Intraoperative Echocardiography Harold G. Jackson IITulane University Anesthesiology Elective

Indications

Chamber Size

Valvular Function

Septal Thickness

Shunts

Masses

Perfusion

Myocardial Ischemia

Global Ventricular Function

Regional Wall Motion abnormalities

Valve Abnormalities

Intracardiac contrast

Venous Paradoxical Air Embolism

ASSESSMENT MONITORING

Contraindications

Esophageal Pathology

Coagulopathy or Heparinization

Left Atrial Myxoma with Embolization

ABSOLUTE RELATIVE

QuickTime™ and aSorenson Video decompressorare needed to see this picture.

Advantage of TEE vs Pulmonary Catheterization

Ventricular Wall motion abnormality detected by TEE is the most sensitive indicator of myocardial ischemia.

Most sensitive modality for detecting intracardiac air embolism.

Only device for monitoring paradoxical air embolism.

American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Recommendations:

TEE should be used for all cardiac or thoracic surgery patients. Including cardiac catheterization when general anesthesia is used.

Functional Mitral RegurgitationbIndicator of acute or chronic ischemia. Marked apical tenting of the mitral leaflets along with reduced leaflet coaptation.

The anterior mitral leaflet has a "dog's leg" shape in systole due to tethering of chordae which attach to the belly of the leaflet.

QuickTime™ and aCinepak decompressor

are needed to see this picture.

QuickTime™ and aCinepak decompressor

are needed to see this picture.

http://pie.med.utoronto.ca/TEE/TEE_content/assets/applications/standardViews/index.htm

TAKE A BETTER LOOK...

Recap: Intraoperative Diagnosis Early Ischemia and Air Embolism

Hypotensive etiology i.e. separation from cardiopulmonary bypass

Adequacy of valve repair and myectomy

Masses (myxoma, thrombus, embolus, vegetation)

Contrast techniques for shunts

References 1. Incidental finding of a large pulmonary valve fibroelastoma: A case report

2. Practice Guidelines for Perioperative Transesophageal Echocardiography:An Updated Report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography*

3. Transesophageal Echocardiography: Intraoperative Uses Anesthesiology Review Chapter 85; Cook M.D.,David J.

4. http://echocardiographer.org/TEE.html

5. http://pie.med.utoronto.ca/TEE/TEE_content/assets/applications/standardViews/index.htm