Intraoperative assessment of left ventricular function with transesophageal echocardiography

Qualitative TEE assessment is used to guide administration of fluids and inotropic drugs and to monitor left ventricular function intraoperatively. Left ventricular hypovolemia or depression is easily recognized by directly noting a small end-diastolic area or low ejection fraction. Appropriate therapy can be instituted and continuously monitored. In contrast, pulmonary artery pressure monitoring does not accurately indicate loading conditions during major cardiovascular procedures or whenever left ventricular compliance is impaired, mitral valve dysfunction is present, or right ventricular distention occurs. New applications and technical improvements in TEE are being developed at a remarkable rate. Future versions of ABD technology are likely to address the problem of anisotropy, require less user intervention, and incorporate 3-D information from multiplane probes to produce real-time estimates of left ventricular volumes. The raw information in the returning signal will most likely be further analyzed to allow characterization of ischemic but still viable tissue. Coupled with the ability to assess regional myocardial perfusion by contrast echocardiography, the clinician will be able to institute more timely and appropriate medical and surgical therapy. TEE assessment of mitral valve function has become the standard of care after mitral valve repair, and in a similar fashion, assessment of myocardial perfusion by TEE may become the standard of care during cardiac and major noncardiac surgery.