Intraoperative Echocardiography Harold G. Jackson II Tulane University Anesthesiology Elective
Dec 18, 2015
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