title: Intraoperative cardiac assessment with transesophageal echocardiography for decision-making in cardiac anesthesia.
abstract: Transesophageal echocardiography is an invaluable hemodynamic monitoring modality. Extended and anatomically based evaluation of cardiac function with transesophageal echocardiography is essential to prompt and accurate decision-making in anesthetic management during cardiac surgery. Fractional shortening and fractional area changes are indices widely used to assess the global systolic performance of the left ventricle. Monitoring regional function using semi-quantitative scoring has been demonstrated to be a more sensitive indicator of myocardial ischemia. Assessment of left ventricular diastolic function should be performed in a systematic way, measuring transmitral flow, pulmonary venous flow, transmitral color M-mode flow propagation velocity, and mitral annulus tissue Doppler imaging. The unique anatomical features of the right ventricle make echocardiographic evaluation complicated and therefore less frequently employed. Right ventricular fractional area change, tricuspid annular plane systolic excursion, maximal systolic tricuspid annular velocity with tissue Doppler imaging, and myocardial performance index are indices successfully incorporated into intraoperative right ventricular assessment. Left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve may develop after cardiac procedures. Transesophageal echocardiography plays a central role in prevention as well as diagnosis of systolic anterior motion. Transesophageal echocardiography is extremely useful not only for detecting and locating intracardiac air, but also for guiding and evaluating the procedures to remove air. Air is likely to persist in the right and left superior pulmonary vein, left ventricular apex, left atrium, right coronary sinus of Valsalva, and ascending aorta. Accurate evaluation of cardiac function depends on performing TEE examination properly and obtaining optimal images.
authors: Department of Anesthesia, Akashi Medical Center, 743-33 Okubo-cho Yagi, Akashi, 674-0063, Japan.
authors: Koichi
authors: K
authors: Akiyama
authors: Shoji
authors: S
authors: Arisawa
authors: Masahiro
authors: M
authors: Ide
authors: Masaaki
authors: M
authors: Iwaya
authors: Yoshiyuki
authors: Y
authors: Naito
mesh_terms: D000758:Anesthesia; D006348:Cardiac Surgical Procedures; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000628:therapy; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007430:Intraoperative Care; D016276:Ventricular Function
references: J Cardiothorac Vasc Anesth. 1996 Apr;10(3):323-8
references: 8725411
references: Anesth Analg. 2001 Feb;92(2):291-8
references: 11159219
references: J Cardiothorac Vasc Anesth. 2000 Aug;14(4):374-7
references: 10972599
references: Ann Thorac Surg. 2011 Jun;91(6):1844-50
references: 21492828
references: Crit Care Med. 2002 Jun;30(6):1214-23
references: 12072671
references: Circulation. 1993 Nov;88(5 Pt 2):II24-9
references: 8222161
references: Echocardiography. 2007 May;24(5):452-6
references: 17456062
references: Circulation. 1996 Feb 15;93(4):712-9
references: 8641000
references: J Am Soc Echocardiogr. 2004 May;17(5):443-7
references: 15122184
references: Anesth Analg. 2011 Sep;113(3):449-72
references: 21813627
references: Br J Anaesth. 2006 Jul;97(1):77-84
references: 16740605
references: Br J Anaesth. 2011 Oct;107(4):519-24
references: 21697182
references: J Am Soc Echocardiogr. 2007 Sep;20(9):1065-72
references: 17566702
references: Am J Cardiol. 1992 Nov 15;70(15):1367-8
references: 1442593
references: Can J Anaesth. 2006 Oct;53(10):1020-9
references: 16987858
references: Heart. 2002 Sep;88(3):244-8
references: 12181215
references: Surgery. 1969 Oct;66(4):655-62
references: 5822753
references: J Thorac Cardiovasc Surg. 2009 Jul;138(1):157-62
references: 19577073
references: Echocardiography. 2010 Feb;27(2):131-8
references: 20380676
references: Anesth Analg. 2009 Feb;108(2):407-21
references: 19151264
references: Ultrasound Med Biol. 1980;6(3):263-9
references: 7414749
references: Anesthesiology. 1993 Mar;78(3):477-85
references: 8457048
references: Cardiovasc Surg. 2000 Jan;8(1):1-9
references: 10661697
references: Am Heart J. 1993 Oct;126(4):956-62
references: 8213455
references: J Am Soc Echocardiogr. 2005 Aug;18(8):779-88
references: 16084328
references: J Am Soc Echocardiogr. 2010 Jul;23(7):685-713; quiz 786-8
references: 20620859
references: Eur Heart J. 2001 Feb;22(4):340-8
references: 11161953
references: Ann Thorac Surg. 1995 Sep;60(3):673-7
references: 7677498
references: Ann Thorac Surg. 2008 Apr;85(4):1310-7
references: 18355517
references: Ann Thorac Surg. 1993 Jun;55(6):1467-71
references: 8512396
references: Eur J Anaesthesiol. 2001 Nov;18(11):713-22
references: 11580777
references: J Thorac Cardiovasc Surg. 1986 Mar;91(3):329-38
references: 3951240
references: Circulation. 2002 Jan 29;105(4):539-42
references: 11815441
references: J Am Soc Echocardiogr. 2002 Aug;15(8):768-76
references: 12174345
references: Anesth Analg. 2002 Dec;95(6):1507-18, table of contents
references: 12456409
references: Anesthesiology. 1998 Apr;88(4):945-54
references: 9579503
references: J Am Coll Cardiol. 1999 Dec;34(7):2096-104
references: 10588230
references: Anesthesiology. 2012 Feb;116(2):362-71
references: 22222471
references: Crit Care. 2010;14(3):R101
references: 20525242