Color Doppler echocardiography in cardiac surgery

The article was professionally consulted by a radiologist, Radiology Department - Vinmec Central Park International General Hospital.

Doppler echocardiography is an imaging method that helps determine cardiac activity, morphology and structure. Color Doppler echocardiography is also used to check blood flow and pulmonary artery pressure. Based on the results obtained, the doctor can map the direction and speed of blood flow in the heart.
Doppler echocardiography has outstanding advantages such as: safe probing procedure, no bleeding, no influence by radiation and can be performed many times on 1 patient.

2.1. Cardiovascular disease diagnosis Widely applied to people at risk or suspected of having cardiovascular disease. Due to the diagnostic and screening nature, the requirements of ultrasound are relatively simple:
Assess the risk of cardiovascular disease. Preliminary information on acquired pathology (eg: mitral valve disease, left ventricular hypertrophy, atrial septal defect ...) Evaluation of heart chamber size, cardiac function. 2.2. Echocardiography indicated for cardiac surgery Usually performed in a cardiology facility. Because the purpose of ultrasound is to prepare for cardiac surgery, the results are quite high:
Accurately diagnose the type of heart disease (eg, mitral regurgitation) Determine the extent of the disease (eg, mitral valve moderate stenosis, severe regurgitation) Evaluation of associated lesions (left atrial thrombosis, carotid valve disease ...) Provide parameters that allow surgery indications and surgical prognosis (eg, diameter) left ventricle, pulmonary artery pressure, cardiac function...) 2.3. Ultrasound to guide surgery In this role, the process of performing color Doppler echocardiography requires a very high level of expertise and synchronization between internal and external surgery. Besides the above requirements, the ultrasound results also need to pay attention to the necessary parameters to help the surgeon choose the incision, surgical technique (valve replacement or valve shaping...) suitable for each patient. patient.

After having an accurate diagnosis of the disease, indications and prognosis for surgery, the actual surgical procedure will be conducted with the guidance of Doppler ultrasound. However, it should be noted that for each type of lesion, there will be different treatment approaches, so the doctor needs to focus on a few special parameters from the echocardiogram results to choose the right treatment. with each disease.
3.1 Mitral valve surgery Before performing mitral valve surgery, the color Doppler echocardiography procedure must determine the following factors:
Left atrium size: the correct determination of left atrial size will help determine the appropriate incision to access the mitral valve. If the left atrium is smaller than 45mm, it is difficult to open the valve using the classic lines, whereas if the left atrium is enlarged, it is necessary to make the atrial reduction to limit postoperative disorders (thromboembolism, heart rate, etc.) Left atrial thrombosis: thrombosis will increase the operating time and the difficulty of the operation. In addition, it is also important not to aspirate the left atrium before stopping the heart because there is a risk of dislodging and pushing the thrombus into the carotid artery. Doppler ultrasound needs to describe specifically and accurately the extent and location of damage to the valve apparatus (according to the Willkins scale) to choose surgical techniques: valve replacement or valve reconstruction. Carotid valve regurgitation: it is necessary to accurately determine if there are signs of combined carotid valve damage, especially in mitral stenosis, to prevent the need for carotid intervention. 3.2. Carotid valve surgery Color Doppler echocardiography should help identify 2 factors before guiding carotid valve surgery:
Valve ring size: especially important for children or patients with small human organs baby if indicated to replace the valve. Based on that, the doctor will prepare a small-sized prosthetic valve, or plan a technique to expand the valve ring to place a larger artificial valve.

Leaf thickness: For patients with indications for valvuloplasty, ultrasound needs to accurately describe the thickness of the leaflets and thickness in all 3 leaflets or localized in 1 valve so that the doctor can calculate the valve thickness. valve shaping engineering. 3.3. Tricuspid valve surgery The condition of tricuspid valve damage often has the following characteristics: causing severe right heart failure, difficult valve shaping techniques, and limited postoperative results... so Doppler ultrasound needs to be accurately determined. consider valve damage due to low or functional valve regurgitation to choose the appropriate valve repair method.
Cardiovascular disease is still a common dangerous disease in Vietnam. When the disease progresses to a certain extent, the patient needs surgery to improve or maintain heart function, as well as prevent unfortunate complications.
Up to now, color Doppler echocardiography is still an important exploratory method to help diagnose disease, indicate and prepare for cardiac surgery. However, in addition to improving the quality of cardiac surgery, it is also necessary to enhance the quality of echocardiography, helping to create a synergistic effect to improve the quality of treatment of cardiovascular diseases.
Vinmec International General Hospital is equipped with a modern echocardiogram system with machinery and equipment on par with the most prestigious hospitals in the world to support doctors in the treatment of cardiovascular diseases for patients. core. Along with that is a team of experts including experienced professors and doctors who have successfully performed many surgeries for patients with heart disease.