Intra-operative echocardiography

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More and more complex surgeries and redo operations make intra operative trans-esophageal echocardiography an essential guide for surgical procedures.
Transgastric view is good for left ventricular systolic function assessment. Diastolic function can be assessed by Doppler. RV function can be assessed from tricuspid annular movement.
Aortic valve and ascending aorta can be assessed in three chamber view. If more of aorta has to be assessed, the TEE probe has to be pulled back a bit. Atheroma screening of the aorta is useful prior to aortic cannulation. Intimal flap in aortic dissection can be evaluated by TEE.
Assessment of resolution of ischemic MR after CABG can be assessed by intra – operative TEE. If it does not improve with phyenylephrine, repair is needed. Air emboli in the coronaries can also be detected by TEE.
Valve dehisence and regurgitation can be detected and corrected prior to final wound closure. Residual systolic anterior movement (SAM) and mitral regurgitation (MR) can be assessed in septal myectomy for hypertrophic cardiomyopathy.
Assessment of paravalvar leak and adequacy of de-airing is elegantly feasible by intraoperative TEE.
Limitations for the echocardiography in the operating room
Lighting and space for the machine may be subobtimal in the operating room. Electrocautery may interfere with the echo signals. Cardiopulmonary bypass can alter the after load and hence the hemodynamics. Surgical manipulation can cause cardiac arrhythmias and interfere with interpretation of parameters like mitral regurgitation.

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