DK2985_C000 1..28 - AlSharqia Echo Club

566 Transesophageal EchocardiographyB. Uncomplicated Endocarditis DuringNoncardiac SurgeryNoncardiac surgery in patients with uncomplicated endocarditisis a category III indication for intraoperative TEE.C. Monitoring of Emboli DuringOrthopedic ProceduresIntraoperative TEE can detect embolized air or medullarycontents in 30–62% of patients undergoing total hip replacementand, after tourniquet deflation, in 27–100% ofpatients undergoing knee arthroplasty. There is little evidence,however, that this information results in improvedclinical outcomes (12). In practice, TEE detection ofemboli during orthopedic procedures often promptsclinical interventions (e.g. replacing tourniquets) but theultimate benefit to the patient of these maneuvers isuncertain. Monitoring for emboli during orthopedic proceduresis a category III indication for intraoperative TEE.D. Assessment of Repair of ThoracicAortic InjuriesAssessing the repair of thoracic aortic injuries is a categoryIII indication for intraoperative TEE. Other indications forTEE in aortic disease have been discussed in previoussections.E. Uncomplicated PericarditisUncomplicated pericarditis is a category III indication forTEE, as previously mentioned.F. Evaluation of PleuropulmonaryDiseaseThere is no direct evidence that intraoperative TEE isaccurate in detecting pleural or pulmonary parenchymaldisease, or that such monitoring results in improved clinicaloutcomes. Pleural effusions and atelectatic lungs aresometimes identified (see Chapter 11, Fig. 11.7). Theevaluation of pleuropulmonary disease is a category IIIindication for perioperative TEE.G. Monitoring of CardioplegiaAdministrationMonitoring cardioplegia administration is a category IIIindication for intraoperative TEE (12). In contrast, in the2003 ACC/AHA/ASE guidelines, placement of intracardiacdevices and monitoring of their position duringport-access and other cardiac surgical procedures havebecome a class I indication. Positioning of a coronarysinus cannula is now one of these new class I indicationsof TEE monitoring.H. Monitoring Placement ofIntra-Aortic Balloon PumpsAlthough the positioning of an intra-aortic balloon pumpcan be optimized by the use of TEE, this is a category IIIindication because it can be done properly and safelywithout TEE.I. Automatic Implantable CardiacDefibrillatorsImplantation of a cardiac defibrillator is a category IIIindication for TEE. Hemodynamic disturbances mayhowever occur in such patients and TEE may thenbecome useful.J. Pulmonary Artery CathetersIt is also a category III indication. TEE may be useful inpatients with hemodynamic instability not responding totreatment based on pulmonary artery catheter data.V. CONCLUSIONThe indications for TEE are reviewed periodically afterinvestigation of new procedures and documentation ofoutcome data. In the meantime, the ACC/AHA/ASE2003 guidelines (11) are a useful tool to help the physicianin making decisions and improving patient care.REFERENCES1. Mishra M, Chauhan R, Sharma KK et al. Real-time intraoperativetransesophageal echocardiography—how useful?Experience of 5,016 cases. J Cardiothorac Vasc Anesth1998; 12:625–632.2. Sutton DC, Kluger R. Intraoperative transoesophagealechocardiography: impact on adult cardiac surgery.Anaesth Intensive Care 1998; 26:287–293.3. Click RL, Abel MD, Schaff HV. Intraoperative transesophagealechocardiography: 5-year prospective reviewof impact on surgical management. Mayo Clin Proc 2000;75:241–247.4. Couture P, Denault AY, McKenty S et al. Impact ofroutine use of intraoperative transesophageal echocardiographyduring cardiac surgery. Can J Anaesth 2000; 47:20–26.5. Michel-Cherqui M, Ceddaha A, Liu N et al. Assessment ofsystematic use of intraoperative transesophageal echocardiographyduring cardiac surgery in adults: a prospective studyof 203 patients. J Cardiothorac Vasc Anesth 2000; 14:45–50.