Intraoperative Transesophageal Echocardiography for Thoracic Surgery

  • Massimiliano Meineri


Despite its intuitive advantages, the use of TEE in noncardiac surgery has been limited by the availability of trained anesthesiologists, the cost of the equipment and, ultimately, by the lack of updated guidelines. In fact, very few studies have looked at the impact of intraoperative TEE in noncardiac surgery on patients’ outcomes. TEE is a considered a safe technique. However, despite its relative noninvasiveness, it carries potentially drastic complications and needs to be supported by congruent indications. Basic hemodynamic monitoring can be easily achieved with TEE. Qualitative and quantitative assessments of right and left ventricular function are feasible and can be integrated as a complete standard in intraoperative hemodynamic monitoring. TEE for lung transplant is considered a category II indication by current guidelines. TEE provides ideal intraoperative hemodynamic monitoring, and it allows the assessment of all vascular anastomoses immediately after the reperfusion of the graft. TEE has a promising role in the diagnosis and follow-up of both acute and chronic pulmonary embolisms. TEE can easily detect and monitor the effects of acute and chronic pressure overload on the right ventricle and can rule out dangerous intracardiac shunts. These characteristics make it a powerful tool for intraoperative monitoring during ­pulmonary embolectomy and endarterectomy surgeries. The ability to image cardiac structures with a high spatial resolution makes TEE suitable for assessing the effect of mediastinal masses on cardiac chambers. TEE may also provide useful information to guide surgical resection.


Right Ventricular Inferior Vena Cava Right Ventricular Function Right Ventricular Dysfunction Noncardiac Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Transesophageal echocardiography


Three-dimensional trasesophageal echocardiography


Transthoracic echocardiography



Left ventricle


Right ventricle


Left atrium


Right atrium


Left ventricular outflow tract


Right ventricular outflow tract


Patent foramen ovale


Tricuspid valve


Pulmonic valve


Interatrial septum


Interventricular septum


Inferior vena cava


Superior vena cava


Pulmonary artery


Right pulmonary artery


Left pulmonary artery


Pulmonary veins


Left upper pulmonary vein


Left lower pulmonary vein


Right upper pulmonary vein


Right lower pulmonary vein

TEE views


Transgastric short axis view


Mid-esophageal four-chamber view


Mid-esophageal two-chamber view

ME RV in–out

Mid-esophageal right ventricle inflow–outflow view


Mid-esophageal bicaval view


Mid-esophageal ascending aorta short axis view

UE Ao Arch SAX

Upper-esophageal aortic arch short axis view



Left ventricular end-diastolic diameter


Left ventricular end-systolic diameter


Left ventricular end-diastolic diameter


Left ventricular end-systolic area


Left ventricular end-diastolic volume


Left ventricular end-systolic volume


Right ventricular end-diastolic area


Fractional shortening


Fractional area change


Left ventricular ejection fraction


Stroke volume


Tricuspid valve annular plane systolic excursion


Tricuspid regurgitation


Right ventricular systolic pressure


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Massimiliano Meineri
    • 1
  1. 1.Department of AnesthesiaToronto General Hospital, University of TorontoTorontoCanada

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