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Transösophageale Echokardiographie für Herzchirurgen

Bewährtes und neuere Entwicklungen

Transesophageal echocardiography for cardiac surgeons

Proven and newer developments

  • Übersicht
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die transösophageale Echokardiographie (TEE) stellt ein unverzichtbares Instrument innerhalb der heutigen Herzchirurgie dar. Die zweidimensionale und Doppler-TEE bestätigen und ergänzen die präoperative Diagnose und bieten zusätzliche, für die Planung der Operation wichtige Informationen. Nach dem Eingriff ermöglicht die TEE eine unmittelbare Kontrolle des Resultats und bei Bedarf eine Revision. Das beste Kosten-Nutzen-Verhältnis weist die TEE bei rekonstruktiven Eingriffen an Herzklappen, bei komplexen Herzoperationen, Hochrisikopatienten sowie Notfällen auf. Die TEE dient gleichzeitig als Monitor der ventrikulären und hämodynamischen Funktion und erlaubt eine schnelle und zuverlässige Diagnose beim schwierigen Abgang von der Herz-Lungen-Maschine (HLM) sowie bei postoperativer hämodynamischer Instabilität. Die Einführung der dreidimensionalen Echtzeit-TEE erweitert wesentlich die diagnostischen Möglichkeiten der perioperativen Echokardiographie.

Abstract

The transesophageal echocardiography (TEE) is invaluable in contemporary cardiac surgery. Two-dimensional and Doppler TEE confirm and complement the preoperative diagnosis and offer additional information, which may be useful for the final planning of the operation. Immediately after surgery, TEE can be used to check the results and, if necessary, prompts revision. TEE has the most favorable cost-benefit ratio in case of valve repair, complex operations, high-risk patients as well as in emergencies. TEE can also be used to monitor ventricular and hemodynamic function and enables quick and reliable diagnosis in situations of difficult weaning from the heart-lung machine and postoperative hemodynamic instability. The introduction of real-time 3-dimensional TEE will further enhance the diagnostic capability of perioperative echocardiography.

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Interessenkonflikt

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Authors and Affiliations

  1. Departement Anästhesie, Universitätsspital Basel, Spitalstr. 21, 4031, Basel, Schweiz

    K. Skarvan & M. Filipovic

Authors
  1. K. Skarvan
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  2. M. Filipovic
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Corresponding author

Correspondence to K. Skarvan.

Zusatzmaterial online

Video 1:

Videosequenz 1 Mittösophagealer 2-Kammerblick zeigt ausgedehnte Akinesie der distalen Vorderwand, der Spitze und der Hinterwand, die nach 3-fachem aortokoronarem Bypass und Abgang von der Herzlungenmaschine (HLM) auftrat.

(MS-Cinepak-Video 1,2 MB)

Video 2:

Videosequenz 2 Mittösophagealer 4-Kammerblick mit Sehnenfädenabriss und Flail des posterioren Mitralklappensegels.

(MS-Cinepak-Video 5,4 MB)

Video 3:

Videosequenz 3 Mittösophagealer Längsachsenblick mit Farbdoppler zeigt einen asymmetrischen Mitralregurgitationsjet. Die Vena contracta und PISA („proximal isovelocity surface area“) sind gut sichtbar.

(MS-Cinepak-Video 2,0 MB)

Video 4:

Videosequenz 4 Mittösophagealer 2-Kammerblick, 2-D (links) und Farbdoppler (rechts), zeigt das Resultat der erfolgreichen Mitralklappenrekonstruktion mit Wedgeresektion des posterioren Segels und Annuloplastik.

(MS-Cinepak-Video 3,6 MB)

Video 5:

Videosequenz 5 Mittösophagealer Kurzachsenblick der Aortenklappe mit Farbdoppler nach Aortenklappenersatz (Zweiflügelprothese), unmittelbar nach Abgang von HLM. Es besteht ein revisionsbedürftiger paravalvulärer Jet im Bereich des akoronaren Sinus.

(MS-Cinepak-Video 0,7 MB)

Video 6:

Videosequenz 6 Echtzeit 3-D TEE (4-D) Schlaufe der Mitralklappe aus der Sicht des Operateurs („en face view“). Die Aortenklappe und das vordere Segel befinden sich oben, das hintere Segel mit P2-Flail und Sehnenfädenabriss unten im Bild.

(MS-Cinepak-Video 0,8 MB)

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Skarvan, K., Filipovic, M. Transösophageale Echokardiographie für Herzchirurgen. Z Herz- Thorax- Gefäßchir 23, 196–203 (2009). https://doi.org/10.1007/s00398-009-0723-z

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  • DOI: https://doi.org/10.1007/s00398-009-0723-z

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