[The contribution and usefulness of routine intraoperative transesophageal echocardiography in cardiac surgery. An analysis of 130 consecutive cases].

Abstract

PURPOSE:

To assess the value of routine intraoperative transesophageal echocardiography (TEE) in unselected patients (P) undergoing cardiac surgery.

DESIGN:

Routine intraoperative TEE in unselected patients undergoing cardiac surgery and evaluation of its usefulness and contribute to a successful surgery.

PATIENTS:

In-hospital patients from cardiology, cardiac surgery and intensive care departments of a general hospital classified as a reference medical centre in cardiovascular pathology.

MATERIAL AND METHODS:

From February 1994 to May 1994 an intraoperative TEE was routinely performed in patients undergoing cardiac surgery. A total of 130 TEE studies were made corresponding to 128 patients, 69 males and 61 females, with a mean age of 49.4 +/- 12.1 years. Indications for surgery were as following: a) Coronary artery bypass grafting (C.A.B.G.)-39; b) Valvular surgery-76; c) C.A.B.G. and valvular surgery-5; d) Thoracic aorta pathology associated or not to aortic valve surgery and/or coronary arteries re-implantation-6; e) Other-4. TEE performed using either a monoplane, biplane or multiplane probe and the images acquisition was made before thoracotomy and cardiopulmonary bypass (CPB) and after CPB with hemodynamic stabilization.

RESULTS:

Pre CPB imaging yielded unsuspected findings in 11 P (8.5%) that changed the planned surgery in 7 cases (5.4%). Post CPB echo study, which was performed after hemodynamic stabilization, modified the surgical strategy in 13 cases (10.9%) avoiding 1 predetermined surgical procedure (tricuspid ring annuloplasty) and a new surgery in another case, leading to a 3 non-predetermined surgical procedures (by showing significative tricuspid regurgitation), to a further surgery in the same valve in 6 patients (mitral paravalvular leak with significative regurgitation in 1P, another mitral prosthesis dysfunction in 1P, residual mitral valve insufficiency after mitral valve repair in 3 P and aortic prosthesis dysfunction in 1 P), to a intraaortic counterpulsation balloon device in 1 P and to new CPB due to an insufficient extraction of calcified pericardium in one case of constrictive pericarditis. In 23 cases (17.7%) TEE has modified the anesthetic procedure by demonstrating signs of hemodynamic changes before Swan-Ganz catheter, thus prompting changes in the administrations of fluids and either in inotropic or vasodilator agents. In total, intraoperative TEE has changed the surgical and/or anesthetic plan in 43 cases (33.0%). There was no difficulties or complications related to the procedure.

CONCLUSION:

These data indicate that intraoperative TEE is useful in formulating the surgical plan and assessing immediate operative results as well as a guide to anesthetic procedures. Its high rentabillity in modifying the surgical and/or anesthetic plans lead us to believe that it must be used as a routine procedure in patients undergoing cardiac surgery.

• Authors: R C Sousa, M A García-Fernandéz, M Moreno, M Tizón, M Valdeviesos, M Rubio, E Bastida, E Torrecilla, D San Román, J L Délcan
• Journal: Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology (Rev Port Cardiol) Vol. 14 Issue 1 Pg. 15-27 (Jan 1995) ISSN: 0870-2551 [Print] Portugal
• Vernacular Title: Contributo e rentabilidade da ecocardiografia transesofágica intraoperatória de rotina em cirurgia cardíaca. Análise de 130 casos consecutivos.
• PMID: 7695952 (Publication Type: Comparative Study, English Abstract, Journal Article)

Topics

• Adult
• Cardiac Surgical Procedures (methods, statistics & numerical data)
• Diagnostic Tests, Routine
• Echocardiography, Transesophageal (methods, statistics & numerical data)
• Evaluation Studies as Topic
• Female
• Heart Valves (physiopathology)
• Humans
• Male
• Middle Aged
• Monitoring, Intraoperative (methods, statistics & numerical data)
• Spain
• Ventricular Function