Clinical & Experimental Cardiology
Open Access

Role of Trans-esophageal Echocardiogram in Monitoring Heart Function during Surgery

Waltair Brait^{* *}Correspondence: Waltair Brait, Department of Cardiac Surgery, University of Lille, Lille, France, Email:

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Description

Trans-Esophageal Echocardiography (TEE) has become a cornerstone in the intraoperative monitoring of heart function during various types of cardiac and non-cardiac surgeries. By providing real-time, detailed images of the heart’s structure and function, TEE plays an invaluable role in guiding surgical decisions, assessing cardiac function and ensuring optimal outcomes. This technique, which involves the insertion of an ultrasound probe into the esophagus, allows clinicians to obtain high-resolution images of the heart, especially in situations where traditional Transthoracic Echocardiography (TTE) is not feasible due to limited acoustic windows. In this article, we will explain the role of TEE in monitoring heart function during surgery, its applications, benefits and challenges.

TEE is a specialized form of echocardiography that involves placing an ultrasound probe in the esophagus, which is anatomically close to the heart. This proximity allows the probe to capture high-quality images of the heart's chambers, valves and major blood vessels. The procedure is minimally invasive and is performed under sedation or anesthesia, making it ideal for use during surgeries. TEE can provide both two-dimensional and three-dimensional images, as well as Doppler imaging to assess blood flow through the heart. These images are critical in assessing the function of the heart, detecting any abnormalities and guiding surgical interventions in real-time. TEE is extensively used in cardiac valve surgeries, such as mitral valve repair or replacement, aortic valve surgery and tricuspid valve repair. Intraoperatively, TEE allows real-time evaluation of the repair or replacement, ensuring that the valve functions properly before the heart is closed. Surgeons rely on TEE to confirm the success of procedures and to detect any potential complications such as residual regurgitation or stenosis.

In patients undergoing Coronary Artery Bypass Grafting (CABG), TEE is used to assess left ventricular function, wall motion abnormalities and valvular function. It helps in detecting ischemic regions of the heart and evaluating the success of the bypass grafts. Additionally, TEE can identify complications such as cardiac tamponade, which may arise after the surgery. TEE plays a key role in aortic surgeries, particularly in procedures involving the ascending aorta, such as aneurysm repair or dissection. TEE provides accurate information on the size and extent of aortic pathology and helps monitor blood flow through the aorta during and after the procedure. It is also essential for detecting aortic dissections and ensuring proper placement of prosthetic devices in the aorta. In congenital heart surgery, TEE is used to visualize complex congenital heart defects and assess the effectiveness of surgical corrections. Surgeons depend on TEE to guide their interventions, particularly in cases of septal defects, anomalous pulmonary venous return, or complex valve repairs. The real-time imaging provided by TEE ensures that congenital defects are repaired effectively, reducing the risk of postoperative complications.

During heart transplantation, TEE is used to assess the function of the donor heart, confirm proper anastomosis (surgical connection of blood vessels) and detect any signs of complications such as right or left ventricular dysfunction. TEE is important in ensuring that the transplanted heart is functioning optimally before the patient is taken off cardiopulmonary bypass support. TEE is not limited to cardiac surgeries; it is also used in non-cardiac surgeries where hemodynamic monitoring is critical. For example, in major vascular surgeries, liver transplants, or trauma surgeries, TEE can provide valuable information about cardiac output, volume status and ventricular function. This enables anesthesiologists and surgeons to make informed decisions about fluid management and pharmacologic support during the surgery.

Conclusion

While TEE provides excellent images of the heart, it may have limited views of certain structures, particularly the distal portions of the ascending aorta or pulmonary arteries. In such cases, other imaging modalities, such as intravascular ultrasound or computed tomography, may be needed to complement the information obtained from TEE. Its ability to provide real-time, detailed images of the heart’s structures and function makes it an invaluable tool for guiding surgical decisions, assessing the success of interventions and detecting complications early. From cardiac valve surgeries to heart transplants and non-cardiac procedures, TEE plays a essential role in ensuring optimal outcomes for patients undergoing surgery. Despite its challenges, TEE remains a gold standard in intraoperative cardiac monitoring, contributing to the safety and success of complex surgical procedures.