Intraoperative echocardiography

Intraoperative echocardiography

More and more complex surgeries and redo operations make intraoperative transesophageal echocardiography an essential guide for surgical procedures. Cardiac anaesthesiologists have acquired the skill of providing good intraoperative TEE imaging for the surgeons. With the advent of live 3D imaging this is all the more important. In a difficult case rarely cardiac imaging specialist may be called into the theatre. The continuous intraoperative monitoring of left ventricular function is now routine in prolonged non cardiac surgeries like liver transplantation.

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 intraoperative TEE. If it does not improve with phenylephrine, repair is needed. Air emboli in the coronaries can also be detected by TEE.

Valve dehiscence and regurgitation can be detected and corrected prior to final wound closure. Residual systolic anterior movement and mitral regurgitation 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 echocardiography in the operating room

Lighting and space for the machine may be suboptimal 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.