Transesophageal and contact ultrasound echographic assessments of pulmonary vessels in bilateral lung transplantation

Abstract

Background: Intraoperative transesophageal echocardiographic visualization of the vascular anastomosis of lung grafts can be difficult. The goal of this prospective study was to compare intraoperative transesophageal echocardiography and contact ultrasound.

Methods: Vessel imaging and Doppler analysis obtained before chest closure by both techniques were compared in 18 bilateral lung transplant recipients.

Results: Twenty-four arteries in 36 and 45 pulmonary veins in 72 were recorded using transesophageal echocardiography versus 34 and 60 by contact ultrasound (p = 0.05). Views of the left pulmonary artery (p = 0.04) and of the left superior and inferior pulmonary veins (p = 0.04 and p = 0.02, respectively) were more often obtained with contact ultrasound. Measurements of vessel diameters were similar by both methods except for the left superior vein, which was smaller by the transesophageal approach (p = 0.002). In 1 patient, inferior venous diameters could not be obtained by either method. Nine arterial and 47 venous velocities were recorded by transesophageal echocardiography versus 21 and 33 by contact ultrasound (p = 0.001). Contact ultrasound produced better left pulmonary artery recordings (p = 0.02), whereas transesophageal echocardiography was more effective on venous velocities. Left inferior vein velocity was twofold higher using transesophageal echocardiography (p < 0.001).

Conclusions: These results suggest clinicians should exercise caution when making treatment decisions when using transesophageal echocardiography alone.