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Transösophageale Echokardiographie in der Notfall- und Intensivmedizin

Einsatzgebiet und Durchführung
  • S. Stöbe
  • M. Metze
  • C. Spies
  • A. HagendorffEmail author
Leitthema
  • 307 Downloads

Zusammenfassung

Die transösophageale Echokardiographie (TEE) ist in der Notfall- und Intensivmedizin eine zusätzliche semiinvasive echokardiographische Methode, um potenzielle Verdachtsdiagnosen bei Notfall- und Intensivpatienten bestätigen oder verwerfen zu können. Mittlerweile ist die dreidimensionale (3-D-)TEE-Untersuchung auch im klinischen Ablauf der modernen Notfall- und Intensivmedizin etabliert, da insbesondere Artefakte von Schnittbildphänomenen – u. a. durch Ergänzung simultaner Schnittbild-Cine-Loops und En-face-Darstellungen charakteristischer kardialer Strukturen – sicher abgegrenzt werden können und die diagnostische Aussagekraft dadurch weiter erhöht werden kann. Die wesentlichen Indikationen zu einer Notfall-TEE-Untersuchung sind hämodynamische Instabilität infolge von myokardialen, perikardialen oder valvulären Herzerkrankungen sowie der Verdacht auf Endokarditis oder Aortendissektion.

Schlüsselwörter

Notfallbehandlung Endokarditis  Herzklappenerkrankungen  Myokarderkrankungen Aortendissektion 

Transesophageal echocardiography in emergency and intensive care medicine

Indication and implementation

Abstract

Transesophageal echocardiography (TEE) in emergency and intensive care medicine represents an additional semi-invasive method to confirm or rebut suspected diagnoses in critically ill patients. Three-dimensional (3D)-TEE investigations are established in the clinical workflow of emergency and intensive care units because 3D-TEE investigations permit a differentiation of artifacts due to oblique views by simultaneous documentation of sectional planes and en face views of characteristic cardiac structures. Thus, the level of diagnostic validity can be significantly increased by 3D-TEE investigation. The main indications of TEE investigation in emergency medicine are hemodynamic instability due to myocardial, pericardial or valvular heart diseases as well as suspected endocarditis and aortic dissection.

Keywords

Emergency treatment Endocarditis Valvular heart diseases Myocardial diseases Aortic dissection 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Stoebe, M. Metze, C. Spies und A. Hagendorff geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Agmon Y, Khandheria BK, Meissner I et al (2000) Left atrial appendage flow velocities in subjects with normal left ventricular function. Am J Cardiol 86:769–773CrossRefGoogle Scholar
  2. 2.
    Ahmed MI, McGiffin DC, O’Rourke RA et al (2009) Mitral regurgitation. Curr Probl Cardiol 34(3):93–136CrossRefGoogle Scholar
  3. 3.
    Douglas PS, Khandheria B, Stainback RF et al (2007) ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation. J Am Coll Cardiol 50:187–204CrossRefGoogle Scholar
  4. 4.
    Erbel R, Aboyans V, Boileau C et al (2014) ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 35:2873–2926CrossRefGoogle Scholar
  5. 5.
    Falk V, Baumgartner H, Bax JJ (2017) ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791CrossRefGoogle Scholar
  6. 6.
    Farese G, Tayal B, Stoebe S et al (2019) Regional disparities of left atrial appendage wall contraction in patients with sinus rhythm and atrial fibrillation. J Am Soc Echocardiogr. In pressGoogle Scholar
  7. 7.
    Goldman ME, Pearce LA, Hart RG et al (1999) Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: I. Reduced flow velocity in the left atrial appendage (The Stroke Prevention in Atrial Fibrillation [SPAF-III] study). Am Soc Echocardiogr 12:1080–1087CrossRefGoogle Scholar
  8. 8.
    Habib G, Lancellotti P, Antunes MJ et al (2010) Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 11:202–219CrossRefGoogle Scholar
  9. 9.
    Habib G, Lancellotti P, Antunes MJ et al (2015) ESC Guidelines for management of infectious endocarditis. Eur Heart J 11:202–219Google Scholar
  10. 10.
    Hagendorff A, Stoebe S, Tayal B (2018) A systematic approach to 3D echocardiographic assessment of the aortic root. Glob Cardiol Sci Pract.  https://doi.org/10.21542/gcsp.2018.12 Google Scholar
  11. 11.
    Hahn RT, Abraham T, Adams MS et al (2013) Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 26(9):921–964CrossRefGoogle Scholar
  12. 12.
    Hussain ST, Witten J, Shrestha NK et al (2017) Tricuspid valve endocarditis. Ann Cardiothorac Surg 6:255–261CrossRefGoogle Scholar
  13. 13.
    Incani A, Hair C, Purnell P et al (2013) Staphylococcus aureus bacteraemia: evaluation of the role of transoesophageal echocardiography in identifying clinically unsuspected endocarditis. Eur J Clin Microbiol Infect Dis 32:1003–1008CrossRefGoogle Scholar
  14. 14.
    Iung B, Baron G, Butchart EG et al (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24:1231–1243CrossRefGoogle Scholar
  15. 15.
    Kirchhof P, Benussi S, Kotecha D et al (2016) ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRefGoogle Scholar
  16. 16.
    Lancellotti P, Price S, Edvardsen T et al (2015) The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care 4:3–5CrossRefGoogle Scholar
  17. 17.
    Michels G, Zinke H, Möckel M et al (2017) Empfehlungen zur Ultraschallausbildung in der internistischen Intensiv- und Notfallmedizin: Positionspapier der DGIIN, DEGUM und DGK. Kardiologe 11:285–290CrossRefGoogle Scholar
  18. 18.
    Kortz MRA, Delemarre BJ, van Dantzig JM et al (1993) Left atrial appendage blood flow determined by transesophageal echocardiography in healthy subjects. Am J Cardiol 71:976–981CrossRefGoogle Scholar
  19. 19.
    Muegge A, Daniel WG, Frank G et al (1989) Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol 14:631–638CrossRefGoogle Scholar
  20. 20.
    Neskovic AN, Hagendorff A, Lancellotti P et al (2013) Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations. Eur Heart J Cardiovasc Imaging 14:1–11CrossRefGoogle Scholar
  21. 21.
    Palraj BR, Baddour LM, Hess EP et al (2015) Predicting risk of Endocarditis using a clinical tool (PREDICT): scoring system to guide use of echocardiography in the management of staphylococcus aureus Bacteremia. Clin Infect Dis 61:18–28CrossRefGoogle Scholar
  22. 22.
    Piazza N, de Jaegere P, Schultz C et al (2008) Anatomy of the aortic valvar complex and its implications for trancatheter implantation of the aortic valve. Circ Cardiovasc Interv 1:74–81CrossRefGoogle Scholar
  23. 23.
    Rasmussen RV, Host U, Arpi M et al (2011) Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography. Eur J Echocardiogr 12:414–420CrossRefGoogle Scholar
  24. 24.
    Zamorano JL, Monteagudo M, Mesa D et al (2016) Frequency, mechanism and severity of mitral regurgitation: are there any differences between primary and secondary mitral regurgitation? J Heart Valve Dis 25(6):724–729Google Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik und Poliklinik für KardiologieUniversitätsklinikum LeipzigLeipzigDeutschland

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