Transesophageal Echocardiography in Heart and Lung Transplantation

The number of heart and lung transplantations has risen over the years, and they remain the mainstay of treatment for end-stage heart failure and end-stage lung diseases. From the assessment of the donor's heart to intraoperative management during separation from cardiopulmonary bypass (CPB) to the postoperative follow-up of heart transplant patients, echocardiography plays a vital role throughout this process. Patients with chronic lung diseases also may have cardiovascular compromise secondary to pulmonary hypertension, pre-existing coronary artery disease, or valvular heart disease. Preoperative echocardiographic assessment allows for optimization before major surgery. An intraoperative transesophageal echocardiography (TOE) for continuous monitoring of the cardiac function is important especially in a procedure where hemodynamic instability is often encountered. Postoperative complications are common, and they can be diagnosed with the help of TOE. The authors aim to conduct a narrative review on the use of TOE mainly in the intraoperative setting during heart and lung transplantation and also to highlight some of its uses preoperatively as well as in the immediate postoperative period.