Nursing practices for accelerated perioperative recovery of patients undergoing esophageal ultrasound-guided mitral valve chordae tendineae repair at the cardiac apex

Summary of the Experience in Perioperative Accelerated Recovery Care of a Patient with Severe Mitral Valve Regurgitation,Mitral Valve Prolapse,Coronary Heart Disease,and Hypertension Undergoing Transesophageal Echocardiography-Guided Mitral Valve Chord Repair System and Artificial Chord Implantation through the Apex of the Heart The patient had a history of coronary heart disease and hypertension,and was diagnosed with mitral valve prolapse and severe mitral regurgitation at admission.According to the comprehensive evaluation of the patient's condition by the cardiac surgery and MDT(Multidisciplinary Team)team of our hospital before operation,the patient had severe degenerative mitral regurgitation.Considering the high risk of surgical valvuloplasty,the treatment plan of transapical mitral valve artificial chordae implantation with mitral chordae repair system under the guidance of esophageal ultrasound was formulated.Following the guidelines for accelerated recovery,a multidisciplinary approach was taken during the surgery to monitor the patient's condition.Preoperative waiting periods,the postoperative critical period,and the stabilization period were considered,and a rehabilitation program that included exercise,nutritional support,health education,and psychological care was developed for the entire perioperative accelerated recovery process.Nutritional support,health education and psychological nursing were throughout the whole process of perioperative enhanced recovery.The patient was implanted with 4 artificial chordae tendineae.Transesophageal echocardiography monitoring showed that the surgical treatment effect was satisfactory,and no complications occurred during the perioperative period.

Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry

AIM: To determine the gastroesophageal refl uxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) f indings [anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)]; to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the TCEUS f indings as a predictor of gastroesophageal refl ux (GER). METHODS: In 45/500 patients, refl uxate was visualized in TCEUS. 38/45 patients underwent esophagogastroduo denoscopy (EGD), 24-h pH monitoring and manometry. RESULTS: The 38 patients were grouped according to 24-h pH monitoring as follows: Group A: GER-positive (n = 20) [Includes Group B: isolated proximal refl ux (PR) (n = 6), Group C: isolated distal reflux (DR) (n = 6), and Group D: both PR/DR (n = 8)]; Group E: no refl ux (n = 13); and Group F: hypersensitive esophagus (HSE) (n = 5). Groups B + D indicated total PR patients (n = 14), Groups E + F refl ux-negatives with HSE (n = 18), and Groups A + F refl ux-positives with HSE (n = 25). When the 38 patients were grouped according to manometry fi ndings, 24 had normal esophageal manometry; 7 had hypotensive and 2 had hypertensive lower esophageal sphincter (LES); and 5 had ineffective esophageal motility disorder (IEM). The ELD measurement was greater in group A + F than group E (P = 0.023, 5.0 ± 1.3 vs 3.9 ± 1.4 mm). In 27/38 patients, there was at least one pathologic acid refl ux and/or pathologic manometry fi nding. The cut-off value for ELD of 4.83 mm had 79% sensitivity and 61% specificity in predicting the PRbetween Groups B + D and E (AUC = 0.775, P = 0.015). CONCLUSION: Visualizing refluxate in TCEUS was useful as a pre-diagnostic tool for estimating GER or manometric pathology in 71.1% of adults in our study, but it was not diagnostic for CE WT.