title: Critical importance of unsuspected findings detected by intraoperative transesophageal echocardiography for decision making during cardiac surgery.
abstract: OBJECTIVE
  To report the frequency of unsuspected pathologies detected by presurgical and/or postsurgical intraoperative transesophageal echocardiography (IOTEE) and its impact on the extent of cardiac surgery and the number of pathologies remaining unoperated.
  
  
  RESULTS
  In a 2-year study period, 469 patients (male/female = 273/196; age 68.0 ± 11.9 years) with presurgical and/or postsurgical IOTEE out of 2,035 patients submitted for cardiac surgery were analyzed retrospectively. Presurgical IOTEE was performed in all patients referred to valve surgery or suspicious valve disease or valve diseases with open surgical decision. Postsurgical IOTEE was performed in all patients after valve surgery. Pathologies relevant for surgery were defined as valve disease of moderate degree or higher or structural disease like shunt lesions. In 464 patients (98.9 %), a total number of 757 IOTEEs were successfully performed including 351 presurgical and 384 postsurgical studies, 1-s presurgical IOTEE, 20-s postsurgical, and one-third postsurgical IOTEE. Surgically relevant unsuspected findings were detected in 33.0 % of presurgical IOTEE leading to alteration of surgery in 27.6 %. Relevant pathologies detected by postsurgical IOTEE were found in 7.8 % as remnant valvular dysfunction of the operated valve and in 12.3 % related to other structures. Relevant pathologies detected by postsurgical IOTEE finally remained unoperated in 21.2 % of patients with only postsurgical IOTEE versus only 10.7 % (p < 0.05) of patients with both presurgical and postsurgical IOTEE.
  
  
  CONCLUSIONS
  We found an alarming high number of unsuspected pathologies by IOTEE causing substantial alterations of surgery. Beyond this, whether patients received presurgical IOTEE or not made a significant difference on the number of pathologies left unoperated.
authors: Department of Cardiology, West German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. thomas.buck@uk-essen.de
authors: Thomas
authors: T
authors: Buck
authors: Kathrin
authors: K
authors: Kortmann
authors: Björn
authors: B
authors: Plicht
authors: Markus
authors: M
authors: Kamler
authors: Konstantinos
authors: K
authors: Tsagakis
authors: Matthias
authors: M
authors: Thielmann
authors: Heinz G
authors: HG
authors: Jakob
authors: Raimund
authors: R
authors: Erbel
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D003661:Decision Support Techniques; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies
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