[Intraoperative application of transesophageal echocardiography]

Transesophageal echocardiography (TEE) has become a routine monitor in the operating room for cardiac surgery because it provides instantaneous and continuous assessment of cardiac function and anatomy. TEE aids intraoperative management and improves outcome in patients undergoing cardiac valve repairs, complex congenital heart corrections, and high-risk patients undergoing coronary artery bypass graft surgery. Especially in mitral valve repair surgery, it is mandatory to evaluate the results of the surgical procedure after cardiopulmonary bypass during surgery. Multiple investigations have also documented the improved sensitivity of TEE for the detection of myocardial ischemia compared with ECG or pulmonary capillary wedge pressure measurements. Intraoperative TEE is, however, not without risks, so emerging evidence demonstrating the utility of TEE as a diagnostic monitor or to alter the management of patients is required, especially in non-cardiac surgery. TEE is less frequently used in non-cardiac surgery; however, the emergent use of intraoperative or perioperative TEE to determine the cause of an acute, persistent, and life-threatening hemodynamic abnormality is well indicated. A task force of the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists developed guidelines for the appropriate use of TEE, which were evidence-based and focused on the effectiveness of perioperative TEE in improving clinical outcomes. Compliance with the guidelines for basic intraoperative TEE resulted in a marked improvement in intraoperative TEE practice. Technical progress of echocardiographic equipment and the TEE probe will increase the application of intraoperative and perioperative TEE in the future.