DK2985_C000 1..28 - AlSharqia Echo Club

Lung Transplantation 483(A)(B)LARUPVRARV(C)(D) ASCENDING AORTAAIR EMBOLISMFigure 21.2 Presence of air embolism detected at the completion of the vascular anastomosis. Air bubbles are seen in the right upperpulmonary vein (RUPV) (A, B) and in the ascending aorta (C, D) (LA, left atrium; RA, right atrium; RV, right ventricle).(Fig. 21.4) or thrombosis should be excluded by measuringthe diameter of the donor and recipient vessels and if thereare discrepancies, the corresponding pressure gradient.The pulmonary veins and left atrium (LA) should be carefullyexamined for the presence of thrombus, and if thereare any, their size, precise location and associated flowabnormalities noted. The correction of such intraoperativefindings are key in preventing life-threatening complicationspost-operatively (1,14). Figures 21.5–21.7 representour approach in aquiring TEE 2D, Doppler dataacquisition and hemodynamic evaluation of patientsundergoing lung transplantation.III.ROLE OF TEE AFTER THE PROCEDURETransesophageal echocardiography, whether used intraoperativelyor postoperatively in the ICU, plays a valuablerole in the assessment of arterial and veno-atrial anastomoticcomplications following lung transplantation. As reportedby Griffith et al. (15), all too often, even the most experiencedtransplant surgeons may underestimate these anastomoticproblems. Generally, TEE will easily display theright pulmonary artery (PA) anastomosis (Fig. 21.1) aswell as those of the right upper and lower pulmonaryveins to the LA. However, on the left, due to the locationFigure 21.3 Bilateral lung transplantation complicatedby transient right ventricular dysfunction. (A,B) On the transgastric view at 08, significant dilatationof the right ventricle (RV) and paradoxical septalmotion suggests RV failure, possibly secondary toclamping of the pulmonary artery or air embolisationin the right coronary artery. (C, D) Vasoactivesupport re-established RV size and normal septalmotion (LV, left ventricle).