Intraoperative echocardiography (including transesophageal echocardiography, epiaortic ultrasound and epicardial echocardiography) is commonly performed in North American hospitals during cardiac anesthesia. Several authors have reported on the positive impact of intraoperative echocardiography on patients’ outcomes. Transesophageal echocardiography is useful in identifying anatomic and functional abnormalities either before or after cardiopulmonary bypass and helps to make decisions in the care of high-risk and unstable patients. In minimally invasive and robotically assisted surgery, transesophageal echocardiography is essential in order to guide cannulation of venous and arterial vessels for cardiopulmonary bypass and in providing immediate assessment of the quality of the performed repair. Intraoperative echocardiography can also detect complications associated with the performed procedure and can be an excellent hemodynamic monitor in unstable patients. In this paper different scenarios where intraoperative echocardiography is useful are reviewed, some clinical cases are shown to illustrate, and a review of related literature is reported.
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References
1.
Morewood GH, Gallagher ME, Gaughan JP, et al: Current practice patterns for adult perioperative transesophageal echocardiography in the United States. Anesthesiology95(6):1507-1512, 2001.
2.
Stevenson JG: Utilization of intraoperative transesophageal echocardiography during repair of congenital cardiac defects: A survey of North American centers. Clin Cardiol26(3):132-134, 2003.
Kolev N, Brase R, Swanevelder J, et al: The influence of transoesphageal echocardiography on intra- operative decision making. A European multicentre study. European Perioperative TOE Research Group. Anaesthesia53(8):767-773, 1998.
5.
Mishra M, Chauhan R, Sharma KK, et al: Real-time intraoperative transesophageal echocardiography—how useful? Experience of 5,016 cases. J Cardiothorac Vasc Anesth12(6):625-632, 1998.
6.
Thys DM: Practice guidelines for perioperative transesophageal echocardiography. A report by the SCA/ASE task force on transesophageal echocardiography. Anesthesiology84:986-1006, 1996.
7.
Pearlman AS, Gardin JM, Martin RP, et al: Guidelines for physician training in transesophageal echocardiography: Recommendations of the American Society of Echocardiography Committee for Physician training in echocardiography. J Am Soc Echocardiogr5:187-194, 1992.
8.
Shanewise JS, Cheung AT, Aronson S, et al: ASE/SCA Guidelines for performing a comprehensive multiplane transesophageal echocardiography examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in perioperative transesophageal echocardiography. Anest Analg89:870-884, 1999.
9.
Cahalan M, Stewart W, Pearlman A, et al: American Society of Echocardiography and Society of Cardiovascular Anesthesiologists Task Force Guidelines for Training in Perioperative Echocardiography. Anesth Analg94:1384-1388, 2002.
10.
Sharony R, Bizekis CS, Kanchuger M, et al: Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: A case control study. Circulation108(10 Suppl 1):II15-II120, 2003.
11.
Iglesias I, Murkin JM: Beating heart surgery or conventional CABG: Are neurologic outcomes different?Semin Thorac Cardiovasc Surg13(2):158-169, 2001.
12.
John R, Choudhri AF, Weinberg AD, et al: Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting after coronary artery bypass grafting. Ann Thorac Surg69(1):30-35, 2000.
13.
Sylivris S, Calafiore P, Matalanis G, et al: The intraoperative assessment of ascending aortic atheroma: Epiaortic imaging is superior to both transesophageal echocardiography and direct palpation. J Cardiothorac Vasc Anesth11(6):704-707, 1997.
14.
Royse AG, Royse CF, Ajani AE, et al: Reduced neuropsychological dysfunction using epiaortic echocardiography and the exclusive Y graftAnn Thorac Surg69(5):1431-1438, 2000.
15.
Nienaber CA, Spielmann RP, von Kodolitsch Y, et al: Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography. Circulation85:434-437, 1992.
16.
Pepi M, Campodonico J, Galli C, et al: Rapid diagnosis and management of thoracic aortic dissection and intramural haematoma: A prospective study of advantages of multiplane vs. biplane transoesophageal echocardiography. Eur J Echocardiogr1(1):72-79, 2000.
17.
Applebaum RM, Adelman MA, Kanschuger MS, et al: Transesophageal echocardiographic identification of a retrograde dissection of the ascending aorta caused by inadvertent cannulation of the common carotid artery. J Am Soc Echocardiogr10(7):749-751, 1997.
18.
Applebaum RM, Cutler WM, Bhardwaj N, et al: Utility of transesophageal echocardiography during port-access minimally invasive cardiac surgery. Am J Cardiol82(2):183-188, 1998.
19.
Kort S, Applebaum RM, Grossi EA, et al: Minimally invasive aortic valve replacement: echocardiographic and clinical results. Am Heart J142(3):476-481, 2001.
Lambert AS, Miller JP, Merrick SH, et al: Improved evaluation of the location and mechanism of mitral valve regurgitation with a systematic transesophageal echocardiography examination. Anesth Analg88(6):1205-1212, 1999.
22.
Aronson S: Adherence to physician training guidelines for pediatric transesophageal echocardiography affects the outcome of patients undergoing repair of congenital cardiac defects. [Letter]. J Am Soc Echocardiogr12(11):1008-1008, 1999.
23.
Jacka MJ, Cohen MM, To T, et al: The use of and preferences for the transesophageal echocardiogram and pulmonary artery catheter among cardiovascular anesthesiologists. Anesth Analg94(5):1065-1071, 2002.
24.
Harsen RM, Viquerat CE, Matthay MA, et al: Poor correlation between pulmonary arterial wedge pressure and left ventricular end-diastolic volume after coronary artery bypass graft surgery. Anesthesiology64:764-770, 1986.
25.
DiCorte CJ, Latham P, Greilich PE, et al: Esophageal Doppler monitor determinations of cardiac output and preload during cardiac operations. Ann Thorac Surg69:1782-1786, 2000.
26.
Coriat P, Vrillon M, Perel A, et al: A comparison of systolic blood pressure variations and echocardiographic estimates of end-diastolic left ventricular size in patients after aortic surgery. Anesth Analg78:46-53, 1994.
27.
Swenson JD, Bull D, Stringham J: Subjective assessment of left ventricular preload using transesophageal echocardiography: corresponding pulmonary artery occlusion pressures. J Cardiothorac Vasc Anesth15(5):580-583, 2001.
28.
Royse CF, Barrington MJ, Royse AG: Transesophageal echocardiography values for left ventricular end-diastolic area and pulmonary vein and mitral inflow Doppler velocities in patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth14(2):130-132, 2000.
29.
Fontes ML, Bellows W, Ngo L, et al: Assessment of ventricular function in critically ill patients: limitations of pulmonary artery catheterization. Institutions of the McSPI Research Group. J Cardiothorac Vasc Anesth13(5):521-527, 1999.
30.
Couture P, Denault AY, McKenty S, et al: Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery. Can J Anaesth47(1):20-26, 2000.
31.
Savage RM, Lytle BW, Aronson S, et al: Intraoperative echocardiography is indicated in high-risk coronary artery bypass grafting. Ann Thorac Surg64(2):368-373, 1997.
32.
Murkin JM: Attenuation of neurologic injury during cardiac surgery. Ann Thorac Surg72(5):S1838-S1844, 2001.
33.
Eltzschig HK, Kallmeyer IJ, Mihaljevic T, et al: A practical approach to a comprehensive epicardial and epiaortic echocardiographic examination. J Cardiothorac Vasc Anesth17(4):422-429, 2003.
34.
Murkin JM, Menkis A, Adams SJ, et al: Epiaortic scanning significantly decreases intervention-related and total cerebral emboli. Heart Surg Forum6(4):203-204, 2003.
35.
Leacche M, Carrier M, Bouchard D, et al: Improving neurologic outcome in off-pump surgery: the “no touch” technique. Heart Surg Forum6(3):169-175, 2003.
36.
Miller JP, Lambert AS, Shapiro WA, et al: The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologists. Anesth Analg92(5):1103-1110, 2001.
