Transesophageal echocardiography in thoracic anesthesia: pulmonary hypertension and right ventricular function.
OBJECTIVE
Pulmonary hypertension is associated with increased postoperative morbidity and mortality. Early diagnosis and echocardiographic detection of right ventricular (RV) dysfunction are paramount in perioperative management. The goal of this review is to provide an overview of the recent literature on this topic.


RESULTS
Doppler interrogation of pulmonary artery flow may provide an insight into the severity and mechanism of pulmonary hypertension. Established echocardiographic techniques of RV assessment have multiple limitations. Newer echocardiographic technologies (strain and three-dimensional imaging) are promising, but require further validation in the perioperative setting before they are adopted.


CONCLUSIONS
More pulmonary hypertension patients are presenting for noncardiac surgery, creating a challenge for the anesthesiologist. Echocardiographic detection of RV dysfunction can be difficult. Routine use of intraoperative transesophageal echocardiography in major thoracic surgery is not advocated yet, but the development of automated techniques may provide an objective assessment of RV function.
aDepartment of Anaesthesia, St Vincent's Hospital, Sydney, New South Wales, Australia bDepartment of Anaesthesia, Papworth Hospital, Cambridge, UK.
Catherine
C
Ashes
Andrew
A
Roscoe
D000758:Anesthesia / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D016343:Monitoring, Intraoperative; D019616:Thoracic Surgical Procedures / Q000379:methods*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy