Year : 2016 | Volume
: 19 | Issue : 5 | Page : 1-
"TEE or not to TEE?"
Director, Department of Anaesthesia, Max Smart Super Speciality Hospital, President, Indian Association of Cardiovascular Thoracic Anaesthesiologists (IACTA)
|How to cite this article:|
Kapoor M. "TEE or not to TEE?".Ann Card Anaesth 2016;19:1-1
|How to cite this URL:|
Kapoor M. "TEE or not to TEE?". Ann Card Anaesth [serial online] 2016 [cited 2019 Nov 19 ];19:1-1
Available from: http://www.annals.in/text.asp?2016/19/5/1/192571
Perioperative hemodynamic management during major cardiac surgery can be challenging. Several physiological parameters need to be monitored. Basic monitoring is best supplemented by advanced systems. Multiple modalities of advanced monitoring have been tried, with variable success, but consistent benefit has not been demonstrated with their use.
Amongst the new techniques, Trans-Esophageal Echocardiography (TEE) is considered most promising. The ability of TEE to provide direct, real-time visualization of cardiac structures, during cardiac surgery, gives it a distinct edge over the other modes of monitoring. The use of TEE in both adults and children has provided a large amount of new information, previously not available. An increasing number of complex interventional cardiology procedures are possible today under TEE guidance.
In cardiac surgery, TEE is now used with increasing frequency for diagnosis, perioperative hemodynamic monitoring and as a guide for surgical correction of cardiac lesions. TEE is most frequently used to measure cardiac output, left ventricular preload, for early diagnosis of myocardial ischemia, determination of acute hemodynamic disorders, weaning off cardiopulmonary bypass, for functional assessment of the LV, and for assessment of valve function. In valve surgery, TEE plays a pivotal role in assessing results of surgical reconstruction or replacement. TEE had more influence on intra-operative decision making than any other monitoring modality and its use is inescapable in modern cardiac surgery practice.
There is a need for specific training for perioperative use of TEE. Guidelines on the application of TEE have been defined by American Society of Echocardiography (ASE), the Society of Cardiovascular Anesthesiologists (SCA) and Indian Association of Cardiovascular Thoracic Anesthesiologists (IACTA). Anesthesiologists can acquire competence in this field through specific training programs.
The basic prerequisites for proper use of TEE and its interpretation include: study of cardiac anatomy and physiology, understanding the basic physics of ultrasound, technical ability to acquire images and their interpretation, and correlating them with the hemodynamics. A book comprehensively covering all aspects of TEE is the need of the day.