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Perioperative transösophageale Echokardiographie außerhalb der Kardiochirurgie

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Perioperative transesophageal echocardiography in non-cardiac surgery

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Zusammenfassung

Ziel der Arbeit

Die Vermittlung von Kenntnissen zur fokussierten transösophagealen Echokardiographie (TEE) als Diagnostikum bei nichtkardiochirurgischen Patienten ist das Ziel dieser Arbeit. Die transösophageale Echokardiographie (TEE) ist perioperativ sehr hilfreich, da sie eine rasche echokardiographische Untersuchung ohne Behinderung des Operationsfelds bzw. bei eingeschränkten transthorakalen Untersuchungsbedingungen ermöglicht. Neue Empfehlungen zur perioperativen TEE mit erweiterten Standardschnitten und dem daraus abgeleiteten verkürzten Untersuchungsgang als Grundlage für eine orientierende Basisuntersuchung waren ausschlaggebend für diese Arbeit.

Material und Methoden

Hintergrund ist die zu diesem Thema publizierte Literatur (Peer-Review-Arbeiten aus PubMed).

Ergebnisse

Die TEE bei nichtkardiochirurgischen Patienten hat im Wesentlichen 2 Einsatzgebiete: 1. die Abklärung der akuten perioperativen hämodynamischen Instabilität in OP, Schockraum und auf der Intensivstation, 2. die geplante intraoperative Überwachung, wenn aufgrund der Art des Eingriffs oder aufgrund bekannter oder vermuteter kardiovaskulärer Vorerkrankungen des/r Patienten/in mit schweren hämodynamischen, pulmonalen oder neurologischen Komplikationen gerechnet werden muss. Im Jahr 2013 wurden 11 relevante Standardschnitte als Grundlage für die Basisuntersuchung außerhalb der Herzchirurgie definiert. Die konsequente Einhaltung dieses verkürzten Untersuchungsgangs sollte bei jedem Patienten erfolgen. Bei speziellen Fragestellungen kann eine Erweiterung des Untersuchungsgangs nötig werden.

Diskussion

Die perioperative TEE ist auch bei nichtkardiochirurgischen Patienten mittlerweile unverzichtbar. Mithilfe der TEE ist es möglich, eine lebensbedrohliche perioperative hämodynamische Instabilität innerhalb weniger Minuten abzuklären. Weiterhin kann das hämodynamische Management von Hochrisikopatienten/innen erleichtert werden. Entsprechende Qualifikation und Weiterbildung sind notwendig, um die Kompetenz der Untersucher/innen sicherzustellen.

Abstract

Aim

The aim of this article is to impart knowledge concerning focused transesophageal echocardiographic examination (TEE) for non-cardiac surgery which is an essential part of perioperative monitoring. It allows a rapid echocardiographic examination without interference with the surgical field or under limited transthoracic examination conditions. New recommendations for a comprehensive perioperative TEE examination with expanded standard views and the recently published consensus statement for a shortened baseline examination were crucial for this study.

Material and methods

The background is the peer-reviewed literature from PubMed.

Results

Apart from cardiac surgery TEE has two main applications: firstly, the evaluation of patients developing acute life-threatening hemodynamic instability in the operating room, in the emergency room or in the intensive care unit (ICU). Secondly, TEE is used as planned intraoperative monitoring when severe hemodynamic, pulmonary or neurological complications are expected because of the type of surgery or due to the cardiopulmonary medical history of the patient. In 2013 a total of 11 relevant standard views were defined for the basic perioperative TEE examination in non-cardiac surgery. These 11 views should be performed for each patient. Appropriate extension to a comprehensive examination may be necessary if complex pathology is obvious.

Discussion

Even in non-cardiac surgery TEE is an important tool allowing clarification of a life-threatening perioperative hemodynamic instability within a few minutes. Furthermore, the hemodynamic management of high-risk patients can be facilitated. Appropriate qualification and continuous training are necessary in order to assure the competence of the examiner.

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Literatur

  1. Alsamara M, Alharethi R (2014) Heart failure with preserved ejection fraction. Expert Rev Cardiovasc Ther 12(6):743–750

    Article  CAS  PubMed  Google Scholar 

  2. Anonymous (1996) Practice guidelines for perioperative transesophageal echocardiography. A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 84:986–1006

    Article  Google Scholar 

  3. Anonymous (2010) Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 112:1084–1096

    Google Scholar 

  4. Augoustides JG, Hosalkar HH, Savino JS (2005) Utility of transthoracic echocardiography in diagnosis and treatment of cardiogenic shock during noncardiac surgery. J Clin Anesth 17:488–489

    Article  PubMed  Google Scholar 

  5. Barbier C, Loubieres Y, Schmit C et al (2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 30:1740–1746

    PubMed  Google Scholar 

  6. Boersma E, Poldermans D, Bax JJ et al (2001) Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 285:1865–1873

    Article  CAS  PubMed  Google Scholar 

  7. Bose RR, Matyal R, Warraich HJ et al (2011) Utility of a transesophageal echocardiographic simulator as a teaching tool. J Cardiothorac Vasc Anesth 25:212–215

    Article  PubMed  Google Scholar 

  8. Burger-Klepp U, Karatosic R, Thum M et al (2012) Transesophageal echocardiography during orthotopic liver transplantation in patients with esophagoastric varices. Transplantation 94:192–196

    Article  PubMed  Google Scholar 

  9. Burtenshaw AJ, Isaac JL (2006) The role of trans-oesophageal echocardiography for perioperative cardiovascular monitoring during orthotopic liver transplantation. Liver transpl 12:1577–1583

    Article  PubMed  Google Scholar 

  10. Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542

    Article  PubMed  Google Scholar 

  11. Cunningham AJ, Turner J, Rosenbaum S et al (1993) Transoesophageal echocardiographic assessment of haemodynamic function during laparoscopic cholecystectomy. Br J Anaesth 70:621–625

    Article  CAS  PubMed  Google Scholar 

  12. Denault AY, Couture P, Mckenty S et al (2002) Perioperative use of transesophageal echocardiography by anesthesiologists: impact in noncardiac surgery and in the intensive care unit. Can J Anaesth 49:287–293

    Article  PubMed  Google Scholar 

  13. Derouin M, Couture P, Boudreault D et al (1996) Detection of gas embolism by transesophageal echocardiography during laparoscopic cholecystectomy. Anesth Analg 82:119–124

    CAS  PubMed  Google Scholar 

  14. Fahy BG, Hasnain JU, Flowers JL et al (1999) Transesophageal echocardiographic detection of gas embolism and cardiac valvular dysfunction during laparoscopic nephrectomy. Anesth Analg 88:500–504

    CAS  PubMed  Google Scholar 

  15. Fathi AR, Eshtehardi P, Meier B (2009) Patent foramen ovale and neurosurgery in sitting position: a systematic review. Br J Anaesth 102:588–596

    Article  PubMed  Google Scholar 

  16. Fattori R, Caldarera I, Rapezzi C et al (2000) Primary endoleakage in endovascular treatment of the thoracic aorta: importance of intraoperative transesophageal echocardiography. J Thorac Cardiovasc Surg 120:490–495

    Article  CAS  PubMed  Google Scholar 

  17. Filipovic M, Seeberger MD, Schneider MC et al (2000) Transthoracic echocardiography for perioperative haemodynamic monitoring. Br J Anaesth 84:800–803

    Article  CAS  PubMed  Google Scholar 

  18. Garcia-Tsao G, Bosch J (2010) Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med 362:823–832

    Article  CAS  PubMed  Google Scholar 

  19. Grossgasteiger M, Hien MD, Graser B et al (2013) Assessment of left ventricular size and function during cardiac surgery. An intraoperative evaluation of six two-dimensional echocardiographic methods with real time three-dimensional echocardiography as a reference. Echocardiography 30:672–681

    Article  PubMed  Google Scholar 

  20. Haddad F, Couture P, Tousignant C et al (2009) The right ventricle in cardiac surgery, a perioperative perspective: I. Anatomy, physiology, and assessment. Anesth Analg 108:407–421

    Article  PubMed  Google Scholar 

  21. Haddad F, Couture P, Tousignant C et al (2009) The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance, and management. Anesth Analg 108:422–433

    Article  PubMed  Google Scholar 

  22. Hahn RT, Abraham T, Adams MS et al (2013) Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 26:921–964

    Article  PubMed  Google Scholar 

  23. Hainer C, Bernhard M, Scheuren K et al (2006) Echocardiography during acute hemodynamic instability. Anaesthesist 55:1117–1131 (quiz 1132)

    Article  CAS  PubMed  Google Scholar 

  24. Haller I, Kofler A, Lederer W et al (2008) Acute pulmonary artery embolism during transcatheter embolization: successful resuscitation with veno-arterial extracorporeal membrane oxygenation. Anesth Analg 107:945–947

    Article  PubMed  Google Scholar 

  25. Harris SN, Ballantyne GH, Luther MA et al (1996) Alterations of cardiovascular performance during laparoscopic colectomy: a combined hemodynamic and echocardiographic analysis. Anesth Analg 83:482–487

    CAS  PubMed  Google Scholar 

  26. Hilberath JN, Oakes DA, Shernan SK et al (2010) Safety of transesophageal echocardiography. J Am Soc Echocardiogr 23:1115–1127 (quiz 1220–1221)

  27. Hofer CK, Zollinger A, Rak M et al (2004) Therapeutic impact of intra-operative transoesophageal echocardiography during noncardiac surgery. Anaesthesia 59:3–9

    Article  CAS  PubMed  Google Scholar 

  28. Hoole SP, Falter F (2007) Evaluation of hypoxemic patients with transesophageal echocardiography. Crit Care Med 35:S408–S413

    Article  PubMed  Google Scholar 

  29. Hope MD, De La Pena E, Yang PC et al (2003) A visual approach for the accurate determination of echocardiographic left ventricular ejection fraction by medical students. J Am Soc Echocardiogr 16:824–831

    Article  PubMed  Google Scholar 

  30. Huang YC, Cheng YJ, Lin YH et al (2000) Graft failure caused by pulmonary venous obstruction diagnosed by intraoperative transesophageal echocardiography during lung transplantation. Anesth Analg 91:558–560

    Article  CAS  PubMed  Google Scholar 

  31. Jerath A, Vegas A, Meineri M et al (2011) An interactive online 3D model of the heart assists in learning standard transesophageal echocardiography views. Can J Anaesth 58:14–21

    Article  PubMed  Google Scholar 

  32. Kallmeyer IJ, Collard CD, Fox JA et al (2001) The safety of intraoperative transesophageal echocardiography: a case series of 7200 cardiac surgical patients. Anesth Analg 92:1126–1130

    Article  CAS  PubMed  Google Scholar 

  33. Kneeshaw JD (2006) Transoesophageal echocardiography (TOE) in the operating room. Br J Anaesth 97:77–84

    Article  CAS  PubMed  Google Scholar 

  34. Koessler MJ, Fabiani R, Hamer H et al (2001) The clinical relevance of embolic events detected by transesophageal echocardiography during cemented total hip arthroplasty: a randomized clinical trial. Anesth Analg 92:49–55

    Article  CAS  PubMed  Google Scholar 

  35. Kolev N, Brase R, Swanevelder J et al (1998) The influence of transoesophageal echocardiography on intra-operative decision making. A European multicentre study. European Perioperative TOE Research Group. Anaesthesia 53:767–773

    Article  CAS  PubMed  Google Scholar 

  36. Koschyk DH, Nienaber CA, Knap M et al (2005) How to guide stent-graft implantation in type B aortic dissection? Comparison of angiography, transesophageal echocardiography, and intravascular ultrasound. Circulation 112:I260–I264

    Article  PubMed  Google Scholar 

  37. Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  38. Lavine SJ, Salacata A (2003) Visual quantitative estimation: semiquantitative wall motion scoring and determination of ejection fraction. Echocardiography 20:401–410

    Article  PubMed  Google Scholar 

  39. Lennon MJ, Gibbs NM, Weightman WM et al (2005) Transesophageal echocardiography-related gastrointestinal complications in cardiac surgical patients. J Cardiothorac Vasc Anesth 19:141–145

    Article  PubMed  Google Scholar 

  40. Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology 72:153–184

    Article  CAS  PubMed  Google Scholar 

  41. Margreiter J, Hormann C, Mair P (2000) Possible uses of transesophageal echocardiography in perioperative monitoring. Anaesthesist 49:74–92

    Article  CAS  PubMed  Google Scholar 

  42. Matsumoto M, Oka Y, Lin YT et al (1979) Transesophageal echocardiography; for assessing ventricular performance. N Y State J Med 79:19–21

    CAS  PubMed  Google Scholar 

  43. Matyal R, Skubas NJ, Shernan SK et al (2011) Perioperative assessment of diastolic dysfunction. Anesth Analg 113:449–472

    PubMed  Google Scholar 

  44. Mcgowan JH, Cleland JG (2003) Reliability of reporting left ventricular systolic function by echocardiography: a systematic review of 3 methods. Am Heart J 146:388–397

    Article  PubMed  Google Scholar 

  45. Michel-Cherqui M, Brusset A, Liu N et al (1997) Intraoperative transesophageal echocardiographic assessment of vascular anastomoses in lung transplantation. A report on 18 cases. Chest 111:1229–1235

    Article  CAS  PubMed  Google Scholar 

  46. Mojadidi MK, Bogush N, Caceres JD et al (2014) Diagnostic accuracy of transesophageal echocardiogram for the detection of patent foramen ovale: a meta-analysis. Echocardiography 31:752–758

    Article  PubMed  Google Scholar 

  47. Muth CM, Shank ES (2000) Gas embolism. N Engl J Med 342:476–482

    Article  CAS  PubMed  Google Scholar 

  48. Nienaber CA (2013) The role of imaging in acute aortic syndromes. Eur Heart J Cardiovasc Imaging 14:15–23

    Article  PubMed  Google Scholar 

  49. Orihashi K, Matsuura Y, Sueda T et al (2000) Echocardiography-assisted surgery in transaortic endovascular stent grafting: role of transesophageal echocardiography. J Thorac Cardiovasc Surg 120:672–678

    Article  CAS  PubMed  Google Scholar 

  50. Owall A, Stahl L, Settergren G (1992) Incidence of sore throat and patient complaints after intraoperative transesophageal echocardiography during cardiac surgery. J Cardiothorac Vasc Anesth 6:15–16

    Article  CAS  PubMed  Google Scholar 

  51. Papadopoulos G, Kuhly P, Brock M et al (1994) Venous and paradoxical air embolism in the sitting position. A prospective study with transoesophageal echocardiography. Acta Neurochir 126:140–143

    Article  CAS  PubMed  Google Scholar 

  52. Phillip B, Pastor D, Bellows W et al (2003) The prevalence of preoperative diastolic filling abnormalities in geriatric surgical patients. Anesth Analg 97:1214–1221

    Article  PubMed  Google Scholar 

  53. Piercy M, Mcnicol L, Dinh DT et al (2009) Major complications related to the use of transesophageal echocardiography in cardiac surgery. J Cardiothorac Vasc Anesth 23:62–65

    Article  PubMed  Google Scholar 

  54. Poortmans G, Schupfer G, Roosens C et al (2000) Transesophageal echocardiographic evaluation of left ventricular function. J Cardiothorac Vasc Anesth 14:588–598

    Article  CAS  PubMed  Google Scholar 

  55. Rapezzi C, Rocchi G, Fattori R et al (2001) Usefulness of transesophageal echocardiographic monitoring to improve the outcome of stent-graft treatment of thoracic aortic aneurysms. Am J Cardiol 87:315–319

    Article  CAS  PubMed  Google Scholar 

  56. Reddy S, Ueda K (2014) Unexpected refractory intra-operative hypotension during non-cardiac surgery: diagnosis and management guided by trans-oesophageal echocardiography. Indian J Anaesth 58:51–54

    Article  PubMed Central  PubMed  Google Scholar 

  57. Reeves ST, Finley AC, Skubas NJ et al (2013) Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 26:443–456

    Article  PubMed  Google Scholar 

  58. Reichert CL, Visser CA, Van Den Brink RB et al (1992) Prognostic value of biventricular function in hypotensive patients after cardiac surgery as assessed by transesophageal echocardiography. J Cardiothorac Vasc Anesth 6:429–432

    Article  CAS  PubMed  Google Scholar 

  59. Ristic AD, Imazio M, Adler Y et al (2014) Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 35:2279–2284

    Article  PubMed  Google Scholar 

  60. Roizen MF, Beaupre PN, Alpert RA et al (1984) Monitoring with two-dimensional transesophageal echocardiography. Comparison of myocardial function in patients undergoing supraceliac, suprarenal-infraceliac, or infrarenal aortic occlusion. J Vasc Surg 1:300–305

    Article  CAS  PubMed  Google Scholar 

  61. Schulmeyer MC, Santelices E, Vega R et al (2006) Impact of intraoperative transesophageal echocardiography during noncardiac surgery. J Cardiothorac Vasc Anesth 20:768–771

    Article  PubMed  Google Scholar 

  62. Seif D, Mailhot T, Perera P et al (2012) Caval sonography in shock: a noninvasive method for evaluating intravascular volume in critically ill patients. J Ultrasound Med 31:1885–1890

    PubMed  Google Scholar 

  63. Shanewise JS, Cheung AT, Aronson S et al (1999) ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Anesth Analg 89:870–884

    CAS  PubMed  Google Scholar 

  64. Souquet J, Hanrath P, Zitelli L et al (1982) Transesophageal phased array for imaging the heart. IEEE Trans Biomed Eng 29:707–712

    Article  CAS  PubMed  Google Scholar 

  65. Spier BJ, Larue SJ, Teelin TC et al (2009) Review of complications in a series of patients with known gastro-esophageal varices undergoing transesophageal echocardiography. J Am Soc Echocardiogr 22:396–400

    Article  PubMed  Google Scholar 

  66. Suriani RJ (1998) Transesophageal echocardiography during organ transplantation. J Cardiothorac Vasc Anesth 12:686–694

    Article  CAS  PubMed  Google Scholar 

  67. Suriani RJ, Cutrone A, Feierman D et al (1996) Intraoperative transesophageal echocardiography during liver transplantation. J Cardiothorac Vasc Anesth 10:699–707

    Article  CAS  PubMed  Google Scholar 

  68. Suriani RJ, Neustein S, Shore-Lesserson L et al (1998) Intraoperative transesophageal echocardiography during noncardiac surgery. J Cardiothorac Vasc Anesth 12:274–280

    Article  CAS  PubMed  Google Scholar 

  69. Swaminathan M, Lineberger CK, Mccann RL et al (2003) The importance of intraoperative transesophageal echocardiography in endovascular repair of thoracic aortic aneurysms. Anesth Analg 97:1566–1572

    Article  PubMed  Google Scholar 

  70. Tank S, Rath T, Kerner T (2014) Anaesthesia for extrathoracal vascular surgery – Part 2: anaesthesiological management. Anasthesiol Intensivmed Notfallmed Schmerzther 49:12–23

    Article  PubMed  Google Scholar 

  71. Verhaeghen D, Poelaert J, Ama R et al (2005) Case 2–2005: evaluation of the lungs via transesophageal echocardiography. J Cardiothorac Vasc Anesth 19:242–249

    Article  PubMed  Google Scholar 

  72. Vieillard-Baron A, Chergui K, Rabiller A et al (2004) Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med 30:1734–1739

    PubMed  Google Scholar 

  73. Woo R, Minster GJ, Fitzgerald RH Jr et al (1995) The Frank Stinchfield Award. Pulmonary fat embolism in revision hip arthroplasty. Clin Orthop Relat Res 319:41–53

    PubMed  Google Scholar 

  74. Zaman A, Hapke R, Flora K et al (1999) Prevalence of upper and lower gastrointestinal tract findings in liver transplant candidates undergoing screening endoscopic evaluation. Am J Gastroenterol 94:895–899

    Article  CAS  PubMed  Google Scholar 

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Wally, D., Velik-Salchner, C. Perioperative transösophageale Echokardiographie außerhalb der Kardiochirurgie. Anaesthesist 64, 669–682 (2015). https://doi.org/10.1007/s00101-015-0066-y

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