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Review
. 2018 Apr;65(4):381-398.
doi: 10.1007/s12630-017-1017-7. Epub 2017 Nov 17.

Perioperative transesophageal echocardiography for non-cardiac surgery

Ashraf Fayad  1 , Sasha K Shillcutt  2
Affiliations
Review

Perioperative transesophageal echocardiography for non-cardiac surgery

Ashraf Fayad et al. Can J Anaesth. 2018 Apr.

Abstract
in English, French

Purpose: The use of transesophageal echocardiography (TEE) has evolved to include patients undergoing high-risk non-cardiac procedures and patients with significant cardiac disease undergoing non-cardiac surgery. Implementation of basic TEE education in training programs has increased across a broad spectrum of procedures in the perioperative arena. This paper describes the use of perioperative TEE in non-cardiac surgery and provides an overview of the basic TEE examination.

Principal findings: Perioperative TEE is used to monitor hemodynamic parameters in non-cardiac procedures where there is a high risk of hemodynamic instability. Its use extends to include moderate-risk procedures for patients with significant cardiac diseases such as low ejection fraction, hypertrophic cardiomyopathy, severe valve lesions, or congenital heart disease. Vascular procedures involving the aorta, blunt trauma, and liver transplantation are all examples of procedures that may benefit from TEE. Transesophageal echocardiography examination allows assessment of volume status, ventricular function, diagnosis of gross valvular pathology and pericardial tamponade, as well as close monitoring of cardiac output, response to therapy, and the impact of ongoing surgical manipulation. In patients with unexplained and unexpected hemodynamic instability, "rescue TEE" can be used to help identify the underlying cause.

Conclusions: Perioperative TEE is emerging as a preferred tool to manage hemodynamics in high-risk procedures and in high-risk patients undergoing non-cardiac surgery. A rescue TEE examination protocol is a helpful approach for early identification of the etiology of hemodynamic instability.

Objectif: L’ utilisation de l’échocardiographie transœsophagienne (ETO) a évolué et est aujourd’hui utilisee aupres de patients subissant des interventions non cardiaques á risque élevé ainsi que de patients souffrant de cardiopathie grave subissant une chirurgie non cardiaque. Dans les programmes d’éducation, la mise en œuvre d’une formation de base en ETO a augmenté et permet son utilisation dans plusieurs types d’interventions réalisees en période perioperatoire. Cet article décrit l’utilisation d’ETO perioperatoire en chirurgie non cardiaque et propose un apercu de l’examen d’ETO de base.

Constatations principals: L’ETO périopératoire est utilisée pour monitorer les paramétres hémodynamiques lors d’interventions non cardiaques lorsque le risque d’instabilité hémodynamique est eleve. Son utilisation s’étend pour inclure les interventions á risque modéré pour les patients souffrant d’importantes cardiopathies telles qu’une faible fraction d’éjection, une cardiomyopathie hypertrophique, des lesions valvulaires graves, ou encore une cardiopathie congenitale. Les interventions vasculaires au niveau de I’aorte, les traumatismes contondants et les greffes hépatiques sont quelques exemples d’interventions dans lesquelles l’ETO pourrait être utile. L’examen d’ETO permet non seulement d’évaluer la volémie et la fonction ventriculaire, de poser un diagnostic préliminaire de pathologie valvulaire et de tamponnade péricardique, mais aussi d’executer un monitorage precis du debit cardiaque, de la réponse au traitement, et de l’impact des manipulations chirurgicales en cours. Chez les patients manifestant une instabilité: hemodynamique inexpliquee et inattendue, une « ETO de sauvetage » peut etre utilisee pour aider le medecin a en trouver la cause sous-jacente.

Conclusion: L’ETO périopératoire émerge en tant qu’outil de choix pour prendre en charge l’hémodynamie en cas d’interventions á risque élevé ainsi que les patients présentant des risques élevés et subissant une chirurgie non cardiaque. Un protocole d’examen d’ETO ciblé de sauvetage peut être utile pour identifier rapidement l’étiologie d’une instability; hemodynamique.

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Conflict of interest statement

Conflicts of interest

None declared.

Figures

Fig. 1
Fig. 1
Transesophageal echocardiographic (TEE) probe manipulation and terminology used during image acquisition. (A) Terminology used for the manipulation of the TEE probe. (B) Four standard TEE positions within the esophagus and stomach and the associated imaging planes. Reproduced with permission from the Journal of the American Society of Echocardiography
Fig. 2
Fig. 2
Cross-sectional images of the suggested 16 views (approximate angle is indicated top right) of the transesophageal echocardiography. AMVL = anterior mitral valve leaflet; Ao = Aorta; AV = aortic valve; IAS = intra-atrial septum; IVC = inferior vena cava; L = left coronary cusp; LA = left atrium; LAX = long axis; LPA = left pulmonary artery; LV = left ventricle; ME = mid-esophageal; MPA = main pulmonary artery; MV = mitral valve; N = non-coronary cusp; PM & AL = posteromedial and anterolateral papillary muscles; PMVL = posterior mitral valve leaflet; R = right coronary cusp; RA = right atrium; RPA = right pulmonary artery; RV = right ventricle; SAX = short axis; SVC = superior vena cava; TG = transgastric; TV = tricuspid valve
Fig. 3
Fig. 3
Mid-esophageal ascending aorta transesophageal echocardiographic view shows pulmonary embolism in the right pulmonary artery (arrow). AA = ascending aorta; PA = pulmonary artery
Fig. 4
Fig. 4
Transesophageal echocardiography (TEE) estimation of left-sided cardiac output utilizing pulsed wave (PW) Doppler of the left ventricular outflow tract (LVOT) and LVOT diameter (LVOTd). Left ventricular outflow tract diameter is best measured at the mid-esophageal long-axis view just adjacent to the aortic annulus during systole (A). The deep transgastric (TG) view is then obtained, and the PW cursor is positioned in the LVOT close to the aortic valve (AV) leaflets (B). The velocity time integral (VTI) is traced and the stroke volume (SV) is obtained (C). Heart rate (HR) is shown and cardiac output (CO) is calculated
Fig. 5
Fig. 5
A mid-esophageal five-chamber animation showing the left ventricular outflow tract (LVOT) in a normal heart (A) compared with a patient with dynamic LVOT obstruction (B). The obstruction is caused by systolic anterior motion of the anterior leaflet of the mitral valve. Ao = aorta; LA = left atrium; LV = left ventricle; MR = mitral regurgitation; 1 = anterior leaflet; 2 = posterior leaflet
Fig. 6
Fig. 6
Transesophageal echocardiographic view showing left pleural effusion. Notice the location of the effusion in relation to the descending aorta
Fig. 7
Fig. 7
Transgastric mid-papillary view in a patient with pericardial effusion (arrow)
Fig. 8
Fig. 8
Recommended approach and views for rescue transesophageal echocardiography (TEE) exam., LA = left atrium; LAX = long axis; ME = mid-esophageal; PI = pulmonary insufficiency; RA = right atrium; Rt = right; RV = right ventricle; RWMA = regional wall motion abnormality; TG = transgastric; TR = tricuspid regurgitation; 4/5 = four & five chamber
See this image and copyright information in PMC

References

    1. Oka Y. The evolution of intraoperative transesophageal echocardiography. Mt Sinai J Med 2002; 69: 18–20. - PubMed
    1. Suriani RJ, Neustein S, Shore-Lesserson L, Konstadt S. Intraoperative transesophageal echocardiography during noncardiac surgery. J Cardiothorac Vasc Anesth 1998; 12: 274–80. - PubMed
    1. Markin NW, Gmelch BS, Griffee MJ, Holmberg TJ, Morgan DE, Zimmerman JM. A review of 364 perioperative rescue echocardiograms: findings of an anesthesiologist-staffed perioperative echocardiography service. J Cardiothorac Vasc Anesth 2015; 29: 82–8. - PubMed
    1. Shillcutt SK, Markin NW, Montzingo CR, Brakke TR. Use of rapid ‘‘rescue’’ perioperative echocardiography to improve outcomes after hemodynamic instability in noncardiac surgical patients. J Cardiothorac Vasc Anesth 2012; 26: 362–70. - PubMed
    1. Mahmood F, Christie A, Matyal R. Transesophageal echocardiography and noncardiac surgery. Semin Cardiothorac Vasc Anesth 2008; 12: 265–89. - PubMed

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