Peri-Operative Applications of Transesophageal Echocardiography

  • C. A. Visser
  • O. Kamp
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1997)


Transesophageal echocardiography (TEE) provides a rather new view of the heart. It is one of the latest advances in ultrasound technology with improved capabilities for the diagnosis of cardiovascular disease. Originally, this technique has been developed to image patients in whom transthoracic echocardiograms (EKG) were technically difficult to obtain. TEE has become more and more a routine procedure in the diagnostic field of cardiology. Various structures of the heart are better visualized with TEE than with the traditional transcutaneous approach. Specific conditions and applications include its use in evaluating patients with endocarditis, cardiac emboli and prosthetic valves, especially in the mitral position. New fields of interest are evaluation of the ascending and descending thoracic aorta, and guidance during interventional procedures such as mitral balloon valvuloplasty. No doubt that with smaller probes, congenital heart disease in children is often better evaluated.


Congenital Heart Disease Mitral Regurgitation Left Atrial Transesophageal Echocardiography Residual Shunting 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Simon P, Mohl W (1990) Intra-operative echocardiographic assessment of global and regional myocardial function. Echocardiography 7: 333–341PubMedCrossRefGoogle Scholar
  2. 2.
    Kyo S, Takamoto S, Matsumura M, et al (1987) Immediate and early post-operative evaluation of results of cardiac surgery by transesophageal two-dimensional Doppler echocardiography. Circulation 76 (Suppl V): 114–121Google Scholar
  3. 3.
    Kremer P, Cahalan M, Beaupre P, et al (1985) Intraoperative Überwachung mittels Transoesophagealer Zweidimensionaler Echokardiographie. Anesthesist 34: 111–117Google Scholar
  4. 4.
    Topol EJ, Weiss JL, Guzman PA, et al (1984) Immediate improvement of dysfunctional myocardial segments after coronary revascularization: Detection by intra-operative transesophageal echocardiography. J Am Coll Cardiol 4: 1123–1134PubMedCrossRefGoogle Scholar
  5. 5.
    Ream AK, Fogdall RP (1982) Acute cardiovascular management. Anesthesia and Intensive Care. JB Lippincott Company, Philadelphia, pp 481–549Google Scholar
  6. 6.
    Raby KE, Goldman L, Creager MA, et al (1989) Correlation between peri-operative and major cardiac events after peripheral vascular surgery. N Engl J Med 321: 1296–1300PubMedCrossRefGoogle Scholar
  7. 7.
    Leung IM, O’Kelly BF, Mangano DT, et al (1990) Relationship of regional wall motion abnormalities to hemodynamic indices of myocardial oxygen supply and demand in patients undergoing CABG surgery. Anesthesiology 73: 802–814PubMedCrossRefGoogle Scholar
  8. 8.
    Deanfield JE, Selwyn AP, Chierchia S, et al (1983) Myocardial ischemia during daily life in patients with stable angina: Its relation to symptoms and heart rate changes. Lancet 2: 753–758PubMedCrossRefGoogle Scholar
  9. 9.
    London MJ, Tubau JF, Wong MG, et al (1990) The “natural history” of segmental wall motion abnormalities in patients undergoing non-cardiac surgery. Anesthesiology 73: 644–655PubMedCrossRefGoogle Scholar
  10. 10.
    Deanfield JE, Ribeiro P, Oakley K, et al (1989) Analysis of ST-segment changes in normal subjects: Implications for ambulatory monitoring in angina pectoris. Am J Cardiol 54: 1321–1325CrossRefGoogle Scholar
  11. 11.
    Thomson IR, Cannon JE, Rosenbloom M (1987) Electrocardiographic ST-segment elevation after myocardial perfusion. Anesth Analg 66: 1183–1186PubMedCrossRefGoogle Scholar
  12. 12.
    Slogoff S, Keats AS (1985) Does peri-operative myocardial ischemia lead to post-operative myocardial infarction? Anesthesiology 62: 107–114PubMedCrossRefGoogle Scholar
  13. 13.
    Koolen JJ, Visser CA, Odoom JA, et al (1987) Transesophageal echocardiography during abdominal aortic surgery. In: Visser CA, Kan G, Meltzer RS (eds) Echocardiography in ischemic heart disease. Martinus Nijhoff, BostonGoogle Scholar
  14. 14.
    Visser CA, David GK, Kan G, et al (1986) Two-dimensional echocardiography during percutaneous transluminal coronary angioplasty. Am Heart J 11: 1035–1041CrossRefGoogle Scholar
  15. 15.
    Pandian NG, Kerber RE (1982) Two-dimensional echocardiography in experimental coronary stenosis. I. Sensitivity and specificity in detecting transient myocardial dyskinesis: Comparison with sonomicrometers. Circulation 66: 597–602PubMedCrossRefGoogle Scholar
  16. 16.
    Pandian NG, Kieso RA, Kerber RE (1982) Two-dimensional echocardiography in experimental coronary stenosis. II. Relationship between systolic wall thinning and regional myocardial perfusion in severe coronary stenosis. Circulation 66: 603–611PubMedCrossRefGoogle Scholar
  17. 17.
    Leung JM, O’Kelly B, Browner WS, et al (1989) Prognostic importance of post-bypass regional wall motion abnormalities in patients undergoing coronary artery bypass surgery. Anesthesiology 71: 16–25PubMedCrossRefGoogle Scholar
  18. 18.
    Thomson IR (1989) Peri-operative myocardial ischemia. Can J Anaesth 36: 35–40CrossRefGoogle Scholar
  19. 19.
    Mangano DT, Browner WS, Hollenberg M (1990) Association of peri-operative myocardial ischemia with cardiac morbidity and mortality in men undergoing non-cardiac surgery. N Engl J Med 323: 1781–1788PubMedCrossRefGoogle Scholar
  20. 20.
    Smith JS, Cahalan MK, Benefiel DJ, et al (1985) Intra-operative detection of myocardial ischemia in high risk patients. Electrocardiography versus two-dimensional transesophageal echocardiography. Circulation 72: 1015–1021PubMedCrossRefGoogle Scholar
  21. 21.
    Abel MD, Nishimura RA, Callahan MJ, Rehder K, Ilstrup DM, Tajik AJ (1987) Evaluation of intraoperative transesophageal two-dimensional echocardiography. Anesthesiology 66: 64–68PubMedCrossRefGoogle Scholar
  22. 22.
    Roelandt JR, Thomson IR (1991) The diagnosis of myocardial ischemial during surgery by transesophageal echocardiography. The Thoraxcentre Journal Vol 3 /3Google Scholar
  23. 23.
    Vandenberg BF, Rath L, Stuhlmuller P, et al (1991) Estimation of left ventricular cavity area with a new, on-line automated echocardiographic edge detection system. J Am Coll Cardiol 17: 291A (Abst)Google Scholar
  24. 24.
    Bosch JG, Reiber JHC, van Burken, et al (1988) Automated endocardial contour detection in short-axis 2-D echocardiograms: Methodology and assessment of variability. In: Ripley KL (ed) Proceedings of the I5th international conference on computers in cardiology. Long Beach, CA, pp 137–140Google Scholar
  25. 25.
    Lehmann KG, Lee FA, McKenzie WB, et al (1990) Onset of altered interventricular septal motion during cardiac surgery: Assessment of continuous intra-operative transesophageal echocardiography. Circulation 82: 1325–1334PubMedCrossRefGoogle Scholar
  26. 26.
    Thomson IR, Cannon JE, Rosenbloom M (1987) Electrocardiographic ST-segment elevation after myocardial reperfusion. Anesth Analg 66: 1183–1186PubMedCrossRefGoogle Scholar
  27. 27.
    Beaupre PN, Kremer P, Cahalan MK, et al (1984) Intra-operative detection of changes in left ventricular segmental wall motion by transesophageal two-dimensional echocardiography. Am Heart J 107: 1021–1023PubMedCrossRefGoogle Scholar
  28. 28.
    Zeiher AM, Wollschlaeger HW, Bonzel T, et al (1987) Hierarchy of levels of ischemia-induced impairment of regional left ventricular systolic function in man. Circulation 76: 768–776PubMedCrossRefGoogle Scholar
  29. 29.
    Weyman AE, Franklin TD, Hogan RD, et al (1984) Importance of temporal heterogeneity in assessing the contraction abnormalities associated with acute myocardial ischemia. Circulation 70: 102–122PubMedCrossRefGoogle Scholar
  30. 30.
    Leung JM, O’Kelly B, Browner WS, Tubau MPH, Hollenberg M, Mangano DT (1989) Prognostic importance of post-bypass regional wall motion abnormalities in patients undergoing coronary artery bypass surgery. Anesthesiology 71: 16–25PubMedCrossRefGoogle Scholar
  31. 31.
    Koolen JJ (1987) Left ventricular monitoring by transesophageal echocardiography. Rodopi, Amsterdam (Academic thesis)Google Scholar
  32. 32.
    Koolen JJ, Visser CA, David GK, et al (1990) Transesophageal echocardiographic assessment of systolic and diastolic dysfunction during PTCA. J Am Soc Echo 3: 374–383Google Scholar
  33. 33.
    Rosenthal A, Kawasuji M, Sawa S, Iwa T (1991) Transesophageal echocardiography monitoring during coronary artery bypass surgery. Jpn Circ J 55: 109–116PubMedCrossRefGoogle Scholar
  34. 34.
    Knight AA, Hollenberg M, London MJ, et al (1988) Peri-operative myocardial ischemia: Importance of the pre-operative ischemic pattern. Anesthesiology 68: 681–688PubMedCrossRefGoogle Scholar
  35. 35.
    Smith RC, Leung JM, Mangano DT, et al (1991) Post-operative myocardial ischemia in patients undergoing coronary artery bypass graft surgery. Anesthesiology 74: 464–473PubMedCrossRefGoogle Scholar
  36. 36.
    De Bruyn N, Clements FM, Kisslo JA (1987) Intra-operative transesophageal color flow mapping: Initial experience. Anesth Analg 66: 386–390CrossRefGoogle Scholar
  37. 37.
    Sheik KH, De Bruijn NP, Scott Rankin J, et al (1990) The utility of transesophageal echocardiography and Doppler color flow imaging in patients undergoing cardiac valve surgery. J Am Coll Cardiol 15: 363–372CrossRefGoogle Scholar
  38. 38.
    Stewart WJ, Currie PJ, Lytle BW, et al (1988) The role of intra-operative echocardiography during cardiac valvular surgery. J Am Coll Cardiol 11: 217A (Abst)Google Scholar
  39. 39.
    Czer LSC, Maurer G, Bolger AF, et al (1987) Intra-operative evaluation of mitral regurgitation by Doppler color flow mapping. Circulation 76 (Suppl III): 108–116Google Scholar
  40. 40.
    Carpentier A, Chauvaud S, Fabiani JN, et al (1980) Reconstructive surgery of mitral valve incompetence. Ten year appraisal. J Thoracic Cardiovasc Surg 79: 338–348Google Scholar
  41. 41.
    Goldman ME, Mindich BP, Teichholz LE, et al (1984) Intra-operative contrast echocardiography to evaluate mitral valve operations. J Am Coll Cardiol 4: 1035–1040PubMedCrossRefGoogle Scholar
  42. 42.
    Dahm M, Iversen S, Drexler M, et al (1987) Intra-operative Beurteilung der Rekonstruktion von Atrioventrikularklappen mittels Transesophagealer Echokardiographie. Zeitschr Kardiologie 7612: 779–783Google Scholar
  43. 43.
    Helmcke F, Nanda NC, Hsiung M, et al (1987) Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 75: 175–183PubMedCrossRefGoogle Scholar
  44. 44.
    Klein AL, Obarski TP, Stewart WJ, et al (1991) Transesophageal Doppler echocardiography of pulmonary venous flow: A new marker of mitral regurgitation severity. J Am Coll Cardiol 18: 518–526PubMedCrossRefGoogle Scholar
  45. 45.
    Sutherland G, Roelandt J, Fraser A, Anderson T (1991) TEE in clinical practice. Gower Medical Publishing, LondonGoogle Scholar
  46. 46.
    Cyran SE, Kimball TR, Meyer RA, et al (1989) Efficacy of intra-operative transesophageal echocardiography in children with congenital heart disease. Am J Cardiol 63: 593–598CrossRefGoogle Scholar
  47. 47.
    Mouhiudeen IA, Roberson DA, Silverman NH, et al (1990) Intra-operative echocardiography in infants and children with congenital cardiac shunt lesions: Transesophageal versus epicardial echocardiography. J Am Coll Cardiol 17: 1687–1695CrossRefGoogle Scholar
  48. 48.
    Ritter SB (1990) Pediatric transesophageal color flow imaging 1990: The long and the short of it. Echocardiography 7: 713–725PubMedCrossRefGoogle Scholar
  49. 49.
    Stümper OFW, Elzenga NJ, Hess J, Sutherland GR (1990) Transesophageal echocardiography in children with congenital heart diasease. An initial experience. J Am Coll Cardiol 16: 433–441PubMedCrossRefGoogle Scholar
  50. 50.
    Sutherland GR, Quaegebeur J, van Daele ME, et al (1989) Intra-operative echocardiography in congenital heart disease: An overview. In: Erbel R, Khanderia BK, Brenecke R, et al (eds) Transesophageal echocardiography. Springer Verlag, Heidelberg, pp 306–316CrossRefGoogle Scholar
  51. 51.
    Ungerleider RM (1990) The use of intra-operative echocardiography with Doppler color flow imaging in the repair of congenital heart defects. Echocardiography 7: 289–304PubMedCrossRefGoogle Scholar
  52. 52.
    Dan M, Bonato R, Mazzucco A, et al (1990) Value of transesophageal echocardiography during repair of congenital heart defects. Ann Thoracic Surg 50: 637–643CrossRefGoogle Scholar
  53. 53.
    Perkins-Pearson N, Marshall W, Bedford R (1982) Atrial pressures in the seated position. Anesthesiology 57: 493–497PubMedCrossRefGoogle Scholar
  54. 54.
    Cucchiara RF, Nugent M, Seward JB, Messick JM (1984) Air embolism in upright neurosurgical patients: Detection and localization by two-dimensional transesophageal echocardiography. Anesthesiology 60: 353–355PubMedCrossRefGoogle Scholar
  55. 55.
    Topol EJ, Humphrey LS, Borkon AM, et al (1985) Value of intra-operative left ventricular micro-bubbles detected by TEE in predicting neurological outcome after cardiac operations. Am J Cardiol 56: 773–775PubMedCrossRefGoogle Scholar
  56. 56.
    Glenski JA, Cucchiara RF, Michenfelder JD (1986) Transesophageal echocardiography and transcutaneous Oz and CO, monitoring for detection of venous air embolism. Anesthesiology 64: 541–545PubMedCrossRefGoogle Scholar
  57. 57.
    Heinrich H, Kremer P, Winter H, et al (1985) Transoesophageale Zweidimensionale Echokardiographie bei Hüftendoprothesen. Anaesthesist 34: 118–123PubMedGoogle Scholar
  58. 58.
    Bednarz F, Roewer N (1989) Intra-operativer Nachweis von Luftembolien and Korpukelren Embolien mit Hilfe der Pulsoximetrie and Kapnometrie. Vergleichende Untersuchungen mit der Transoesophagealen Echokardiographie. Anesth Intensivther Notfallmed 24: 20–26CrossRefGoogle Scholar
  59. 59.
    Ulrich C, Burri C, Worsdorfer 0, Heinrich H (1986) Intra-operative transesophageal two-dimensional echocardiography in total hip replacement. Arch Orthop Trauma Surg 105: 274–278PubMedCrossRefGoogle Scholar
  60. 60.
    Hanrath P, Kreis A, Schreuder B, et al (1989) Diagnostic value of transesophageal echocardiography in critically ill patients. In: Erbel R et al (eds) Transesophageal echocardiography a new window to the heart. Springer Verlag, Berlin Heidelberg New York, pp 193–201CrossRefGoogle Scholar
  61. 61.
    Oh JK, Seward JB, Mandheria BK, et al (1990) Transesophageal echocardiography in critically ill patients. Am J Cardiol 66: 1492–1495PubMedCrossRefGoogle Scholar
  62. 62.
    Topol EJ, Humphrey LS, Black TJJ, et al (1983) Characterization of postcardiopulmonary bypass hypotension with intra-operative transesophageal echocardiography. Anesthesiology 59: A2 (Abst)Google Scholar
  63. 63.
    Lappas DG, Powell WJM, Daggett WM (1977) Cardiac dysfunction in the peri-operative period: Pathophysiology, diagnosis and treatment. Anesthesiology 47: 117–137PubMedCrossRefGoogle Scholar
  64. 64.
    Chan KL (1988) Transesophageal echocardiography for assessing cause of hypotension after cardiac surgery. Am J Cardiol 62: 1142–1143PubMedCrossRefGoogle Scholar
  65. 65.
    Kochar GS, Jacobs LE, Kotler MN (1988) Right atrial compression for assessing cause of hypotension after cardiac surgery. Am J Cardiol 62: 1142–1143CrossRefGoogle Scholar
  66. 66.
    Reichert CLA (1991) Peri-operative applications of transesophageal echocardiography. Rodopi, Amsterdam (Academic thesis)Google Scholar
  67. 67.
    Schiller NB, Shah PM, Crawford M, et al (1989) Reccommendations for quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echo 2: 358–368Google Scholar
  68. 68.
    Pennington DG, McBride LR, Kanter KR, et al (1988) Effect of peri-operative myocardial infarction on survival of postcardiotomy patients supported with ventricular assist devices. Circulation 78 (Suppl III): 110–115Google Scholar
  69. 69.
    Pennington DG, Meijavi JP, Swartz MT, et al: The importance of biventricular failure in patients with post-operative cardiogenic shockGoogle Scholar
  70. 70.
    Fisher EA, Goldman ME (1990) Transesophageal echocardiography: A new view to the heart. Ann Intern Med 11: 91–131Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • C. A. Visser
  • O. Kamp

There are no affiliations available

Personalised recommendations