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Chapter 5 - Point-of-Care Transesophageal Echocardiography

Published online by Cambridge University Press:  28 April 2020

By
Ronald A. Kahn
Edited by
Andrew B. Leibowitz  and
Suzan Uysal
Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
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Summary

Transesophageal echocardiography is an important tool for point of care diagnostic imaging, with minimal complications by trained practitioners. The trans-gastric mid-papillary short axis view allows for assessment of preload, ventricular function, myocardial ischemia, and pericardial effusions. The mid-esophageal views allow for further evaluation of right and left ventricular function, as well as mitral, tricuspid, and aortic valve evaluation. The descending aortic views are used for the evaluation of aortic pathology such as aortic dissections.

Keywords

Transesophageal echocardiographypreloadafterloadcontractilitymyocardial ischemiavalvular regurgitationvalvular stenosisaortic pathologypericardial effusion
Type
Chapter
Information
Modern Monitoring in Anesthesiology and Perioperative Care , pp. 35 - 54
Publisher: Cambridge University Press
Print publication year: 2020

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References

Kahn, RA, Fischer, GW. Transesophageal echocardiography. In: Reich, DL, Kahn, RA, Mittnacht, AN, et al. eds. Monitoring in Anesthesia and Perioperative Care. New York, NY: Cambridge University Press, 2011;105–35.Google Scholar
Urbanowicz, JH, Kernoff, RS, Oppenheim, G, et al. Transesophageal echocardiography and its potential for esophageal damage. Anesthesiology 1990;72:40.CrossRefGoogle ScholarPubMed
Min, JK, Spencer, KT, Furlong, KT, et al. Clinical features of complications from transesophageal echocardiography: a single-center case series of 10,000 consecutive examinations. J Am Soc Echocardiogr 2005;18:925–9.CrossRefGoogle Scholar
Kallmeyer, IJ, Collard, CD, Fox, JA, et al. The safety of intraoperative transesophageal echocardiography: a case series of 7200 cardiac surgical patients. Anesth Analg 2001;92:1126–30.Google Scholar
Piercy, M, McNicol, L, Dinh, DT, Story, DA, Smith, JA. Major complications related to the use of transesophageal echocardiography in cardiac surgery. J Cardiothorac Vasc Anesth 2009;23:62–5.Google Scholar
Ellis, JE, Lichtor, JL, Feinstein, SB, et al. Right heart dysfunction, pulmonary embolism, and paradoxical embolization during liver transplantation. Anesth Analg 1989;68:777.CrossRefGoogle ScholarPubMed
Suriani, RJ, Cutrone, A, Feierman, D, Konstadt, S. Intraoperative transesophageal echocardiography during liver transplantation. J Cardiothorac Vasc Anesth 1996;10:699–707.CrossRefGoogle ScholarPubMed
Reeves, ST, Finley, AC, Skubas, NJ, et al. Council on Perioperative Echocardiography of the American Society of Echocardiography; Society of Cardiovascular Anesthesiologists. Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013;26:443–56.Google Scholar
Lang, RM, Badano, LP, Mor-Avi, V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 2015;28:1–39.CrossRefGoogle ScholarPubMed
Rapaport, E, Rackley, CE, Cohn, LH. Aortic valve disease. In: Schlant, RC, Alexander, RW, O’Rourke, RA, et al. eds. Hurst’s The Heart: Arteries and Veins. New York: McGraw Hill, 1994.Google Scholar
Stoddard, MF, Arce, J, Liddell, NE, et al. Two dimensional transesophageal echocardiographic determination of aortic valve area in adults with aortic stenosis. Am Heart J 1991;122:1415.CrossRefGoogle ScholarPubMed
Otto, C.M., Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol 2006;47:2141–51.CrossRefGoogle ScholarPubMed
Baumgartner, H, Hung, J, Bermejo, J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2017;30(4):372–92.Google Scholar
Lancellotti, P, Tribouilloy, C, Hagendorff, A, et al. Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013;14(7):611–44.Google Scholar
Roberson, WS, Stewart, J, Armstrong, WF, Dillon, JC, Feigenbaum, H. Reverse doming of the anterior mitral leaflet with severe aortic regurgitation. J Am Coll Cardiol 1984;3:431.Google Scholar
Ambrose, JA, Meller, J, Teichholz, LE, Herman, MV. Premature closure of the mitral valve: echocardiographic clue for the diagnosis of aortic dissection. Chest 1978;73:121.CrossRefGoogle ScholarPubMed
Zoghbi, WA, Adams, D, Bonow, RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017;30:303–71.CrossRefGoogle ScholarPubMed
Ranganathan, N, Lam, JHC, Wigle, ED, Silver, MD. Morphology of the human mitral valve: II. The valve leaflets. Circulation 1970;41:459–67.Google Scholar
Perloff, JK, Roberts, WC. The mitral apparatus: functional anatomy of mitral regurgitation. Circulation 1972;46:227–39.Google Scholar
Hammer, WJ, Roberts, WC, deLeon, AC Jr. Mitral stenosis secondary to combined massive mitral annular calcific deposits and small, hypertrophied left ventricles: hemodynamic documentation in four patients. Am J Med 1978;64:371–6.CrossRefGoogle Scholar
Pai, RG, Tarazi, R, Wong, S. Constrictive pericarditis causing extrinsic mitral stenosis and a left heart mass. Clin Cardiol 1996;19:517.Google Scholar
Felner, JM, Martin, RP. The echocardiogram. In: Schlant, RC, Alexander, RW, O’Rourke, RA, et al. eds. Hurst’s The Heart: Arteries and Veins. New York: McGraw Hill, 1994, 375–422.Google Scholar
Roberts, WE. Morphological features of the normal and abnormal mitral valve. Am J Cardiol 1983;51: 1005–28.Google Scholar
Chen, YT, Kan, MN, Chen, JS, et al. Contributing factors to formation of left atrial spontaneous echo contrast in mitral valvular disease. J Ultrasound Med 1990;9:151–5.Google Scholar
Baumgartner, H, Hung, J, Bermejo, J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009;22:1–23.Google Scholar
Feigenbaum, H. Acquired valvular heart disease in Echocardiography, Philadelphia: Lea & Febiger, 1994, pp. 239–349.Google Scholar
Currie, PJ, Seward, JB, Reeder, GS, et al. Continuous-wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: a simultaneous Doppler-catheter correlative study in 100 adult patients. Circulation 1985;71:1162.CrossRefGoogle ScholarPubMed
Ormiston, JA, Shah, PM, Tei, C, Wong, M. Size and motion of the mitral valve annulus in man. Circulation 1981;64:113.Google Scholar
Burwash, IG, Blackmore, GL, Koilpillai, CJ. Usefulness of left atrial and left ventricular chamber sizes as predictors of the severity of mitral regurgitation. Am J Cardiol 1992;15:774.CrossRefGoogle Scholar
Nishimura, RA, Otto, CM, Bonow, RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017;70(2):252–89.CrossRefGoogle Scholar
Anyanwu, AC, Adams, DH. Etiologic classification of degenerative mitral valve disease: Barlow’s disease and fibroelastic deficiency. Semin Thorac Cardiovasc Surg 2007;19:90–6.CrossRefGoogle ScholarPubMed
Mintz, GS, Kotler, MN, Segal, BL, Parry, WR. Two dimensional echocardiographic recognition of ruptured chordae tendineae. Circulation 1978;57:244.CrossRefGoogle ScholarPubMed
Ogawa, S, Mardelli, TJ, Hubbard, FE. The role of cross-sectional echocardiography in the diagnosis of flail mitral leaflet. Clin Cardiol 1978;1:85.Google Scholar
Tribouilloy, CB, Shen, WF, Quere, JP, et al. Assessment of severity of mitral regurgitation by measuring regurgitant jet width at its origin with transesophageal Doppler color flow imaging. Circulation 1992;85:1248–53.Google Scholar
Silver, MD, Lam, JHC, Ranganathan, N, Wigle, ED. Morphology of the human tricuspid valve. Circulation 1971;43:333–48.Google Scholar
Guyer, DE, et al. Comparison of the echocardiographic and hemodynamic diagnosis of rheumatic tricuspid stenosis. J Am Coll Cardiol 1984;3:1135.CrossRefGoogle ScholarPubMed
Lundin, L, Landelius, J, Andrea, B, Oberg, K. Transesophageal echocardiography improves the diagnostic value of cardiac ultrasound in patients with carcinoid heart disease. Br Heart J 1990;64:190–4.Google Scholar
Perez, JE, Ludbrook, PA, Ahumada, GG. Usefulness of Doppler echocardiography in detecting tricuspid valve stenosis. Am J Cardiol 1985;55:601.CrossRefGoogle ScholarPubMed
Tribouilloy, CM, Enriquez-Sarano, M, Bailey, KR, Tajik, AJ, Seward, JB. Quantification of tricuspid regurgitation by measuring the width of the vena contracta with Doppler color flow imaging: a clinical study. J Am Coll Cardiol 2000;36:472–8.Google Scholar
Klein, AL, Abbara, S, Agler, DA, et al. American society of echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2013;26(9):965–1012.Google Scholar
Sagrista-Sauleda, J, Merce, J, Permanyer-Miralda, G, Soler-Soler, J. Clinical clues to the causes of large pericardial effusions. Am J Med 2000;109:95–101.Google Scholar
Berge, KH, Lanier, WL, Reeder, GS. Occult cardiac tamponade detected by transesophageal echocardiography. Mayo Clin Proc 1992;67:667–70.Google Scholar
Gillam, LD, Guyer, DE, Gibson, TC, et al. Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade. Circulation 1983;68:294–301.Google Scholar
Wann, S, Passen, E. Echocardiography in pericardial disease. J Am Soc Echocardiogr 2008;21: 7–13.Google Scholar
Himelman, RB, Kircher, B, Rockey, DC, Schiller, NB. Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol 1988;12:1470–7.Google Scholar
Ballal, RS, Nanda, NC, Gatewood, R, et al. Usefulness of transesophageal echocardiography in assessment of aortic dissection. Circulation 1991;84:1903–14.CrossRefGoogle ScholarPubMed
Simon, P, Owen, AN, Havel, M, et al. Transesophageal echocardiography in the emergency surgical management of patients with aortic dissection. J Thor Card Surg 1992;103:1113–8.Google Scholar
Hiratzka, LF, Bakris, GL, Beckman, JA, et al.; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol 2010–4;55:e27–e129.CrossRefGoogle Scholar
Shiga, T, Wajima, Z, Apfel, CC, et al. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med 2006;166:1350–6.CrossRefGoogle ScholarPubMed
Goldstein, SA, Evangelista, A, Abbara, S, et al. Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2015;28:119–82.Google Scholar

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