Indications for Intraoperative TEE



Indications for Intraoperative TEE


Solomon Aronson1

Daniel M. Thys2


1OUTLINE AUTHOR

2ORIGINAL CHAPTER AUTHOR





▪ KEY POINTS



  • The comprehensive perioperative transesophageal echocardiographic (TEE) exam recommended by the SCA/ASE guidelines consists of 20 views.


  • Develop a consistent, systematic approach to performing the comprehensive exam.


  • Performing a comprehensive TEE exam whenever possible rapidly increases knowledge and skill, provides a baseline for later comparison, and is more likely to detect previously undiagnosed abnormalities.


  • Screen for esophageal disease BEFORE inserting the TEE probe.


  • NEVER apply excessive force when inserting or manipulating the TEE probe.


  • Adjust image depth, overall gain, focus, and frequency to optimize two-dimensional image quality.


  • Determine the location of the TEE transducer in relation to the heart, then the orientation of the imaging as it passes through the heart.


  • The imaging plane can be moved through the structure being examined by advancing and withdrawing the probe, turning (rotating) the probe to left and right, or increasing and decreasing the multiplane angle.


  • The centerline of the image stays the same if the probe is not moved as the multiplane angle is changed.


  • Examine each structure with multiple views.


  • An abbreviated exam of eight views can achieve the basic applications of perioperative TEE more rapidly than the comprehensive.


▪ INDICATIONS FOR INTRAOPERATIVE TEE EXAM



  • In 1996 the ASA/SCA published the first indications for perioperative TEE practice parameter guidelines document, which characterized indications based on supporting evidence at the time.



  • The recommendations were divided into three categories, based on the strength of supporting evidence or expert opinion that intraoperative TEE improves outcome.


  • Category I being supported by the strongest evidence or expert opinion (Table 6-1).


  • Category II is supported by weaker evidence and expert consensus.


  • Category III represents the least evidence or expert support. The lack of evidence is often attributed to lack of relevant studies rather than evidence of the technology’s ineffectiveness, and therefore further research and development would be indicated.


  • The medical indication for intraoperative TEE should be related to the individual patient’s need rather than the disease itself; for example, hemodynamic instability for unknown cause rather than coronary artery disease.


  • In 1997 the AHA/ACC also published guidelines for clinical application of echocardiography and in 2000 these guidelines were updated to include intraoperative TEE indications (Table 6-2).









TABLE 6.1 INDICATIONS FOR PERIOPERATIVE TEE


























Only gold members can continue reading. Log In or Register to continue

Related posts:

  1. Imaging Artifacts and Pitfalls
  2. Optimizing Two-Dimensional Transesophageal Echocardiographic Imaging
  3. Regional Ventricular Function Assessment
  4. Ultrasound for Vascular Cannulation

Stay updated, free articles. Join our Telegram channel

Tags:
May 26, 2016 | Posted by in CARDIOLOGY | Comments Off on Indications for Intraoperative TEE

Full access? Get Clinical Tree

 Get Clinical Tree app for offline access

Category I


Intraoperative evaluation of acute, persistent, and life-threatening hemodynamic disturbances in which ventricular function and its determinants are uncertain and have not responded to treatment


Intraoperative use in valve repair


Intraoperative use in congenital heart surgery for most lesions requiring cardiopulmonary bypass


Intraoperative use in repair of hypertrophic obstructive cardiomyopathy


Intraoperative use for endocarditis when preoperative testing was inadequate or extension of infection to perivalvular tissue is suspected


Preoperative use in unstable patients with suspected thoracic aortic aneurysms, dissection, or disruption who need to be evaluated quickly


Intraoperative assessment of aortic valve function in repair of aortic dissections with possible aortic valve involvement


Intraoperative evaluation of pericardial window procedures


Use in intensive care unit for unstable patients with unexplained hemodynamic disturbances, suspected valve disease, or thromboembolic problems (if other tests or monitoring techniques have not confirmed the diagnosis or if patients are too unstable to undergo other tests)


Intraoperative assessment of repair of cardiac aneurysms


Intraoperative evaluation of removal of cardiac tumors