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Basic Transesophageal Echocardiography

This document provides information on basic transesophageal echocardiography (TEE). It discusses how TEE can be used to evaluate cardiac and aortic structure/function when transthoracic echocardiography (TTE) is nondiagnostic or not possible. It also describes how TEE guides intraoperative and transcatheter procedures. The document outlines contraindications and risks of TEE, as well as pre-procedure preparation and moderate sedation protocols. It provides guidance on probe insertion techniques.

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Stella CooKey
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197 views17 pages

Basic Transesophageal Echocardiography

This document provides information on basic transesophageal echocardiography (TEE). It discusses how TEE can be used to evaluate cardiac and aortic structure/function when transthoracic echocardiography (TTE) is nondiagnostic or not possible. It also describes how TEE guides intraoperative and transcatheter procedures. The document outlines contraindications and risks of TEE, as well as pre-procedure preparation and moderate sedation protocols. It provides guidance on probe insertion techniques.

Uploaded by

Stella CooKey
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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BASIC

TRANSESOPHAGEAL
ECHOCARDIOGRAPHY
DR Stella N. Cookey
1. Evaluation of cardiac and aortic
structure and function
◦ Evaluation of cardiac and aortic structure and function in situations where the findings will alter
management and TTE is nondiagnostic or TTE is deferred because there is a high probability that it will
be non-diagnostic.
◦ a. Detailed evaluation of the abnormalities in structures that are typically in the far field such as the aorta
and the left atrial appendage.
◦ b. Evaluation of prosthetic heart valves.
◦ c. Evaluation of paravalvular abscesses (both native and prosthetic valves).
◦ d. Patients on ventilators.
◦ e. Patients with chest wall injuries.
◦ f. Patients with body habitus preventing adequate TTE imaging.
◦ g. Patients unable to move into left lateral decubitis position.
2. Intraoperative TEE.

◦ a. All open heart (i.e., valvular) and thoracic aortic surgical procedures.
◦ b. Use in some coronary artery bypass graft surgeries.
◦ c. Noncardiac surgery when patients have known or suspected cardiovascular pathology which may
impact outcomes.
◦ .
3. Guidance of transcatheter procedures

◦ a. Guiding management of catheter-based intracardiac procedures (including septal defect closure or


atrial appendage obliteration, and transcatheter valve procedures).
4. Critically ill patients

◦ a. Patients in whom diagnostic information is not obtainable by TTE and this information is expected to
alter management
Contraindications
A. Absolute Contraindications
◦ Perforated viscus
◦ Esophageal stricture
◦ Esophageal tumor
◦ Esophageal perforation,
◦ laceration
◦ Esophageal diverticulum
◦ Active upper GI bleed
Relative Contraindications
◦ History of radiation to neck
◦ and mediastinum History of GI surgery
◦ Recent upper GI bleed Barrett’s esophagus
◦ History of dysphagia
◦ Restriction of neck mobility (severe cervical arthritis, atlantoaxial joint disease)
◦ Symptomatic hiatal hernia
◦ Esophageal varices
◦ Coagulopathy, thrombocytopenia
◦ Active esophagitis
◦ Active peptic ulcer disease
◦ Overall complication rate 0.18-2.8% (refs 24,25) 0.2% (ref 7) Mortality
Pre-procedure preparation
◦ Obtain history to exclude contraindication
◦ Allow proper booking
◦ Quick general Examination
◦ Stop blood thinners
◦ 6-8 hrs of fast( from meals but fluid and 3 hrs of complete fast)
◦ Educate patient on procedure and include risk
◦ Obtain written consent
◦ Intravenous access is required for transesophageal echocardiographic procedures and the left arm is
recommended to facilitate contrast injections when evaluating the presence of intracardiac shunts.
◦ Oropharyngeal Anaesthesia
◦ Please protect YOUR PROBE use a mouth gag(5,000,000-10,000,000)
◦ TEE is a semi-invasive procedure with well-defined criteria for training of personnel.15 There are three
groups of patients to consider when discussing management of sedation for an individual requiring TEE:
◦ (1) awake patients (either ambulatory or inpatient),
◦ (2) ventilated patients in the intensive care unit, and
◦ (3) anesthetized patients in the operating room. This section focuses on patients undergoing procedures in
the echocardiography laboratory with conscious (moderate) sedation.
MODERATE SEDATION( Non
Anaethesiologist)
- as purposeful response to verbal or tactile stimulation with spontaneous ventilation without need for
airway support (i.e., jaw thrust).
- Patients undergoing procedures with sedation should abstain from food and beverages (other than clear
liquids) for a minimum of 6 hours before the planned procedure and restrain from all intake for 3 hours
before the procedure
- Physicians must screen patients for medical problems that contraindicate or increase the risk of conscious
sedation
- Some patients will tolerate TEE with no sedation if topical anesthesia is adequate. The most commonly
used sedative agents are benzodiazepines, because of their anxiolytic properties, with midazolam being
the best choice for most transesophageal echocardiographic procedures. Midazolam has a quick onset (1–
2 min) and short duration of action (typically 15–30 min), and it provides better amnesia than other
benzodiazepines.
Table 8 American Society of Anesthesiologists Physical Status
Classification American Society of Anesthesiologists Physical Status
Classification

◦ Class I A normal healthy patient


◦ Class II A patient with mild systemic disease
◦ Class III A patient with severe systemic disease
◦ Class IV A patient with severe systemic disease that is a constant threat to life
◦ Class V A moribund patient who is not expected to survive without operation
◦ Class VI A declared brain-dead patient whose organs are being removed for
donor purposes E If the surgery is an emergency, the physical status
classification is followed by ‘‘E’’
Probe Insertion Techniques
◦ After adequate application of topical anesthetic, a bite block should be placed in the patient’s mouth
before the administration of conscious sedation. The patient is typically placed in the left lateral
decubitus position, and the echocardiographer stands facing the patient on the left-hand side of the
stretcher.
◦ Before probe insertion, the echocardiographer should check the probe for any obvious damage, ensure
proper probe function, and confirm that the probe is in the unlocked position. The transesophageal
echocardiographic probe is inserted to the back of the pharynx, which may require slight anteflexion of
the
◦ With a bite block in place, it is safe to insert one or two fingers into the mouth and guide the probe
toward the midline and depress the tongue if it is blocking passage. A small percentage of patients will
not tolerate probe placement under moderate sedation

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