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Perioperative Transesophageal Echocardiography

  • Anita Sadeghpour
  • Azin Alizadehasl
Chapter

Abstract

This chapter explains the role of perioperative transesophageal echocardiography in the care and treatment of an unstable surgical patient. Although it may encompass a broad range of anatomic imaging, noninvasive monitoring should focus on the cardiac causes of hemodynamic or ventilatory instability—including ventricular size and function, valvular anatomy and function, volume status, pericardial abnormalities, and complications from invasive procedures—as well as the clinical impact or the etiology of pulmonary dysfunction. Indeed, a basic perioperative transesophageal echocardiography examination is not designed to prepare practitioners for the use of the full diagnostic potential of transesophageal echocardiography, but sometimes it is needed to provide an advanced examination with detailed data on issues outside the scope of practice as defined within the related guidelines. We will, therefore, review its rules in detail.

Keywords

Perioperative transesophageal echocardiography Unstable surgical patient Right ventricular function Hypovolemia Air embolism during surgery Pericardial effusion 

Abbreviations

ALPM

Anterolateral papillary muscle

ASA

American society of anesthesiologists

ASC

Ascending

ASD

Atrial septal defect

ASE

American society of echocardiography

AV

Aortic valve

CABG

Coronary artery bypass graft surgery

CHDs

Complex congenital heart diseases

CT

Computed tomography

DESC

Descending

IVC

Inferior vena cava

LAX

Long axis

LE

Lower esophageal

LV

Left ventricular

MRI

Magnetic resonance imaging

PA

Pulmonary artery

PFO

Patent foramen ovale

PPM

Posteromedial papillary muscle

PO-TEE

Perioperative transesophageal echocardiography

PV

Pulmonic valve

RVOT

Right ventricular outflow tract

SAM

Systolic anterior motion

SAX

Short axis

TTE

Transthoracic echocardiography

Supplementary material

Movie 29.1

Left-sided intracavitary air with intramyocardial air as is manifested by apical myocardial echogenicity and brightness. Left: Four-chamber view, Right: Long-axis view (MP4 1979 kb)

Movie 29.2

Left-sided intracavitary air with intramyocardial air as is manifested by apical myocardial echogenicity and brightness. Left: Four-chamber view, Right: Long-axis view (MP4 1978 kb)

Movie 29.3

Intraoperative transesophageal echocardiography images of an adult patient after sinus venosus type atrial septal defect repair. Left and middle panels show a significant turbulent flow and an increased gradient, suggestive of the superior vena cava to the right atrial junction stenosis. Right panel: Gradient and turbulent flow decreased after fluid therapy (MP4 993 kb)

Movie 29.4

Intraoperative transesophageal echocardiography images of an adult patient after sinus venosus type atrial septal defect repair. Left and middle panels show a significant turbulent flow and an increased gradient, suggestive of the superior vena cava to the right atrial junction stenosis. Right panel: Gradient and turbulent flow decreased after fluid therapy (MP4 994 kb)

Movie 29.5

Systolic anterior motion (SAM) of the anterior mitral valve leaflet associated with posterior directed mitral regurgitation (MP4 1964 kb)

Movie 29.6

Systolic anterior motion (SAM) of the anterior mitral valve leaflet associated with posterior directed mitral regurgitation (MP4 988 kb)

Movie 29.7

Fibromuscular sub-aortic valve stenosis (thickness and length of the subvalvular thickening are important because of the systolic anterior motion (SAM) of the anterior mitral valve leaflet and posterior directed mitral regurgitation. These measurements are useful parameters for estimating the extent of the septomymectomy (AVI 21174 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Anita Sadeghpour
    • 1
  • Azin Alizadehasl
    • 2
  1. 1.Professor of CardiologyEchocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical ScienceTehranIran
  2. 2.Associate Professor of Cardiology, Echocardiologist, Echocardiography and Cardiogenetic Research CentersCardio-Oncology Department, Rajaie Cardiovascular Medical and Research CenterTehranIran

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