Use of multi-plane transoesophageal echocardiography in visualization of the main hepatic veins and acquisition of Doppler sonography curves. Comparison with the transabdominal approach

Abstract

The role of multi-plane transoesophageal echocardiography (TOE) in the visualization of the three main hepatic veins and acquisition of Doppler sonography curves has not been established. We have studied this diagnostic option of TOE in 34 patients during general anaesthesia. The findings were compared with the results of conventional transabdominal sonography (TAS). Using TOE, each of the three main hepatic veins could be visualized in all patients. In contrast, TAS allowed adequate two-dimensional visualization of the right, middle, and left hepatic vein in only 97%, 85%, and 61% of the patients, respectively. Adequate Doppler tracings of the right and middle hepatic vein could be obtained in 100% and 97% of the patients by TOE and in 91% and 50% of the patients by TAS. Doppler tracings of the left hepatic vein could only be acquired in 18% of the patients by TOE, but in 47% of the patients by TAS. As blood flow may be calculated from the diameter of the vessel, velocity time integral of the Doppler curve and heart rate, TOE may provide an interesting non-invasive tool to monitor blood flow in the right and middle hepatic vein.

Influence of Hemodynamic Variations on the Pharmacokinetics of Landiolol in Patients Undergoing Cardiovascular Surgery

“…[16][17][18][19][20][21] However, 3 to 27% of patients receiving TEE evaluation of hepatic blood flow are reported to present poor quality sonographic images. 20,21,25) In this study, decreased HVBFI was observed after administration of heparin with one excluded patient (5%, 1/19). Though poor quality of sonographic images may occur, TEE is effective for management of hepatic blood flow in order to investigate drug metabolism.…”

“…19,20,[24][25][26] To visualize the hepatic veins, the tip of the probe was advanced into the antrum of the stomach and flexed anteriorly. The Doppler sonography curve was attained by pulsed wave Doppler technique (PWmode).…”

Partial anomalous pulmonary venous return: Scimitar vein

“…Methods for the two-dimensional (2D) identification and the PWD interrogation of the HVs and the characteristic waveform comprising antegrade systolic (S) and diastolic (D) waves and a retrograde (A) wave have been well described. [5] PWD interrogation of the scimitar vein demonstrates a monophasic, high-velocity waveform [Figure 2]. [6] This may be explained by the large volume of blood flowing into a compliant IVC.…”

Could transesophageal echocardiography be useful in selected cases during liver surgery resection?

“…Using TEE, Kirkeby-Garstad et al reported good liver anatomy visualization and an acceptable-quality image of the IVC and the RHV in 95 and 87 % of cases, respectively [10]. Meierhenrich et al [11], on the other hand, studied 34 patients scheduled for abdominal surgery and using multiplane TEE, they successfully identified the three main hepatic veins in all patients. Indeed, a number of studies support the proposition that TEE can provide good visualizations of both the IVC and RHV [12][13][14].…”