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Intraoperative and Postoperative Applications

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Transesophageal Echocardiography for Pediatric and Congenital Heart Disease

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Abstract

Early experience with epicardial imaging during surgical interventions for congenital heart disease (CHD) provided strong evidence that intraoperative echocardiography could guide surgical and anesthetic management in these patients. Since transesophageal echocardiography (TEE) began to be used intraoperatively in the late 1980s, numerous publications have documented its utility in the care of patients with CHD. Subsequent technologic advances—multiplane TEE imaging, the evolution of three-dimensional echocardiography, and the miniaturization of probes—have made it possible to comprehensively assess structural abnormalities, evaluate hemodynamics, and, importantly, appraise surgical results in most CHD patients. Identifying hemodynamically significant residual disease during congenital heart surgery and guiding surgical revision represent major contributions of TEE to perioperative care. Additionally, TEE adds value by providing real-time perioperative assessment of hemodynamics, volume status, and myocardial function. This monitoring helps direct anesthetic care intraoperatively and pharmacologic therapy in the immediate postoperative period. Finally, TEE can guide management planning and help characterize unexpected or unusual postoperative findings or problems.

This chapter provides an overview of the applications of TEE in the intraoperative care of pediatric patients with congenital and acquired heart disease and of adults with CHD, particularly regarding surgical, medical, and anesthetic management. Data on the cost-effectiveness, pitfalls, and limitations of intraoperative TEE are reviewed. Lastly, the role of TEE in the postoperative care of these patients is briefly addressed.

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Abbreviations

CHD:

Congenital heart disease

CPB:

Cardiopulmonary bypass

CVC:

Central venous catheter

EF:

Ejection fraction

FAC:

Fractional area change

ICE:

Intracardiac echocardiography

ICU:

Intensive care unit

LAX:

Long-axis

LV:

Left ventricle

ME:

Midesophageal

MR:

Mitral regurgitation

MRI:

Magnetic resonance imaging

RV:

Right ventricle, right ventricular

RVOT:

Right ventricular outflow tract

RWMA:

Regional wall motion abnormalities

SAX:

Short-axis

SV:

Stroke volume

SVC:

Superior vena cava

TEE:

Transesophageal echocardiography

TG:

Transgastric

TTE:

Transthoracic echocardiography

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Acknowledgments

The authors would like to gratefully acknowledge Isobel A. Russell, MD for her expertise and contribution to this chapter and co-authorship in the prior edition.

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Arthur S. Keats Division of Pediatric Cardiovascular Anesthesiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Wanda C. Miller-Hance

  2. Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Wanda C. Miller-Hance

  3. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto General Hospital, Toronto, ON, Canada

    Annette Vegas

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  1. Wanda C. Miller-Hance
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  2. Annette Vegas
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Correspondence to Wanda C. Miller-Hance .

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  1. Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Pierre C. Wong

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Arthur S. Keats Division of Pediatric Cardiovascular Anesthesiology and Department of Pediatrics, Section of Cardiology, Baylor College of Medicine, Texas Children’s Hospital; Texas Heart Institute, Houston, TX, USA

    Wanda C. Miller-Hance

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Miller-Hance, W.C., Vegas, A. (2021). Intraoperative and Postoperative Applications. In: Wong, P.C., Miller-Hance, W.C. (eds) Transesophageal Echocardiography for Pediatric and Congenital Heart Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-57193-1_18

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