title: The importance of transesophageal echocardiography in heart harvesting for cardiac transplantation.
abstract: OBJECTIVE
  The use of transesophageal echocardiography (TEE) during heart harvesting for transplantation can guide the heart assessment, as harvesting a marginal heart can jeopardize the cardiac transplantation.
  
  
  METHODS
  Male, 30 years old, suffered a car crash that resulted in a severe traumatic brain injury (TBI) that evolved to brain death. The patient was intubated and ventilated with a fraction of inspired oxygen of 0.6, presetting Vt 500 mL, RR 14 bpm, PEEP of 3 mm Hg, 99% O(2) saturation, and normal blood gases. He was also hypovolemic, with urine output of 9,300 mL.day(-1), sodium level of 157 mEq.L(-1), hematocrit of 27%, and BP 90/60 mm Hg maintained by infusion of norepinephrine 0.5 mcg.kg.min(-1). The patient was clinically optimized and evaluated by TEE, which showed normal size cardiac chambers, ejection fraction 66%, anatomical and functional heart valves with no changes, and foramen ovale integrity. Immediately after the confirmation of cardiac viability and clinical stabilization, the patient was taken to the operating room and the harvest began. The ischemic period lasted two hours and the heart was successfully transplanted.
  
  
  CONCLUSIONS
  In most heart transplant services, the cardiac assessment is made subjectively by the surgeon who often does not have the anesthesiologist support to clinically optimize the donor. At the Instituto Nacional de Cardiologia (INC/MS), the anesthesiologist is part of the harvesting team in order to perform intraoperative TEE, evaluating objectively the harvested heart. In doing so, it provides greater chances of heart transplantation success with lower costs for the Brazilian public health system.
authors.affiliation: National CardiologyInstitute/Health Ministry, Brazil. mfonsecasalgado@hotmail.com
authors.forename: Marcello Fonseca
authors.initials: MF
authors.lastname: Salgado Filho
authors.forename: Arthur
authors.initials: A
authors.lastname: Siciliano
authors.forename: Alexandre
authors.initials: A
authors.lastname: Siciliano
authors.forename: Andrey José de
authors.initials: AJ
authors.lastname: Oliveira
authors.forename: Júlia
authors.initials: J
authors.lastname: Salgado
authors.forename: Izabela
authors.initials: I
authors.lastname: Palitot
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D016027:Heart Transplantation; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D020858:Tissue and Organ Harvesting / Q000379:methods*