Hemodynamics derived from transesophageal echocardiography (TEE)

Table 1 lists the parameters that are sought routinely in developing a complete hemodynamic profile by TEE. The arterial blood pressure is an essential starting point. Knowledge of the cardiac output (flow velocity integral) allows placement of the other parameters in context by providing a notion of the status of the general circulation and of the level of pulmonary and systemic vascular resistance. The mitral inflow allows segregation of the diastolic function of the left ventricle into one of three categories: (1) normal, (2) restrictive, or (3) delayed relaxation. Pulmonary vein inflow is complementary to mitral inflow and further confirms the status of the filling pressure. The MR jet is another means of gauging the systemic blood pressure and the filling pressure but is more technically demanding than recording mitral valve and pulmonary valve inflows. Tricuspid regurgitation, also technically demanding, reliably provides peak pulmonary systolic pressure, and PR provides the end-diastolic pulmonary artery pressure. Doppler [table: see text] flow in the great veins is useful in estimating right atrial pressure; this information must be integrated with TR and PR velocities to estimate pulmonary artery pressure. Finally, the motion and curvature direction of the IAS allows identification of the atrium with the higher pressure. Using the dynamic behavior of this structure enables reconstructing of the pressure in one atrium from knowledge of pressure in the other. As the case example shows, using these techniques in a routine fashion enables an accurate, comprehensive, and reliable qualitative assay of hemodynamic status.