title: Role of transesophageal echocardiography in hemodynamically unstable patients.
abstract: OBJECTIVE
  To evaluate the clinical impact of transesophageal echocardiography on subsequent management and outcome in hemodynamically unstable patients with suspected cardiovascular pathologic conditions.
  
  
  METHODS
  We reviewed data on patients with hemodynamic instability (hypotension, shock, or pulmonary edema) who underwent transesophageal echocardiography between December 1987 and May 1994.
  
  
  METHODS
  A total of 127 patients (70 male and 57 female patients with a mean age of 68 years) underwent transesophageal echocardiography at our institution as part of the diagnostic procedures used to evaluate unstable hemodynamics.
  
  
  RESULTS
  No clinically significant complication was encountered during the procedure; transesophageal echocardiographic imaging was inadequate in three patients (2%). Of the 124 patients with adequate images, transesophageal echocardiography disclosed a severe cardiovascular abnormality responsible for the unstable hemodynamics in 65 patients (52%), and 26 patients (21%) underwent urgent pericardiocentesis or a cardiac surgical procedure, primarily based on transesophageal echocardiographic findings.
  
  
  CONCLUSIONS
  Transesophageal echocardiography can be safely performed in hemodynamically unstable patients, it produces a high diagnostic yield, and it provides important information for prompt therapeutic decision making. Therefore, we recommend transesophageal echocardiography as one of the initial diagnostic procedures in critically ill patients suspected of having an underlying cardiovascular disorder.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Sohn
authors.forename: G J
authors.initials: GJ
authors.lastname: Shin
authors.forename: J K
authors.initials: JK
authors.lastname: Oh
authors.forename: A J
authors.initials: AJ
authors.lastname: Tajik
authors.forename: R L
authors.initials: RL
authors.lastname: Click
authors.forename: F A
authors.initials: FA
authors.lastname: Miller
authors.forename: J B
authors.initials: JB
authors.lastname: Seward
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016638:Critical Illness; D017548:Echocardiography, Transesophageal / Q000009:adverse effects / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000000981:diagnostic imaging; D012769:Shock / Q000000981:diagnostic imaging