[Usefulness of transesophageal echocardiography during myocardial revascularization surgery without extracorporeal circulation]. / Utilidad de la ecocardiografía transesofágica intraoperatoria durante revascularización miocárdica sin circulación extracorpórea.

OBJECTIVE: Intraoperative transesophageal echocardiography can be a highly useful monitoring technique during myocardial revascularization surgery when extracorporeal circulation (ECC) is not being used. Transesophageal echocardiography provides real-time images on both volume status and segmental myocardial contractility without interfering with the surgical field. PATIENTS AND METHODS: A total of 25 patients undergoing myocardial revascularization by sternotomy without ECC were monitored by transesophageal echocardiography during surgery. RESULTS: The 18 men and 7 women studied had a mean (SD) age of 71.3 (8) years. A third of them had hypertension and diabetes, 3 had suffered a cerebrovascular accident, and 2 had renal failure. Nine patients had a history of acute myocardial infarction and 3 had undergone angioplasty. Baseline echocardiograms on all patients established that 6 had a low ejection fraction (<30%). Twelve had altered segmental contractility, which was transient in 11 cases. Six patients had improved ejection fraction at the final assessment. Transesophageal electrocardiography also monitored volume status and the effects of inotropic drugs and beta-blockers in 83% of the patients. CONCLUSION: Transesophageal electrocardiography is a minimally invasive, safe, and precise way to directly monitor the beating heart in real time during myocardial revascularization without ECC. Image quality is good.

[Intracoronary air embolism detected during intraoperative transesophageal echocardiography]. / Detección de embolia aérea intracoronaria con ecocardiografía transesofágica intraoperatoria.

A 39-year-old hypertensive man with severe aortic stenosis underwent aortic valve replacement monitored by intraoperative transesophageal echocardiography. Upon weaning the patient off extracorporeal circulation, hemodynamics became severely compromised, with hypotension, tachycardia, and elevated precordial electrocardiographic tracings. The echocardiographic images were instrumental during the episode to demonstrate that the anterior wall presented hypokinesis consistent with ischemia in the region but that there were also images of hyperrefringence highly suggestive of intracoronary air embolism. Intraoperative transesophageal echocardiography allowed us to diagnose the real cause of the ischemic event and rule out an atheromatous plaque as the source. Perfusion pressure was increased to treat the air embolism. The echocardiographic image demonstrated success, specifically restoration of left ventricular regional contractility. This experience revealed the usefulness of transesophageal echocardiography in intraoperative monitoring to diagnose ischemia, assess the cause, and guide treatment.

[Transesophageal echocardiography: experience with the first 500 consecutive cases]. / Ecocardiografía transesofágica: experiencia en los primeros 500 casos consecutivos.

The results of all the transesophageal echocardiographies (TEE) performed between June 1989 and February 1992 are analyzed. Five hundred patients (240 male) with a median age of 57 years (range 13-88) were examined; during the same period, 5180 transthoracic echocardiographies were performed. TEE were requested for the following reasons: valvular prosthesis disfunction in 132 patients, rheumatic valvulopathy in 103, search for embolic origins in 97, study of congenital cardiopathies in 48, bacterial endocarditis in 35, aortic dissection in 25 and miscellaneous in 78. Among congenital cardiopathies there were 29 cases of interauricular communication and among miscellaneous cases, 9 patients with cardiac tumors. No major complications occurred. The imaging quality of this technique renders it specially important in the study of prosthesis disfunction, mitral valve analysis before valvuloplasty, detection of cardiac origins of emboli and infective endocarditis complications and anatomical and dynamic analysis of aortic dissection. It is concluded that TEE is a safe technique that provides high quality images and visualizes segments of the heart and great vessels formerly inaccessible with transthoracic echocardiography. It has enlarged the diagnostic capacity of echocardiography and improved the support of therapeutic decisions.