Rescue Transesophageal Echocardiography Research Articles

Intraoperative pulmonary embolism during general anesthesia diagnosed with transesophageal echocardiography: A case report

Introduction: Acute pulmonary embolism (APE) is a potentially life-threatening condition with significant morbidity and mortality, particularly in the perioperative period. Early detection and intervention are crucial, but common signs and symptoms may not be easily identifiable under general anesthesia. This report presents a case of intraoperative APE in a 43-year-old female undergoing general anesthesia for left patella tendon repair following a ground-level fall. Case Report: During the procedure, the patient experienced an acute pulmonary embolism. Rescue transesophageal echocardiography (TEE) revealed a thrombus in the right main pulmonary artery and signs of right heart strain, including tricuspid regurgitation and right ventricular dilation. The patient was immediately taken to the interventional radiology suite for catheter thrombectomy. Following the procedure, her condition stabilized, and she was discharged with anticoagulation therapy. Conclusion: This case highlights the clinical challenges of diagnosing intraoperative APE in anesthetized patients, where typical symptoms may be obscured. Intraoperative TEE proved crucial in the timely detection of the embolism and enabled life-saving intervention. The importance of utilizing advanced diagnostic tools in managing intraoperative emergencies is underscored. Future research aimed at developing pathophysiologic models and diagnostic flowcharts for intraoperative APE may help improve outcomes in similarly challenging cases.

Application of a simplified transesophageal echocardiography examination sequence in high-risk cardiac surgery

BackgroundIn cardiac surgical procedures, patients carrying high-risk profiles are prone to encompass complicated cardiopulmonary bypass (CPB) separation. Intraoperative transesophageal echocardiography (TEE), a readily available tool, is utilized to detect cardiac structural and functional pathologies as well as to facilitate clinical management of CPB separation, especially in the episodes of hemodynamic compromise. However, the conventional TEE examination, always performed in a liberal fashion without any restriction of view acquisition, is relatively time-consuming; there appear its flaws in the context of critically severe status. We therefore developed the perioperative rescue transesophageal echocardiography (PReTEE), a simplified three-view TEE protocol consisting of midesophageal four chamber, midesophageal left ventricular long axis, and transgastric short axis.MethodsThis is a single-center and randomized controlled trial which will be implemented in Peking Union Medical College Hospital, Beijing, China. A total of 46 TEE scans are schemed to be performed by 6 operators participating in and randomly assigned to either the PReTEE or the conventional TEE group. This study is purposed to investigate whether the efficiency of discriminating leading causes of difficult CPB wean-off can be significantly improved via an abbreviated sequence of TEE views. The primary outcome of interest is the difference between the groups of PReTEE and the conventional TEE in the successful discrimination of etiologies in specified 120 s. Cox proportional hazards model will be further employed to calculate the outcome difference.DiscussionThe estimated results of this trial are oriented at verifying whether a simplified TEE exam sequence can improve the efficiency of etiologies discrimination during CPB separation in cardiac surgery.Trial registrationClinicalTrials.gov NCT05960552. Registered on 6 July 2023.

Reversal of Total Artificial Heart Mechanical Valve Thrombosis Using Catheter-Directed Thrombolysis.

Total artificial heart is associated with increased incidence of thromboembolism, which can prove to be fatal. The presence of four metallic tilting discs increases the chances of thrombus formation and sudden obstruction of the valve in a closed position resulting in severe hemodynamic collapse. Such a condition is conventionally treated by a surgical approach for device change; however, this procedure is extremely high risk and associated with complications and poor outcomes. We describe two total artificial heart patients with sudden obstruction to the filling of the right side due to fixing of the atrioventricular valve in a closed position due to a thrombus. After a quick diagnosis by rescue transesophageal echocardiography, we successfully treated these patients with catheter-directed thrombolysis with minimal adverse outcomes. We propose a carefully weighed application of this approach in hemodynamically unstable patients too tenuous for a timely surgery and with low risk for bleeding.

A Focused Transesophageal Echocardiography Protocol for Intraoperative Management During Orthotopic Liver Transplantation

The value of a simplified, focused intraoperative transesophageal echocardiography (TEE) protocol in patients undergoing liver transplantation (LT) is unknown. We sought to create and assess a 5-view LT TEE examination focused on 5 prespecified common causes of hypotension during LT. Retrospective cohort study. Single-center tertiary academic hospital. All patients undergoing LT with TEE from January 2010 through May 2019. None. A 5-view LT TEE protocol adapted from a published rescue TEE protocol was assessed retrospectively in a cohort of 106 patients. The primary outcome was the frequency with which the protocol would have detected a composite of 5 prespecified causes of hypotension if the TEE exam had been limited to those views. To assess potential influence on intraoperative care, management changes associated with TEE images were extracted from the medical record. The prespecified diagnoses occurred 24 times; the LT TEE protocol would have detected 22 of 24 of these (92%, 95% confidence interval [CI]: 74%-98%). Intraoperative management changes occurred in 15 of 16 patients (94%) with 1 of the prespecified TEE findings, compared with 1 of 27 patients (3.7%) with TEE findings outside those diagnoses (p < 0.0001). In a retrospective cohort study, a simplified LT TEE protocol would have detected 92% of prespecified TEE findings. Management changes occurred in 94% of those patients, while changes rarely occurred in patients with other TEE findings. A focused LT TEE protocol may diagnose critical pathology adequately and guide management during LT when standard monitors are insufficient.

Development of a Rescue Echocardiography Protocol for Noncardiac Surgery Patients.

Intraoperative transesophageal echocardiography (TEE) is a helpful diagnostic tool when hemodynamic compromise is encountered during noncardiac surgery. At our institution, a Rescue Echo Protocol was created to provide a structured means for requesting and performing a rescue TEE. We analyzed our institutional utilization of this service and found that it was used throughout the spectrum of patients' American Society of Anesthesiologists classifications and surgical services. We demonstrated that 72.9% of rescue examinations resulted in a change in management, supporting the use of TEE as a diagnostic tool during hemodynamic compromise.

Rescue transesophageal echocardiography: Approach and future

Rescue transesophageal echocardiography: Approach and future

Perioperative transesophageal echocardiography for non-cardiac surgery.

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. 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. 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.

Cardiovascular Collapse in the Pregnant Patient, Rescue Transesophageal Echocardiography and Open Heart Surgery

ANESTHESIOLOGISTS with a practice in obstetrics must be acutely aware of the differential diagnosis of maternal cardiovascular collapse during pregnancy. The overall risk of maternal death is 6.5 in 100,000 deliveries and typically occurs in the third trimester. Deaths in the first and second trimesters are rare. The most common etiologies include pre-eclampsia (16%), amniotic fluid embolism (AFE) (14%), hemorrhage (12%), cardiac disease (11%), and pulmonary thromboembolism (9%). Less common etiologies include infection, medication error, and ectopic pregnancy. There is great difficulty in distinguishing between these disorders as they may have similar clinical presentations including hypoxia, cardiovascular lability, bleeding, and neurologic manifestations such as mental status changes and seizures. Transesophageal echocardiography (TEE) may help guide the diagnosis and management of cardiopulmonary collapse in pregnant patients. The authors present a case of a 37-year-old female who was admitted for intrauterine fetal demise (IUFD), which was complicated by cardiovascular collapse necessitating cardiac surgery. Consent for this report was obtained from the patient.

Rescue Transesophageal Echocardiography for the Diagnosis and Management of Paradoxical Carbon Dioxide Embolism With Hemodynamic Compromise During Laparoscopic Surgery

Rescue Transesophageal Echocardiography for the Diagnosis and Management of Paradoxical Carbon Dioxide Embolism With Hemodynamic Compromise During Laparoscopic Surgery

Rapid and Rational Echocardiographic-Assisted Management of Cardiogenic Shock After Coronary Artery Bypass Surgery

IN THE EARLY 1980s, when transesophageal echocardiography (TEE) was first used in the operating room, its main application was the assessment of global and regional left ventricular function. 1 Kahn R.A. Intraoperative echocardiography. in: Kaplan J.A. Reich D.L. Kondstadt S.N. Cardiac Anesthesia. (ed 4). WB Saunders, Philadelphia, PA1999: 401-483 Google Scholar Since then, there have been numerous technical advances in TEE, and the number of clinical applications has markedly increased. 1 Kahn R.A. Intraoperative echocardiography. in: Kaplan J.A. Reich D.L. Kondstadt S.N. Cardiac Anesthesia. (ed 4). WB Saunders, Philadelphia, PA1999: 401-483 Google Scholar The American Society of Anesthesiologists has published practice guidelines for the use of perioperative TEE, but the role and effect of TEE outside the cardiac operating room are still poorly explored. 2 Denault A.Y. Couture P. McKenty S. et al. Perioperative use of transesophaegal echocardiography by anesthesiologists Impact in non-cardiac surgery and in the intensive care unit. Can J Anesth. 2002; 49: 287-293 Crossref PubMed Scopus (89) Google Scholar The clinical applications of TEE have been studied in many conditions and gradually applied in the critical care setting. Echocardiography has been applied perioperatively with a limited but focused purpose, to diagnose rapidly developing perioperative hemodynamic collapse. 3 Cahalan M. Rescue transesophageal echocardiography. IARS review course lecture. Anesth Analg. 2004; 98: 10-13 Google Scholar , 4 Augoustides J. Weiss S.J. Pochettino A. Hemodynamic monitoring of the postoperative adult cardiac surgical patient. Semin Thorac Cardiovasc Surg. 2000; 12: 309-315 Abstract Full Text PDF PubMed Scopus (11) Google Scholar , 5 Griffin M.J. Hines R.L. Management of perioperative ventricular dysfunction. J Cardiothorac Vasc Anesth. 2001; 5: 90-106 Abstract Full Text Full Text PDF Scopus (17) Google Scholar

Intraoperative Iatrogenic Acute Pericardial Tamponade: Use of Rescue Transesophageal Echocardiography in a Patient Undergoing Orthotopic Liver Transplantation

t ATROGENIC PENETRATING CARDIAC injuries are uncommon but potentially fatal.1-12 These injuries may contribte to a precipitous decline in cardiac output resulting from apid accumulation of blood in the pericardium. Prompt recogition and immediate pericardial decompression are required to revent mortality. A case of unexplained intraoperative cardioascular collapse after abdominal closure in a patient immeditely after a successful orthotopic liver transplant is presented. escue transesophageal echocardiography (TEE) was used to cutely assess the hemodynamic instability and provide a rapid iagnosis that prevented a fatal outcome.