Transesophageal echocardiography (TEE) has become an integral part in helping to diagnose,
manage, and assess interventions in the cardiac operating room. Multiple guidelines
have been created by the American Society of Echocardiography for performing a TEE
examination for different cardiac pathologies. The operating room can provide unique
challenges when performing a TEE examination, which include hemodynamic instability,
time constraints, and use of general anesthesia. The Guideline for the use of TEE
to assist in surgical decision- making in the operating room recently was published
to provide a starting protocol for conducting a TEE examination for different cardiac
surgeries and for using the information obtained to interpret and to communicate findings
to the surgical team. This present narrative review focuses and expands upon the relevant
portions for the cardiac anesthesiologist.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography.J Am Soc Echocardiogr. 1999; 12: 884-900
- Adult intraoperative echocardiography: A comprehensive review of current practice.J Am Soc Echocardiogr. 2020; 33 (735-55.e11)
- Guidelines for the use of transesophageal echocardiography to assist with surgical decision-making in the operating room: A surgery-based approach: From the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons.J Am Soc Echocardiogr. 2020; 33: 692-734
- Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography.Anesthesiology. 2010; 112: 1084-1096
- Role of intraoperative transesophageal echocardiography in cardiac surgery: An observational study. Open Access Maced.J Med Sci. 2019; 7: 2480-2483
- The effect of routine intraoperative transesophageal echocardiography on surgical management.J Cardiothorac Vasc Anesth. 2007; 21: 800-804
- Guidelines for performing a comprehensive transesophageal echocardiographic examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.J Am Soc Echocardiogr. 2013; 26: 921-964
- Value of transesophageal echocardiography (TEE) guidance in minimally invasive mitral valve surgery.Ann Cardiothorac Surg. 2013; 2: 796-802
- Assessment of systematic use of intraoperative transesophageal echocardiography during cardiac surgery in adults: A prospective study of 203 patients.J Cardiothorac Vasc Anesth. 2000; 14: 45-50
- Perioperative echocardiographic assessment of mitral valve regurgitation: A comprehensive review.Eur J Cardiothorac Surg. 2016; 50: 801-812
- Intraoperative evaluation of mitral stenosis by transesophageal echocardiography.Anesth Analg. 2016; 123: 14-20
- Management of mitral stenosis using 2D and 3D echo-Doppler imaging.JACC Cardiovasc Imaging. 2013; 6: 1191-1205
- Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.J Am Soc Echocardiogr. 2009; 22 (quiz 101-2): 1-23
- Measurement of mitral valve area in mitral stenosis: Four echocardiographic methods compared with direct measurement of anatomic orifices.J Am Coll Cardiol. 1996; 28: 1190-1197
- Mitral regurgitation grading in the operating room: A systematic review and meta-analysis comparing preoperative and intraoperative assessments during cardiac surgery.J Cardiothorac Vasc Anesth. 2017; 31: 1681-1691
- Mitral valve repair: An echocardiographic review: Part 1.J Cardiothorac Vasc Anesth. 2015; 29: 156-177
- Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance.J Am Soc Echocardiogr. 2017; 30: 303-371
- Of heights, lengths, and distances.J Am Soc Echocardiogr. 2021; 34: 104
- Predicting systolic anterior motion after mitral valve reconstruction: using intraoperative transoesophageal echocardiography to identify those at greatest risk.Eur J Cardiothorac Surg. 2014; 45 (discussion 137-8): 132-137
- Systolic anterior motion after mitral valve repair: Where do we stand in 2015?.Eur J Cardiothorac Surg. 2015; 48: 344-346
- Direct measurement of multiple vena contracta areas for assessing the severity of mitral regurgitation using 3D TEE.JACC Cardiovasc Imaging. 2012; 5: 669-676
- Quantitation of valve regurgitation severity by three-dimensional vena contracta area is superior to flow convergence method of quantitation on transesophageal echocardiography.Echocardiography. 2017; 34: 992-1001
- Right ventricular function in left heart disease.Semin Cardiothorac Vasc Anesth. 2019; 23: 88-107
- External aortic cross-clamping and endoaortic balloon occlusion in minimally invasive mitral valve surgery.Ann Cardiothorac Surg. 2018; 7: 748-754
- Intraoperative transesophageal echocardiography for surgical repair of mitral regurgitation.J Am Soc Echocardiogr. 2014; 27: 345-366
- Very long-term survival and durability of mitral valve repair for mitral valve prolapse.Circulation. 2001; 104: I1-I7
- Long-term outcome after mitral valve repair: A risk factor analysis.Eur J Cardiothorac Surg. 2007; 32: 301-307
- Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: A report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography.J Am Soc Echocardiogr. 2009; 22 (quiz 1082-4): 975-1014
- A quick guide to paravalvular leak closure.Interv Cardiol. 2015; 10: 112-117
- Para-prosthetic leaks following mitral valve replacement: Case analysis on a 20-year period.Curr Cardiol Rev. 2018; 14: 15-24
- Clinical trial principles and endpoint definitions for paravalvular leaks in surgical prosthesis.Eur Heart J. 2018; 39: 1224-1245
- Transcatheter and surgical management of mitral paravalvular leak: Long-term outcomes.JACC Cardiovasc Interv. 2017; 10: 1946-1956
- Transvalvular mitral regurgitation following mitral valve replacement a diagnostic dilemma.Ann Card Anaesth. 2015; 18: 584-586
- Accurate measurement of left ventricular outflow tract diameter: Comment on the updated recommendations for the echocardiographic assessment of aortic valve stenosis.J Am Soc Echocardiogr. 2017; 30: 1038-1041
- Recommendations on the echocardiographic assessment of aortic valve stenosis: A focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography.J Am Soc Echocardiogr. 2017; 30: 372-392
- Outcome implication of aortic valve area normalized to body size in asymptomatic aortic stenosis.Circ Cardiovasc Imaging. 2016; 9
- Comparison of preoperative and intraoperative assessment of aortic stenosis severity by echocardiography.Br J Anaesth. 2017; 118: 699-704
- Transesophageal echocardiographic evaluation during aortic valve repair surgery.Anesth Analg. 2010; 111: 59-70
- Complications after aortic valve repair and valve-sparing procedures.Ann Cardiothorac Surg. 2013; 2: 130-139
- Mechanisms of recurrent aortic regurgitation after aortic valve repair: Predictive value of intraoperative transesophageal echocardiography.JACC Cardiovasc Imaging. 2009; 2: 931-939
- Aortic valve reimplantation in ascending aortic aneurysm: Risk factors for early valve failure.Ann Thorac Surg. 2002; 73: 29-33
- Preservation of the bicuspid aortic valve.Ann Thorac Surg. 2007; 83 (discussion S785-90): S740-S745
- Systematic echocardiographic assessment of aortic regurgitation-what should the surgeon know for aortic valve repair?.Ann Cardiothorac Surg. 2019; 8: 331-341
- Intraoperative evaluation of paravalvular regurgitation by transesophageal echocardiography.Anesth Analg. 2015; 121: 329-336
- Patient-prosthesis mismatch following aortic valve replacement.Heart. 2019; 105: s28-s33
- Transesophageal echocardiography evaluation of tricuspid and pulmonic valves.Ann Card Anaesth. 2016; 19: S21-S25
- Echocardiographic predictors of tricuspid ring annuloplasty repair failure for functional tricuspid regurgitation.J Cardiothorac Vasc Anesth. 2019; 33: 2624-2633
- 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons.J Am Coll Cardiol. 2011; 58: e123-e210
- Transoesophageal echocardiography during coronary artery bypass procedures: Impact on surgical planning.HSR Proc Intensive Care Cardiovasc Anesth. 2010; 2: 43-49
- Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation.N Engl J Med. 2016; 374: 1932-1941
- The role of transesophageal echocardiography in aortic surgery.Best Pract Res Clin Anaesthesiol. 2016; 30: 317-329
- Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance.J Am Soc Echocardiogr. 2015; 28: 119-182
- The importance of intraoperative transesophageal echocardiography in endovascular repair of thoracic aortic aneurysms.Anesth Analg. 2003; 97: 1566-1572
- Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair.J Vasc Surg. 2012; 55: 1255-1262
- Echocardiography in the management of patients with left ventricular assist devices: Recommendations from the American Society of Echocardiography.J Am Soc Echocardiogr. 2015; 28: 853-909
- Echocardiographic assessment for ventricular assist device placement.J Thorac Dis. 2015; 7: 2139-2150
- Transesophageal echocardiography for impella placement and management.J Cardiothorac Vasc Anesth. 2019; 33: 2663-2668
- Positioning an intraaortic balloon pump using intraoperative transesophageal echocardiogram guidance.Anesth Analg. 2011; 113: 40-43
- Implantation of the syncardia total artificial heart.J Vis Exp. 2014; : 50377
- Echocardiography for adult patients supported with extracorporeal membrane oxygenation.Crit Care. 2015; 19: 326
- Mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy: Implications for concomitant valve procedures.J Am Coll Cardiol. 2016; 68: 1497-1504
- Transesophageal echocardiography in heart and lung transplantation.J Cardiothorac Vasc Anesth. 2019; 33: 1548-1558
- Markers of right ventricular dysfunction in adult cardiac surgical patients.J Cardiothorac Vasc Anesth. 2017; 31: 1570-1574
- Modified tricuspid annular plane systolic excursion using transesophageal echocardiography for assessment of right ventricular function.J Cardiothorac Vasc Anesth. 2016; 30: 122-126
- Modified tricuspid annular plane systolic excursion using transesophageal echocardiography and its utility to predict postoperative course in heart transplantation and left ventricular assist device implantation.J Cardiothorac Vasc Anesth. 2018; 32: 1316-1324
- Intraoperative echocardiography for patients undergoing lung transplantation.Anesth Analg. 2014; 118: 725-730
- TEE for lung transplantation: A case series and discussion of vascular complications.J Cardiothorac Vasc Anesth. 2020; 34: 733-740
- TEE as a monitor during pericardiectomy for constrictive pericarditis.Indian J Thorac Cardiovasc Surg. 2015; 31: 200
- Using mitral 'annulus reversus' to diagnose constrictive pericarditis.Eur J Echocardiogr. 2009; 10: 372-375
- Annulus paradoxus: transmitral flow velocity to mitral annular velocity ratio is inversely proportional to pulmonary capillary wedge pressure in patients with constrictive pericarditis.Circulation. 2001; 104: 976-978
- Transesophageal echocardiography and cardiovascular sources of embolism: Implications for perioperative management.Anesthesiology. 2007; 107: 333-346
- Cardiac tumors: Echo assessment.Echo Res Pract. 2016; 3: R65-R77
Article info
Publication history
Published online: February 07, 2021
Footnotes
S.Y. present address is Mayo Clinic in Arizona, Department of Anesthesiology and Perioperative Medicine, 5777 E. Mayo Blvd, Phoenix AZ 85054.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.