Additional Cross-sectional Transesophageal Echocardiography Views Improve Perioperative Right Heart Assessment

@article{Kasper2012AdditionalCT,
  title={Additional Cross-sectional Transesophageal Echocardiography Views Improve Perioperative Right Heart Assessment},
  author={Jorge Kasper and Daniel Bolliger and Karl Skarvan and Peter Theo Buser and Miodrag Filipovic and Manfred Daniel Seeberger},
  journal={Anesthesiology},
  year={2012},
  volume={117},
  pages={726–734}
}
Background:Right heart failure is an important cause of perioperative morbidity and mortality, and transesophageal echocardiography (TEE) is crucial for its diagnosis. However, only four of the 20 cross-sectional views recommended in current guidelines for intraoperative TEE focus on the right heart. This study analyzed whether incorporating additional views into the standard TEE examination improves assessment of the right heart. Methods:Sixty patients underwent standard TEE examination after… 
Update on Perioperative Right Heart Assessment Using Transesophageal Echocardiography
TLDR
Right heart failure continues to contribute to morbidity and mortality in the context of cardiothoracic surgery and the advent and widespread clinical use of innovative tools permitting more accurate echocardiographic assessment will open the door to renewed interest in novel therapeutic strategies.
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Assessment of the difference in systolic pulmonary artery pressure (sysPAP) measuring both, invasively sysPAP and estimated RVSP with TEE in 3 different views found the best agreement between the 2 methods was found in patients with severe TR and in the ME RV inflow-outflow and the modified bicaval view.
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Right ventricular displacement, velocity, and myocardial deformation measured by TEE versus TTE are different; Neither alternative transesophageal echocardiography views nor speckle tracking-based deformation is promising; TAPSE by speckled tracking is unbiased but imprecise.
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While a number of techniques are available for the assessment of the right heart intra‐operatively, echocardiography remains the prime choice being least invasive, relatively safe, readily accessible and cost‐effective.
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This issue of the Journal, Taskesen et al have attempted to in‐ vestigate the feasibility of using the upper esophageal aortic arch in pulmonary valve imaging, and suggest that adequate echocardiographic imaging should be complemented by cardiac magnetic resonance imaging or computed tomography.
Pulmonary valve assessment by three-dimensional echocardiography.
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3D echocardiography en face view allows all three leaflets to be evaluated concurrently, as well as assessments of the RV outflow tract and main pulmonary artery, which has improved quantitative assessment of PV diseases.
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