Skip to main content

Hemodynamic Assessment of the Critically ill Patient Using Transesophageal Echocardiography

  • Chapter
Applied Cardiovascular Physiology

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 28))

Abstract

Transesophageal echocardiography (TEE) has become an established tool to diagnose cardiac structure and function in patients who are critically ill. Mechanical ventilation, along with postoperative dressings and chest tubes may pose significant technical problems for the acquisition of echocardiographic data from the transthoracic approach. TEE can rapidly provide high quality diagnostic information with only minimal risk to the patient. Furthermore, TEE can be performed at the patient’s bedside, without the need for transporting patients who may be hemodynamically unstable to an imaging laboratory, such as the radiology department [1]. This discussion will review the clinical assessment of cardiovascular physiology using transesophageal echocardiography in the intensive care unit setting and introduce recently developed echocardiographic methods to quantify left ventricular (LV) function which may be applied to the intensive care unit setting.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Pearson AC, Castello R, Labovitz AJ (1990) Safety and utility of transesophageal echocardiography in the critically ill patient. Am Heart J 119:1083–1089.

    Article  PubMed  CAS  Google Scholar 

  • Smith MD, MacPhail B, Harrison MR, Lenhoff SJ, DeMaria AN (1992) Value and limitations of transesophageal echocardiography in determination of left ventricular volumes and ejection fraction. J Am Coll Cardiol 19:1213–1222.

    Article  PubMed  CAS  Google Scholar 

  • Clements F, Harpole D, Quill T, Jones R, McCann R (1990) Estimation of left ventricular volume and ejection fraction by two-dimensional transoesophageal echocardiography: Comparison of short-axis imaging and simultaneous radionuclide angiography. Brit J Anaesth 64:331–336.

    Article  PubMed  CAS  Google Scholar 

  • Urbanowitz JH, Shaaban MJ, Cohen NH, Cahalan MK, Botvinick EH, Chatterjee K, Schiller NB, Dae MW, Matthay MA (1990) Comparison of transesophageal echocardiographic and scintigraphic estimates of left ventricular end-diastolic volume index and ejection fraction in patients following coronary artery bypass grafting. Anesthesiology 72:607–612.

    Article  Google Scholar 

  • Cheung AT, Salvino JS, Weiss SJ, Aukburg SJ, Berlin JA (1994) Echocardiographic and hemodynamic indices of left ventricular preload in patients with normal and abnormal ventricular function. Anesthesiology 81:376–387.

    Article  PubMed  CAS  Google Scholar 

  • Nishimura RA, Callahan MJ, Schaff HV, Ilstrup DM, Miller FA, Tajik AJ (1984) Noninvasive measurement of cardiac output by continuous wave Doppler echocardiography: Initial experience and review of the literature. Mayo Clin Proc 59:484–489.

    PubMed  CAS  Google Scholar 

  • Stewart WJ, Jiang L, Mich R, Pandian N, Guerrero JL, Weyman AJ (1985) Variable effects of flow rates through the aortic, pulmonary and mitral valves on valve area inflow velocity: Impact on quantitative Doppler flow calculations. J Am Coll Cardiol 6:653–662.

    Article  PubMed  CAS  Google Scholar 

  • Muhivdeen IA, Kuecherer HF, Lee E, Cahalan MK, Schiller NB (1991) Intraoperative estimation of cardiac output by transesophageal pulsed Doppler echocardiography. Anesthesiology 74:9–14.

    Article  Google Scholar 

  • Gorcsan J, Diana P, Ball BA, Hattler BG (1992) Intraoperative determination of cardiac output by transesophageal continuous wave Doppler. Am Heart J 123:171–176.

    Article  PubMed  Google Scholar 

  • Katz WE, Gasior TA, Quinlan J J, Gorcsan J (1993) Transgastric continuous-wave Doppler to determine cardiac output. Am J Cardiol 71:853–857.

    Article  PubMed  CAS  Google Scholar 

  • Stoddard MF, Prince CR, Ammish N, Goad JL, Vogel RL (1993) Pulsed Doppler transesophageal echocardiographic determination of cardiac output in human beings: Comparison with thermodilution technique. Am Heart J 126:956–962.

    Article  PubMed  CAS  Google Scholar 

  • Darmon PL, Hillel Z, Mogtader A, Mindich B, Thys D (1994) Cardiac output by transesophageal echocardiography using continuous-wave Doppler across the aortic valve. Anesthesiology 80:796–805.

    Article  PubMed  CAS  Google Scholar 

  • Suga H, Sagawa K, Shoukas (1973) Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio. Circ Res 32:314–322.

    PubMed  CAS  Google Scholar 

  • Perez JE, Waggoner AD, Barzilai B, Melton HE, Miller JG, Sobel BE (1992) On-line assessment of ventricular function by automatic boundary detection and ultrasonic backscatter imaging. J Am Coll Cardiol 19:313–320.

    Article  PubMed  CAS  Google Scholar 

  • Vandenberg BF, Rath LS, Stuhlmuller P, Melton HE, Skorton D (1992) Estimation of left ventricular cavity area with an on-line semiautomated echocardiographic edge detection system. Circulation 86:159–166.

    PubMed  CAS  Google Scholar 

  • Appleyard RF, Glantz SA (1990) Two-dimensions describe left ventricular volume change during hemodynamic transients. Am J Physiol 258-.H277–H284.

    PubMed  CAS  Google Scholar 

  • Gorcsan J, Morita S, Mandarino WA, Deneault LG, Kawai A, Kormos RL, Griffith BP, Pinsky MR (1993) Two-dimensional echocardiographic automated border detection accurately reflects changes in left ventricular volume. J Am Soc Echocardiogr 6:482–489.

    PubMed  Google Scholar 

  • Gorcsan J, Lazar JM, Romand J, Pinsky MR (1993) On-line estimation of stroke volume by means of echocardiographic automated border detection in the canine left ventricle. Am Heart J 125:1316–1323.

    Article  PubMed  Google Scholar 

  • Gorcsan J, Gasior TA, Mandarino WA, Deneault LG, Hattler BG, Pinsky MR (1993) On-line estimation of changes in left ventricular stroke volume by transesophageal echocardiographic automated border detection in patients undergoing coronary artery bypass grafting. Am J Cardiol 72:721–727.

    Article  PubMed  Google Scholar 

  • Gorcsan J, Romand JA, Mandarino WA, Deneault LG, Pinsky MR (1994) Assessment of left ventricular performance by on-line pressure-area relations using echocardiographic automated border detection. J Am Coll Cardiol 23:242–252.

    Article  PubMed  Google Scholar 

  • Morrisey RL, Siu SC, Guerrero JL, Newell JB, Weyman AE, Picard MH (1994) Automated assessment of ventricular volume and function by echocardiography: Validation of automated border detection. J Am Soc Echocardiogr 7:107–115.

    Google Scholar 

  • Gorcsan J, Denault A, Mandarino WA, Pinsky MR (1996) Left ventricular pressure-volume relations using transesophageal echocardiographic automated border detection: Comparison with conductance catheter technique. Am Heart J 131:544–552.

    Article  PubMed  Google Scholar 

  • Baan J, Van Der Velde ET (1988) Sensitivity of left ventricular end-systolic pressure-volume relation to type of loading intervention in dogs. Circ Res 62:1247–1258.

    PubMed  CAS  Google Scholar 

  • Katz W, Gasior TA, Reddy SBC, Gorcsan J (1994) Utility and limitations of biplane transesophageal echocardiographic automated border detection for estimation of left ventricular stroke volume and cardiac output. Am Heart J 128:389–396.

    Article  PubMed  CAS  Google Scholar 

  • Gorcsan J, Gasior TA, Mandarino WA, Deneault LG, Hattler BG, Pinsky MR (1990) Assessment of the immediate effects of cardiopulmonary bypass on left ventricular performance by on-line pressure-area relations. Circulation 89:180–190.

    Google Scholar 

  • Stoddard MF, Keedy DL, Longaker RA (1994) Two-dimensional transesophageal echocardiographic characterization of ventricular filling in real time by acoustic quantification: Comparison with pulsed-Doppler echocardiography. J Am Soc Echocardiogr 7:116–131.

    PubMed  CAS  Google Scholar 

  • Glower DD, Spratt, JA, Snow ND, Kabas JS, Davis JW, Olsen CO, Tyson GS, Sabiston DC, Rankin JS (1985) Linearity of the Frank-Starling relationship in the intact heart: the concept of preload recruitable stroke work. Circulation 5:994–1009.

    Article  Google Scholar 

  • Breissblatt WM, Stein KL, Wolfe CJ, et al. (1990) Acute myocardial dysfunction and recovery: A common occurrence after coronary bypass surgery. J Am Coll Cardiol 15:1261–1269.

    Article  Google Scholar 

  • Gorcsan J, Denault A, Gasior TA, Mandarino WA, Kancel MJ, Deneault LG, Hattler BG, Pinsky MR (1994) Rapid estimation of left ventricular contractility from end-systolic relations using echocardiographic automated border detection and femoral arterial pressure. Anesthesiology 81:553–562.

    Article  PubMed  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1997 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Gorcsan, J. (1997). Hemodynamic Assessment of the Critically ill Patient Using Transesophageal Echocardiography. In: Pinsky, M.R. (eds) Applied Cardiovascular Physiology. Update in Intensive Care and Emergency Medicine, vol 28. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60696-0_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-60696-0_15

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-64512-9

  • Online ISBN: 978-3-642-60696-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics