With the expanding use of cardiac implantable electronic device (CIEDs) in older populations with more complicated conditions have bring about higher rates of CIED infections. We report four cases of CIED infections from single-center, who were extracted endocardial leads with intra-op transesophageal echocardiography (TEE) monitoring and guidance. Three of them had fatal complications as pulmonary embolism, pericardial tamponade and tricuspid trauma. The other one was found a massive vegetation detected by TEE not by pre-op transthoracic echocardiogram (TTE), which could avoid intra-op embolism. Application of TEE helps improving efficacy and safety by capacitating the operators to perform the procedure, guiding them to better plans and to rapidly recognize and manage relative complications. Thus, continuously intra-op TEE should be one of the routine monitoring methods in this high-risk procedure.

A document by Hansheng Liang. Click on the document to view its contents.

Objectives: To summarize intraoperative right ventricle function assessments in patients with tumor thrombus in inferior vena cava by transesophageal echocardiography. Design: Retrospective analysis. Settings: University of Peking University People‘s Hospital Participants: Patients who had experienced inferior vena cava tumor resection from Jun 2014 to Oct 2021. Interventions: Analysis of demographic data, intraoperative parameters including TEE (transesophageal echocardiography) assessments on right ventricle (RV) function, outcome data . Variables were compared between groups according to the tumor invasion of right atrium (RA) or not. Measurements and Main Results: Variables associated with intraoperative outcomes were assessed. Fifteen patients were included in this analysis. The invasion of RA was in 11 patients (73.3%). The intraoperative parameters of right ventricle and vasoactive-inotropic score (VIS) were analyzed. There weren’t significant differences between the VIS of Group A and Group B(7.18±4.60 vs 7.50±6.76,p=0.918).The fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) increased significantly postoperatively. The right ventricle end-diastolic area index (RVEDAI, ml/m2) of the cases invading the RA were larger than those without the invasion of the right ventricle postoperatively. The postoperative in-hospital days (POD) also lasted longer in RA involved cases. Conclusions: Right ventricle systolic function improved in patients with tumor thrombus in inferior vena cava (IVC) postoperatively. Patients with tumor invasion in the RA would need longer time to recover. In those patients, the strategy would be managed when IVC obstruction was relieved for prophylaxis of acute RV failure.