-only teams, 12%, and cardiologist-only teams, 17%. Cardiologist-only teams primarily recommended patients to PTCA, surgeon-only teams to CABG, while combined teams made more evenly distributed recommendations (p < .001). Although the patients discussed by the three types of teams were clinically different, the recommendation patterns remained significant after adjusting for these differences (p < .001). For patients with recent myocardial infarction, direct presentation of the case to the team by the referring cardiologist reduced the likelihood that CABG would be recommended.

    Conclusions: The treatment recommended to patients with coronary artery disease is affected by the composition of the team providing the recommendation. These findings have important implications for clinical decision making for patients with cardiovascular disease.