title: Episodic monoplane transesophageal echocardiography impacts postoperative management of the cardiac surgery patient.
abstract: OBJECTIVE
  A new slender, flexible, and miniaturized disposable monoplane transesophageal TEE probe has been approved for episodic hemodynamic transesophageal echocardiographic monitoring. The authors hypothesized that episodic monoplane TEE with a limited examination would help guide the postoperative management of high-risk cardiac surgery patients.
  
  
  METHODS
  The authors analyzed the initial consecutive observational experience with the miniaturized transesophageal echocardiography monitoring system (ClariTEE, ImaCor, Uniondale, New York).
  
  
  METHODS
  Single institution in a university setting.
  
  
  METHODS
  Unstable cardiac surgery patients.
  
  
  METHODS
  The authors assessed fluid responsiveness, echocardiographic data, and concordance among hemodynamic data.
  
  
  RESULTS
  From June 2010 to February 2011, 21 unstable cardiac surgery patients with postoperative instability were identified. Two patients (10%) required reoperation for bleeding and tamponade physiology. Right ventricular dysfunction was diagnosed by episodic TEE monitoring in 7 patients (33%), while hypovolemia was documented in 12 patients (57%). Volume responsiveness was documented in 11 patients. In this observational study, discordance between hemodynamic monitoring and episodic TEE was qualitatively observed in 14 patients (66%).
  
  
  CONCLUSIONS
  The authors demonstrated the ability of episodic monoplane TEE to identify discordance between hemodynamic monitoring to better define clinical scenarios in unstable cardiac surgery patients. For these challenging patients, limited episodic TEE assessment has become a cornerstone of ICU care in this institution.
authors.affiliation: Division of Cardiovascular Surgery, Vanderbilt Heart, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8808, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.forename: William T
authors.initials: WT
authors.lastname: Costello
authors.forename: Frederic T
authors.initials: FT
authors.lastname: Billings
authors.forename: Julian S
authors.initials: JS
authors.lastname: Bick
authors.forename: John G
authors.initials: JG
authors.lastname: Byrne
authors.forename: Rashid M
authors.initials: RM
authors.lastname: Ahmad
authors.forename: Chad E
authors.initials: CE
authors.lastname: Wagner
mesh_terms: D018806:APACHE; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000503:physiopathology; D003422:Critical Care; D016638:Critical Illness; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D020896:Hypovolemia / Q000503:physiopathology; D010490:Pericardial Effusion / Q000000981:diagnostic imaging; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D014662:Vasoconstrictor Agents
keywords: cardiac surgery; hemodynamic monitoring; transesophageal echocardiography