Intraoperative transesophageal echocardiography (TEE)

Intraoperative monitoring with transesophageal echocardiography: indications, risks, and training

There are benefits and risks to the use of TEE. The benefits are derived from the physiologic information that TEE provides, which may not be as readily obtained by any other technique. The risks of TEE are those related to mechanical trauma from the probe, as well as those of an incorrect TEE interpretation by the echocardiographer. Intraoperative TEE is a powerful monitoring and diagnostic tool. Performance of TEE requires special skills. As has been discussed, training guidelines exist. As more clinical studies are published, the indications for intraoperative TEE are likely to expand. Class-I recommendations for intraoperative echocardiography have been listed. The authors have discussed some of the issues involved with each class-I indication. Performance of the TEE is not an end in itself and should not distract the anesthesiologist from the primary goal of patient care. With proper training and experience, the anesthesiologist may learn how to use TEE to improve patient care.

Utilization of intraoperative transesophageal echocardiography during repair of congenital cardiac defects: a survey of North American centers

BACKGROUND

Intraoperative transesophageal echocardiography (TEE) has been increasingly utilized during repair of congenital cardiac defects.

HYPOTHESIS

The aim of this study was to assess the practice of TEE in this setting.

METHODS

A survey was sent to 70 centers in the United States and Canada; replies were obtained from 65 centers (93%). Responses were grouped into four categories: (1) Performance of intraoperative echocardiography, (2) performance practices, (3) equipment and probe issues, (4) billing and reimbursement. Data were available from all responding centers unless specified below.

RESULTS

All responding centers employed intraoperative echocardiography, with 98% employing TEE. All responding centers employed intraoperative echocardiography. The majority of centers (72%) utilized intraoperative echocardiography in all cases or all open cases except atrial septal defects, while the remainder employed it selectively. The average duration of TEE experience at responding centers was 6.1 years. Transesophageal echocardiography was primarily the responsibility of cardiologists, with most centers having individuals meeting published TEE training guidelines. The large majority of centers performed both pre- and postbypass TEE studies. Equipment and probes were widely available. All centers disinfected the TEE probe between studies, but for longer times than recommended.

CONCLUSION

Utilization of intraoperative TEE during surgery for congenital heart disease is widespread; the results of this survey may be useful to individual institutions as they evaluate their utilization of intraoperative echocardiography.