Transoesophageal Echocardiography for Monitoring Liver Surgery: Data from a Pilot Study

Abstract

A pilot study aimed to introduce intraoperative monitoring of liver surgery using transoesophageal echocardiography (TEE) is described. A set of TEE measurements was established as a protocol, consisting of left atrial (LA) dimension at the aortic valve plane; mitral velocity flow integral, calculation of stroke volume and cardiac output (CO); mitral annular plane systolic excursion; finally, right atrial area. A total of 165 measurements (on 21 patients) were performed, 31 occurring during hypotension. The conclusions reached were during acute blood loss LA dimension changed earlier than CVP, and, in one patient, a dynamic left ventricular (LV) obstruction was observed; in 3 patients a transient LV systolic dysfunction was documented. The comparison between 39 CO paired measurements obtained by TEE and PiCCO2 revealed a statistically significant correlation (P < 0.001, r = 0.83). In this pilot study TEE successfully answered the questions raised by the anesthesiologists. Larger cohort studies are needed to address this issue.

A Case Report of Paradoxical Air Embolism Caused by Intrapulmonary Shunting During Liver Transplantation

“…7-9 These findings often impact on patient management. 8 In this case, early placement (as opposed to rescue placement after the cardiac arrest occurred) allowed rapid diagnosis of PAE as a rare cause of cardiac arrest and contributed to improved cardiac and neurological outcome by expediting management.…”

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“…Pissarra et al [46] performed 165 measurements (on 21 patients), 31 occurring during hypotension. They concluded that during acute blood loss LA dimensions changed earlier than CVP, and, in one patient, a dynamic left ventricular (LV) obstruction was observed.…”

Utility of TEE in Anesthesia for Non Cardiac Surgery: A Practical Review

“…TEE accurately measures the left atrial (LA) dimension at the aortic valve plane, mitral flow velocity integral, calculation of stroke volume and cardiac output (CO), mitral annular plane systolic excursion and right atrial area [1,2]. Pissarra et al [46] performed 165 measurements (on 21 patients), 31 occurring during hypotension. They concluded that during acute blood loss LA dimensions changed earlier than CVP, and, in one patient, a dynamic left ventricular (LV) obstruction was observed.…”