DR.KHALIFA ASHMEIK,CONSULTA CARDIOLOGIST PRINCE SULTAN CARDIAC CENTER-RIYADH
Intraoperative TEE 1972-Epicardial M-Mode-Mitral commissurotomy TEE started early 80s,Wide spread use-late 1980s 1993-ASE established the council for I.O Echo. 1997-council create a set of guidelines for performing
a comperhensive TEE.
Intraoperative TEE Why done: Assessment of cardiac lesions-better resolution. To ensure the optimal result of cardiovascular
surgery. To minimize the cardiovascular complications during cardiac,noncardiac operations inhigh risk pt.s-wall motion,air bubbles,ao. atheroma Identify the cause-hemodynamic unstability
Intraoperative TEE Who should do it? Cardiologist,anesthesiologist,cardiac surgeon TEE probe insertion-anesth.-he is incharge of pt.s
hemodynamics and airways. If comfortable with performing TEE, can obtain baseline TEE data,then reviewed with Echocardiographer. It depends on level of TEE training Valve ,cong. surgery,complex cases-better be done by Echocardiographer . Expert Anaesthesiologist can do
Intraoperative TEE Implementation: Preop. TEE findings to be discussed with surgeon and
anaesthesiologist. It helps the surgeon to formulate surgical plan It helps anesth. to have a plan for pt. care. Post bypass TEE- to assess the result of surgery To assess Complications of surgery Second pump if inadequate result of surgery 5-10% needed 2nd pump-now much less
Intraoperative TEE Indications: Mitral valve repair-25 % MVR-14% AVR-24% Other valves -12% CABG-8% Others-cong,HOCM,masses,shunts…
Intraoperative TEE Intraoperative monitoring: Neurosurgical procedures-to monitor intracardiac air. Hip arthroplasty-to monitor fat embolism RWMA during surgery- in severe CAD but positive
predictive value is low.
Intraoperative TEE Contraindications: 0.5% of cases Pt. safety is a priority Eso. Tumor,stricture,diverticulum,recent eos. or
gastric surgery. Check mouth for loose teeth Probe inspection for defects,cracks
Intraoperative TEE Complications: Study 7200 pt.s-Harvard-Boston Mortality 0.001% Morbidity 0.2% Upper GIT bleeding 0.03% Eos. Perforation 0.01% Dental inj. 0.03% Failure of probe insertion 0.1%
Intraoerative TEE Impact: Prebypass-new findings 15%-altering surgery 14%. Postbypass:new inform. 6%, alt. surgery 4% Overall impact 18%. Even for CABG,impact was 5%. Cost analysis-shown IOTEE to be a valued adjunct to
cardiovascular surgery.
Intraoperative TEE General principles: Probe blind insertion by displacing mandible ant.-
neck flexion may help If not easy laryngoscope can be used The tranducer should never be forced through a resistance
Intraoperative TEE Machine settings and adjustments: Important for optimizing image quality Higher freq.,better resol. but less penetration. Closer structures-AV-higher frequency Farther structure-apex-lower frequency Depth-structures examined will be centered in the display ,focus moved to area of interest. Adjust overall image gain and dynamic range (compression). Blood black,tissue grey
Intraoperative TEE Machine settings: Adjust TGC-to create a uniform brightness and
contrast throughout the imaging field. Color flow Doppler gain is set to a threshold that just eleminates any background noise. ↓ the size,depth of color sector-will ↑ aliasing vel. and frame rate. ↓ the width of 2-D imaging sector ↑ frame rate.
Intraoperative TEE Manipulation of probe-Terminologies: Pt. is supine in position Imaging plane is directed anteriorly from the eos.
Through the heart. Superior means toward the head,inf. Means toward feet. Post. Toward spine,ant. toward sternum. Rt. and Lt.denotes pt. right &Lt.
Intraoperative TEE Terminologies: Pushing the tip of the probe more distal,called
advancing the transducer,pulling it called withdrawing. Clockwise rotation-called turning to the right Counterclockwise rotation-called turning to the Lt. Flexing the tip ant.- anteflexion Flexing it post.-called retroflexion Angle rotation:From 0- 180 –forward rotation,opposite-called backward rotation
ME 4-chamber view
ME-4 chamber view
ME-4 chamber view
3-D-MV
ME LVOT view-AV view
ME LVOT view-AV LAX
ME 4-chamber view
ME 4-chamber view
ME 4-chamber view
ME commissural view
ME commissural view
ME commissural view
ME LVOT view-AV LAX
ME LVOT view-AV LAX
ME short axis view
ME 4-chamber view
ME 4-chamber view
TG short axis view
UE aortic arch LAX
ME 4-chamber view
ME 4-chamber view
ME LVOT view
ME LVOT view
TG short axis view
TG 2-chamber view
TG 5-chamber view