Transesophageal echocardiography

Anesthesiologists are increasingly using transesophageal echocardiography in both cardiac and noncardiac cases. In cardiac anesthesia, considerable progress has been made in the evaluation of mitral valvular disease. Transesophageal echocardiography has also become more useful in the hemodynamic evaluation of patients undergoing coronary artery bypass grafting. It is particularly valuable in minimally invasive surgery and in heart surgery to correct congenital defects.     

Intraoperative echocardiography

Intraoperative echocardiography has emerged as a new technique by which the cardiac surgeon can more precisely define the operative anatomy and physiology, immediately evaluate the results, and more accurately monitor left ventricular function in the operating room. This review summarizes the current applications of intraoperative two-dimensional and Doppler echocardiography in both the epicardial and transesophageal forms, and discusses the advantages and possible limitations of these methods in the practice of clinical cardiac surgery.     

Transoesophageal echocardiography

Transesophageal echocardiography has increased the facility of a multidisciplinary approach to patient care and the indications and applications for TOE will continue to develop. The technology has limitations, the equipment is expensive and requires adequate training in order to avoid the potential pitfalls, incorrect or misleading diagnoses which may inevitability lead to inappropriate management decisions. Intraoperative echocardiography is, however, most efficiently employed using the transoesophageal approach. Colour flow Doppler capabilities ensure the assessment of patients in whom standard transthoracic 2D or Doppler echocardiography has significant limitations and it has become the technique of choice in identifying prosthetic valve dysfunction, cardiac sources of embolisation, infective endocarditis and aortic dissection. The introduction of biplane and paediatric probes, continuous wave Doppler, automatic edge detection and its increasing use in the outpatient setting will all ensure that TOE technology will remain at the forefront of cardiac monitoring and diagnosis in the operative and intensive care setting.