Transesophageal Echocardiography in the noncardiac surgical patient

Role of transesophageal echocardiography in the management of pediatric patients with congenital heart disease

Transesophageal echocardiography (TEE) has become a critical diagnostic and perioperative management tool for patients with congenital heart disease (CHD) undergoing cardiac and noncardiac surgical procedures. This review highlights the role of TEE in routine management of pediatric cardiac patient population with focus on indications, views, applications and technological advances.

Transesophageal echocardiography and noncardiac surgery

The use of transesophageal echocardiography (TEE) for monitoring during cardiac and noncardiac surgery has increased exponentially over the past few decades. TEE has evolved from a diagnostic tool to a monitoring device and a procedural adjunct. The close proximity of the TEE transducer to the heart generates high-quality images of the intracardiac structures and their spatial orientation. The use of TEE in noncardiac and critical care settings is not well studied, and the evidence of the benefits of its use in these settings is lacking. Despite the widespread availability of TEE equipment in US hospitals, less than 30% of anesthesiologists are formally trained in the use of perioperative TEE. In this review, the safety and indications of TEE are reviewed and detailed analysis of the best available evidence in this regard is presented. Landmark trials evaluating the use of TEE and its therapeutic impact in noncardiac surgical setting are critically reviewed. This article details recommendations to familiarize anesthesiologists with TEE technology to exploit it to its fullest potential to achieve better patient monitoring standards and eventually improve outcome. Training of greater numbers of anesthesiologists in TEE is needed to increase awareness of the indications and contraindications. Until relatively inexpensive TEE equipment is available, the initial cost of equipment acquisition remains a significant prohibitive factor limiting its widespread use.

Transesophageal echocardiography-guided placement of internal jugular percutaneous venovenous bypass cannula in orthotopic liver transplantation

Venovenous bypass has improved patient survival and decreased morbidity and mortality in the field of orthotopic liver transplantation. The standard at many transplant centers is the use of the internal jugular percutaneous venovenous bypass cannulae (PVVBC) for venous return to the patient. Placement of these large (18F) PVVBC may lead to several complications and requires confirmation before use. Use of transesophageal echocardiography, an effective and rapid method to guide placement of the PVVBC and minimize potential complications associated with insertion of the device, is described.