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Updated: Jul 17, 2026
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Echocardiography allows safer venous cannulation during excision of large right atrial masses
J A Rousou1, D A Tighe, R D Rifkin
1Division of Cardiac Surgery, Baystate Medical Center, Springfield, Massachusetts 01107, USA.
Insights
Combined intraoperative transesophageal and epicardial echocardiography ensures safe venous cannulation for right atrial mass excision. This dual imaging approach guides precise cannulation, preventing tumor fragmentation during complex cardiac surgeries.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Echocardiography
Background:
- Excision of large right atrial masses necessitates bicaval cannulation and cardiopulmonary bypass.
- Accurate intracavitary mass location is crucial for safe venous cannulation and to prevent fragmentation.
- Standard echocardiography methods may not fully delineate tumor-cardiac relationships.
Observation:
- Intraoperative transesophageal echocardiography and epicardial echocardiography were utilized in four patients with large right atrial masses.
- Surgeons used both echocardiographic modalities to guide venous cannulation site and technique, aiming to avoid mass fragmentation.
- Epicardial echocardiography provided complementary information to transesophageal echocardiography.
Findings:
- The combined use of transesophageal and epicardial echocardiography enabled safe venous cannulation in all four patients.
- All right atrial masses were successfully excised using tailored cannulation strategies informed by echocardiographic guidance.
Implications:
- Routine adoption of combined intraoperative transesophageal and epicardial echocardiography is recommended for guiding venous cannulation.
- This integrated imaging strategy enhances safety and efficacy in the surgical excision of large right atrial masses.
Background:
Excision of large right atrial masses requires bicaval cannulation and cardiopulmonary bypass. Safe venous cannulation can be accomplished only by knowing the exact intracavitary location and extension of the mass to avoid fragmentation. Transthoracic echocardiography and intraoperative transesophageal echocardiography, although helpful, cannot always define the exact intracavitary relationships of the tumor.
Methods:
We have used both intraoperative transesophageal and epicardial echocardiography to guide venous cannulation in 4 patients with large right atrial masses. Both echo images are used by the surgeon to select the exact site and method of cannulation to avoid fragmentation of the mass. Epicardial echocardiography complemented the images obtained by transesophageal echocardiography.
Results:
The technique of combined transesophageal and epicardial echocardiography allowed safe venous cannulation in all 4 patients. Each of the right atrial masses was safely excised using case-specific cannulation techniques guided by the echocardiographic images.
Conclusions:
We propose the routine use of both intraoperative transesophageal and epicardial echocardiography in guiding venous cannulation for safe excision of large right atrial masses.
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