Transesophageal Echocardiography In Cardiac Surgery Research Articles

Intraoperative transesophageal echocardiography in cardiac surgery with a focus on mitral valve reconstruction

Intraoperative transesophageal echocardiography in cardiac surgery with a focus on mitral valve reconstruction

Safety of Transesophageal Echocardiography for Cardiac Surgery in Patients with Histories of Bariatric Surgery

Safety of Transesophageal Echocardiography for Cardiac Surgery in Patients with Histories of Bariatric Surgery

Role of Intraoperative Transesophageal Echocardiography in Cardiac Surgery: an Observational Study.

AIM:This study is based on the hypothesis that the routine use of transesophageal echocardiography in cardiac surgery will influence the surgical decision taken by the surgeon intra-operatively in Kasr-Alainy hospitals.METHODS:Patients were examined with intraoperative transesophageal echocardiography (TEE) before and after cardiopulmonary bypass. Complete and comprehensive intraoperative TEE examinations will be performed by TEE certified cardiac anesthesiologists. Data that will be collected from the intraoperative examination and will be compared with preoperative transthoracic echocardiography, and the surgical decision that was taken preoperatively will be revised again with the cardiothoracic surgeon before the start of surgery. Also, TEE will be used again after weaning from bypass for revision and assessment of our decision.RESULTS:We examined the utility of TEE in 100 patients undergoing different types of cardiac procedures in Kasr Al-Ainy hospital. This prospective clinical investigation found that the pre- and post-CPB TEE examinations influenced surgical decision making in 10% of all evaluated patients.CONCLUSION:Intraoperative TEE has the potential to influence clinical decision making for cardiac surgical patients significantly. It is useful in surgical planning, guiding various hemodynamic interventions, and assessing the immediate results of surgery. Thus, IOTEE should be used routinely in all patients undergoing all types of cardiac surgeries.

Multinational Institutional Survey on Patterns of Intraoperative Transesophageal Echocardiography Use in Adult Cardiac Surgery

To assess institutional patterns of perioperative transesophageal echocardiography (TEE) usage. The authors hypothesized that TEE is performed more frequently and comprehensively in academic centers, mainly by anesthesiologists, and barriers to performing TEE are due to inadequate resources. A survey was deployed to selected participants. Collated responses were assessed for demographic patterns in TEE practice, and 2-category comparisons were made with Chi-squared association tests. Web-based survey. Practitioners in cardiovascular anesthesia/surgery in 200 institutions. None. Surveys were completed by respondents representing 200 centers in 27 countries and 1,727 anesthesiologists with a mean annual institutional volume of 924 cases. Most centers were in the USA (53%) and were defined as academic (83%). Anesthesiologists performed (85%) and also read/reported TEEs (78%) in most centers. Three-dimensional TEE is performed routinely at 40% of centers. TEE is used routinely for valve surgery in 95% of institutions compared to 68% for coronary artery bypass graft surgery. Academic institutions assessed diastolic function more often than nonacademic centers (46% v 19%; p = 0.006). The most important reason cited for not using TEE in all cases was insufficient resource availability (47%). These results suggest that TEE is performed more comprehensively in academic centers, mainly by anesthesiologists, and that lack of resources is a significant barrier to routine TEE usage. TEE is used more often for valve surgery than for coronary artery bypass graft surgery, and many centers use 3D TEE. This survey describes international TEE practice patterns and identifies limitations to universal adoption of TEE in cardiac surgery.

127: Benefit of transoesophageal echocardiography in cardiac surgery: change in diagnosis and surgery planned

The value of routine use of transesophageal echocardiography (TOE) in cardiac surgery has been rarely studied in a consecutive series of patients. The aim of this study was to evaluate the contribution of perioperatively TOE in cardiac surgery. This is a prospective study of thirty two consecutive patients undergoing cardiac surgery, in a programmed manner. The data of TOE were compared with preoperative diagnosis retained. In some cases, changing diagnostic led to a modification of the planned intervention. The contributions of TOE were to elucidate of the mechanism of valvular disease, assess its severity, to diagnose morphological, guiding surgery and checking results at the end of the intervention The main types of interventions were: valve replacement or valvuloplasty (51%), CABG (37%), aortic surgery (12%). The diagnosis made preoperatively was modified in 10% of cases (n=21). In 54% of cases, TOE confirmed the diagnosis previously established by transthoracic echocardiography, in 10% of cases the diagnosis made preoperatively was changed, and in 28% of TOE has provided diagnostic and therapeutic solution. The results found for each type of surgical pathology are reported in Table Coronary artery disease Pathology of the mitral valve Pathology of the tricuspid valve Pathology of the aorta Change in diagnosis 3% 20% 11% 16% Change in the intervention planned 1% 13% 9% 16% TOE performed routinely during cardiac surgery may lead to changes in surgery, particularly in the aortic pathology and valvular diseases. In about half of the indications for which review is requested, the supply of TOE is decisive and modifies the treatment instituted. Our study confirms the value of TOE in cardiac surgery, in addition to the indications found in our series of patients, others such as aortic dissection or pulmonary embolism major benefit from the addition of TOE.

Should Cervical and Thoracic Osteophytes Be a Contraindication for Transesophageal Echocardiography in Cardiac Surgery?

TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) has been used in the operating room with increasing frequency since the early 1980s, and its safety has been reported across many centers. The diagnosis of esophageal injury is rare but should be considered in the postoperative setting after cardiac surgery using TEE, with an incidence of one in 1,000 major injuries.1 A case of delayed presentation of esophageal injury in a patient after cardiac surgery is described. The location and shape of the tear suggested the cause to be compression of the esophagus against a thoracic vertebral osteophyte.

Essence of Anesthesia Practice, 3rd ed.

Kaplan's Cardiac Anesthesia has been a highly respected text by the cardiac anesthesia community for >30 years. The new 6th edition focuses on The Echo Era, and it comes at a time when the path of traditional texts and electronic resources are converging. Not surprisingly, this hardcopy edition is accompanied by a full online text, which saves time and provides easy access for tech-savvy anesthesiologists in both academic and private practice environments. This comprehensive textbook, written primarily for more advanced perioperative physicians, is organized into 7 core sections. The 1st section focuses on Preoperative Assessment and Management of the cardiac patient, including risk assessment, cardiovascular imaging, and diagnostics/interventions in the cardiac electrophysiology and catheterization labs. Cardiac physiology and pharmacology, and molecular and genetic medicine as it relates to cardiac anesthesia, are addressed in the 2nd section. A subsection on coronary physiology and atherosclerosis is also included. Monitoring is extensively discussed in the 3rd section with subsections on transesophageal echocardiography (TEE), including its specific role, intraoperative usage, and decision making. The information on TEE has been greatly expanded in comparison with the previous edition of this text. This section also provides in-depth information on electrocardiographic monitoring, as well as central nervous system and coagulation monitoring. Anesthesia and Transesophageal Echocardiography for Cardiac Surgery is the 4th and largest section, and defines the use of echocardiography in cardiothoracic surgical procedures. Although Kaplan's Cardiac Anesthesia does not replace the comprehensive echocardiography books that have been written specially for the anesthesiology community, this 6th edition serves as an information “bridge” between clinical anesthesiology and the practical use of echocardiography, as evidenced by the numerous clinical correlates, figures, and images interspersed throughout the textbook. The 6th section, Extracorporeal Circulation, is masterfully presented with subsections on cardiopulmonary bypass management and organ protection, blood and fluid management, devices and technologies, transfusion medicine and coagulation disorders, and the discontinuation of cardiopulmonary bypass. Logically, the next section of the book is devoted to Postoperative Care and presents the most recent data on postoperative cardiac recovery and outcomes, long-term complications, and central nervous system dysfunction (e.g., postoperative cognitive dysfunction). Subsections on postoperative cardiopulmonary care and pain management are also included. The 7th and final section of the book focuses on Education in Cardiac Anesthesia, which is vital to the continued advancement of the subspecialty. The 3 subsections discuss the “nuts and bolts” of training in cardiothoracic anesthesiology, earning appropriate credentials (e.g., TEE certification), and reducing errors in practice. In comparison with previous editions, the font size is smaller, but overall, the images, tables, and figures are and well labeled and do not “overpower” the text in presentation or content. New information is seamlessly incorporated into the text. For fellows and residents, this approach is especially important and makes this book a valuable resource for enhancing their understanding of cardiothoracic pathophysiology with respect to both cardiac and noncardiac perioperative anesthetic care. For example, those wishing to learn more about pulmonary thromboendarterectomy will be pleasantly surprised to find a wealth of information in text and graphics that pertains to the perioperative management of this challenging patient population. In addition, expert authors thoroughly document their statements in the text with extensive references (e.g., almost 800 in a single chapter alone) to the peer-reviewed literature. The strength of a comprehensive text depends not only upon the up-to-date knowledge of experts, but also the ability of readers to easily find the information they need. In previous editions, readers used the index to locate a topic of interest, assuming that the book was physically nearby when a question arose. Now readers can log onto http://www.expertconsultbook.com and access the entire text, figures/images, and movie clips at any time on virtually any computer with Internet capability, including high-resolution smart phones and tablet devices (e.g., the iPad). The response to readers' queries is focused and presented as a highly organized snapshot of the key information with chapter references. However, the strength of a topic search can vary depending on the syntax of search terms used. For example, the search term “anti-platelet” did not yield results, whereas “antiplatelet” did. On the other hand, hyphenated search terms such as “anti-coagulation” produced the same results as “anticoagulation.” These minor difficulties will no doubt be resolved as users become more familiar with the online version. The new edition of any top-notch medical textbook must be able to link widely accepted knowledge with cutting-edge research and advancements in the field. The 6th edition of Kaplan's Cardiac Anesthesia clearly succeeds in this regard, and its continued expansion is a testament to the growth in this subspecialty. This textbook elegantly presents the up-to-date knowledge of well-recognized researchers and clinicians in the academic community in 1 authoritative text. This new volume is also easily accessible through its high-quality online text and multimedia content. The current emphasis on echocardiography mirrors the ongoing TEE revolution in operating rooms around the world. Although learning TEE does not transform an anesthesiologist into a cardiac anesthesiologist, mastering the core areas of cardiothoracic anesthesiology in this book can help a learner achieve that goal, making this textbook a “must-have” in the library of every cardiothoracic anesthesiologist. Atif Y. Raja, MD Joseph P. Mathew, MD Department of Anesthesiology Duke University Medical Center Durham, North Carolina [email protected]

Intraoperative Monitoring with Transesophageal Echocardiography in Cardiac Surgery

Since its clinical introduction in the 80s, intraoperative transesophageal echocardiography (TEE) has represented one of the greatest advances in modern cardiac anesthesia. It is a semi-invasive technique that allows direct and fast visualization of structural anatomy of the heart and great vessels as well as contributes to hemodynamic and functional evaluation of the cardiovascular system. Thus, it has become an important monitor in aiding the diagnosis of cardiac pathologies and anesthesia and surgical interventions. The objective of this report was to perform a comprehensive review on the use of intraoperative TEE in cardiac surgery. This article reviews some aspects of ultrasound physics, imaging techniques, echocardiographic cuts used more oftenly, indications, and main clinical applications in addition to contraindications and complications. Intraoperative TEE is a safe method of cardiovascular monitoring, which is useful in the formulation of a surgical strategy, orientation of hemodynamic interventions, and immediate assessment of surgical outcomes. Once qualified to use the method, the anesthesiologist expands its role in perioperative medicine, providing clinical information necessary to the anesthetic-surgical procedure in cardiac surgery.

Major Complications Related to the Use of Transesophageal Echocardiography in Cardiac Surgery

The purpose of this study was to determine the incidence of injury associated with transesophageal echocardiography (TEE injuries) in cardiac surgery. Retrospective. University-affiliated hospitals. Four thousand seven hundred eighty-four patients, 89% of all public hospital cardiac surgery patients in Victoria, from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) database undergoing cardiac surgery with TEE between July 1, 2005, and June 30, 2007. Because ASCTS did not record TEE use before July 2005, it was assumed that 89% of an additional 11,719 cardiac surgery patients between July 2001 and June 2005 also had TEE. The authors searched the ASCTS database for cardiac surgery patients who also had endoscopy and/or noncardiac surgery. The files of these patients were screened for possible esophageal or gastric tears or perforations. An expert panel determined likely TEE injuries. There were 6 TEE complications from July 1, 2005, to June 30, 2007 (13/10,000 patients). There were a further 8 TEE complications before June 30, 2005, an extrapolated overall rate of 9/10,000 TEE (95% confidence interval, 5-16/10,000). TEE complications were more frequent in patients more than 70 years old (relative risk [RR], 3.7; p = 0.03) and women (RR, 6.5; p < 0.001). Three patients with TEE injury died (2/10,000). TEE is associated with an incidence of major injuries of about 1 per 1,000 patients, with older women having a much higher risk. TEE use in cardiac surgery should be evaluated in the light of practice guidelines and morbidity and mortality data and not considered routine.

Usefulness of Intraoperative Real‐Time 3D Transesophageal Echocardiography in Cardiac Surgery

Recent advances in three-dimensional (3D) echocardiography allow to obtain real-time 3D transesophageal (RT3DTEE) images intraoperatively. Preoperative transthoracic echocardiography (TTE) revealed: hypertrophic ventricular septum (TTE:19.3 mm), systolic anterior motion (SAM) not causing obstruction and malcoaptation of the anterior mitral valve leaflet (AMVL), and posterior mitral valve leaflet (PMVL) with severe mitral regurgitation. Intraoperative TEE with a x7-2t MATRIX-array transducer (Philips, Andover, MA, USA) with a transducer frequency of x7-2 t mHz, connected to a iE33 (Philips), shows us that the main mechanism and site of regurgitation was an AMVL cleft. We also measured a 24.3-mm thickness of the ventricular septum and analyzing the 3D full volume acquisition revealed that there was no SAM. Intraoperative RT3DTEE permitted comprehensive 3D viewing of the mitral valve revealing the mechanism of mitral valve regurgitation, SAM, and the exact width of the hypertrophic ventricular septum.

Perioperative Diagnostic and Interventional Ultrasound.

Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire. ja5z@virginia.eduPerioperative Diagnostic and Interventional Ultrasound. Edited by Dominic Harmon, M.B., M.Sc., M.D., F.C.A.R.C.S.I., Henry P. Frizelle, M.B., M.D., F.F.A.R.C.S.I., NavParkash S. Sandhu, M.D., Frances Colreavy, M.B., F.F.A.R.C.S.I., and Michael Griffin, M.B., B.Sc., M.D., F.F.A.R.C.S.I. Philadelphia, Saunders Elsevier, 2008. Pages: 212. Price: $149.00.Ultrasound technology is becoming more common in anesthesia practice. Transesophageal echocardiography in cardiac surgery and ultrasound-guided regional anesthesia are two of the more common uses of ultrasound technology in our practice today. Most textbooks on ultrasound use in anesthesia practice are limited to transesophageal echocardiography. Perioperative Diagnostic and Interventional Ultrasound comprehensively illustrates the wide uses of ultrasound technology in our specialty.Structurally, the book is well organized. It essentially covers all aspects of ultrasound technology as it applies to the practice of anesthesiology. There are four main sections to the book. It begins with the basic physical principles of ultrasound that are important to the anesthesiologist. Subsequent sections discuss the use of ultrasound for vascular access, ultrasound in the perioperative and critical care setting, and finally ultrasound use in regional anesthesia.The section on vascular access is sound. It addresses central venous access as well as arterial cannulation and difficult peripheral venous access. It introduces the reader to novel techniques in vascular access not possible without ultrasound, e.g. , transpectoral axillary vein cannulation for central venous access and mid-forearm radial artery cannulation.Ultrasound-guided regional anesthesia is by far the largest section of the book. For each ultrasound-guided nerve block, there is a brief introduction addressing its indications, followed by ultrasound anatomy and block technique. The authors discuss the current evidence supporting the use of ultrasound for each block. They also provide a small but comprehensive bibliography allowing readers to expand their knowledge.The text is accompanied by a DVD that contains more than 150 video clips. Useful aspects of the DVD include demonstrations of vascular cannulation and nerve block techniques. The authors attempt to provide practical aspects of performing ultrasound-guided techniques. However, both the DVD and the text lack emphasis on how to obtain optimal ultrasound images. Those who routinely use ultrasound for peripheral nerve blocks know that simply placing the probe on a body surface is not enough to obtain an optimal image. Pressure, rotation, alignment, and tilting of the probe are frequently used to provide optimal images. These maneuvers allow the ultrasound beam to contact the desired structures in a manner that minimizes scatter. Frequently, small maneuvers such as tilting the transducer in one direction versus another converts a poor image into a great one and vice versa . Readers would be well served by commentary on this issue. As an example, the description of the ultrasound-guided infraclavicular nerve block does not provide a close-up illustration depicting the orientation of the transducer in the infraclavicular region, nor does it provide direction of the next move if the operator does not acquire the desired image.A strength of this text lies in the breadth of illustrations covering ultrasound equipment, patient positioning, and the abundance of ultrasound images. There is, however, a paucity of human gross anatomy. The ultrasound images, although adequate, are not high quality. In addition, most of the patients in the illustrations are covered with blue drapes from head to toe. This hinders appreciation of the orientation of the ultrasound transducer relative to the patient. For example, in the ultrasound-guided femoral nerve block, it is unclear how the transducer is oriented in the groin.One can obviously not provide detailed information on such a vast area of ultrasound practice in anesthesiology in 212 pages. Major textbooks have been written in transesophageal and transthoracic echocardiography. Therefore, a weakness of the text lies in its strength. By covering all aspects of ultrasound technology in anesthesia practice, it lacks depth. The sections on ultrasound physics are brief, lack examples, and are difficult for the novice to grasp.The authors have succeeded in covering most of the common uses of ultrasound in clinical anesthesia practice. They have provided one of the first texts to comprehensively illustrate the wide number of peripheral nerve blocks that can be performed using ultrasound. Despite some of the limitations of the text, given the expanding uses of ultrasound in our practice, Perioperative Diagnostic and Interventional Ultrasound is a textbook that has been overdue.Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire. ja5z@virginia.edu

Delayed repair of esophageal perforation due to transoesophageal echocardiography

Since its introduction into clinical practice in the 1980s, transesophageal echocardiography has become an invaluable tool in cardiac surgery having only a few cases of serious complications reported in the literature. We report a novel case of delayed surgical repair of esophageal perforation due to transesophageal echocardiography in cardiac surgery and reviewed the anecdotal literature.

Gastric Perforation after Transesophageal Echocardiography for Cardiac Surgery: Was There an Indication for the Transesophageal Echocardiogram?

I read with great interest the recent report by Soong et al.1 detailing the delayed presentation of a gastric perforation (lesser curve) most likely due to transesophageal echocardiography (TEE) during coronary revascularization with cardiopulmonary bypass. The patient required surgical repair with an omental patch during laparotomy. Unfortunately, the patient died in the intensive care unit from overwhelming sepsis after 27 days in the hospital. To my knowledge, this is the first reported case of full-thickness gastric perforation on the lesser curve.2The question that this case raises is whether there was an indication for TEE in this case. Let us examine the arguments for and against this invasive procedure whose exceedingly rare complication proved fatal in this index case.The argument against TEE begins with the preoperative echocardiogram that showed no significant valvular disease, and adequate ventricular function with an estimated ejection fraction of 40%. Thus, there was no category I indication (supported by the strongest evidence or expert opinion) as defined by published perioperative TEE guidelines.3 In fact, at our institution, this patient would most likely not qualify for TEE, based on the aforementioned considerations and our conservative approach.However, the argument for TEE begins with the fact that this patient has category II indications (supported by weaker evidence and expert consensus) for TEE, namely a higher risk of perioperative hemodynamic disturbance and ventricular dysfunction. Nationally, there are many centers where TEE is performed in every cardiac surgical case, regardless of level of clinical necessity. Proponents of this approach cite the impact of TEE on therapy in coronary artery surgery, which is at least 10%, many orders of magnitude greater than the risk of upper gastrointestinal injury such as gastric perforation.2,4How do we balance this risk–benefit profile of perioperative TEE in cardiac surgery? Would it help to identify clinical risk factors besides obvious pathology in the upper gastrointestinal tract? Would a case registry allow further analysis of these rare but devastating complications?2There are no easy answers to these questions. Perhaps, the way forward is a case registry, as in the example of perioperative visual loss. It would allow for a more focused examination and analysis of the rare but clinically serious upper gastrointestinal injuries associated with perioperative TEE.

Gastric Perforation after Transesophageal Echocardiography for Cardiac Surgery: Was There an Indication for the Transesophageal Echocardiogram?

Gastric Perforation after Transesophageal Echocardiography for Cardiac Surgery: Was There an Indication for the Transesophageal Echocardiogram?

Delayed Presentation of Gastric Perforation after Transesophageal Echocardiography for Cardiac Surgery

Delayed Presentation of Gastric Perforation after Transesophageal Echocardiography for Cardiac Surgery

Transesophageal echocardiography for cardiac surgery in children

Objective: To evaluate the usefulness of transesophageal echocardiography (TEE) for cardiac surgery in children. Design: Prospective clinical study. Setting: Nagoya City University Hospital. Participants: Children who had cardiac surgery from January 1998 to December 2000 (n = 90). Interventions: TEE was used to the extent permitted by the probe size and the position of the patient during surgery. Measurements and Main Results: TEE monitoring was performed safely without any complications in 88 of the patients. Based on the TEE findings, the anesthesiologists conferred with the surgeon about the efficacy of the surgical procedures in 11 patients (11 of 88 [12.5%]). The cardiac surgeons altered the surgical repair in 2 patients based on the TEE findings (2 of 88 [2.4%]). Conclusion: TEE is a valuable diagnostic tool for monitoring during cardiac surgery in children. The person who performs the TEE should use it carefully after obtaining thorough knowledge of the pathophysiology of pediatric cardiac diseases, their surgical indications, and how specific surgical procedures are done. Copyright 2002, Elsevier Science (USA). All rights reserved.

A retrospective analysis of the costs and benefits related to alterations in cardiac surgery from routine intraoperative transesophageal echocardiography.

We sought to determine how frequently intraoperative transesophageal echocardiography (TEE) altered the planned surgical procedure and to assess the potential cost implications associated with these changes. A retrospective chart review was conducted at one university hospital. Cardiac surgical operative notes from July 1999 through June 2000 were reviewed. We interrogated all adult cardiac surgical records for patients scheduled for repair of coronary artery disease or valvular disease requiring the use of cardiopulmonary bypass. Cancellations based on TEE findings were included in the analysis. Of the 430 patient records reviewed, 24 procedures were ether canceled or changed on the basis of the intraoperative TEE examination (5.6%; 95% confidence interval, 3.6%-8.2%). Six of these cases involved valvular heart disease, and the remaining 18 involved the intraoperative diagnosis and repair of a patent foramen ovale. A cost-benefit analysis based on the 6 valvular diagnoses revealed a saving of $230 per patient. Assuming that unnecessary present or future operations may be avoided by altering the surgical plan on the basis of TEE findings, these preliminary data suggest that routine intraoperative TEE in cardiac surgery is beneficial and cost-effective. A review of 430 adult cardiac surgical records indicates that routine transesophageal echocardiography during cardiac surgery, including coronary artery surgery, is beneficial and cost-effective.

A Retrospective Analysis of the Costs and Benefits Related to Alterations in Cardiac Surgery from Routine Intraoperative Transesophageal Echocardiography

We sought to determine how frequently intraoperative transesophageal echocardiography (TEE) altered the planned surgical procedure and to assess the potential cost implications associated with these changes. A retrospective chart review was conducted at one university hospital. Cardiac surgical operative notes from July 1999 through June 2000 were reviewed. We interrogated all adult cardiac surgical records for patients scheduled for repair of coronary artery disease or valvular disease requiring the use of cardiopulmonary bypass. Cancellations based on TEE findings were included in the analysis. Of the 430 patient records reviewed, 24 procedures were ether canceled or changed on the basis of the intraoperative TEE examination (5.6%; 95% confidence interval, 3.6%–8.2%). Six of these cases involved valvular heart disease, and the remaining 18 involved the intraoperative diagnosis and repair of a patent foramen ovale. A cost-benefit analysis based on the 6 valvular diagnoses revealed a saving of $230 per patient. Assuming that unnecessary present or future operations may be avoided by altering the surgical plan on the basis of TEE findings, these preliminary data suggest that routine intraoperative TEE in cardiac surgery is beneficial and cost-effective.

Transesophageal Echocardiography in Cardiac Surgery

Transesophageal Echocardiography in Cardiac Surgery

Cost-benefit analysis of transesophageal echocardiography in cardiac surgery.

This article evaluates the costs and outcomes associated with TEE during and after cardiac surgery. The costs include the direct and indirect costs--the complications of TEE. The outcomes include the positive consequences or the benefits: money and lives saved. The article uses liberal (high) estimates of the direct and indirect costs of TEE and conservative (low) estimates of the benefits. The exact cost or benefit depends on the number of cases performed. The analysis shows that patients having surgery for congenital heart disease derive the greatest overall benefit: around $600 per case studied. Patients having valvular repair surgery derive the next greatest benefit: around $450 per case studied. In contrast patients having valve replacement have an overall cost of around $150 per case studied. Patients having surgery for coronary artery disease also derive an overall benefit: around $100-$300 per case studied, depending upon assumptions regarding TEE's role in prevention of intraoperative strokes. This analysis indicates that the financial benefits of TEE are substantial and frequently outweigh costs in patients requiring cardiac surgery.