Challenges Regarding the Value of Routine Perioperative Transesophageal Echocardiography in Mitral Valve Surgery.

Autor: Iliuta L; Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.; Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania., Rac-Albu ME; Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Panaitescu E; Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Andronesi AG; Nephrology Department, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.; Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania., Moldovan H; Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.; Department of Cardiovascular Surgery, Clinical Emergency Hospital, 014461 Bucharest, Romania.; Academy of Romanian Scientist (AOSR), 050711 Bucharest, Romania., Furtunescu FL; Department of Public Health and Management, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Scafa-Udriște A; Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.; Department of Cardiology, Clinical Emergency Hospital, 014461 Bucharest, Romania., Dobra MA; Center of Uronephrology and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Dinescu CM; Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Petrescu GD; Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Rac-Albu M; Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.; Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania.
Jazyk: angličtina
Zdroj: Diagnostics (Basel, Switzerland) [Diagnostics (Basel)] 2024 May 24; Vol. 14 (11). Date of Electronic Publication: 2024 May 24.
DOI: 10.3390/diagnostics14111095
Abstrakt: Background and Objectives: Transesophageal echocardiography (TEE) is considered an indispensable tool for perioperative evaluation in mitral valve (MV) surgery. TEE is routinely performed by anesthesiologists competent in TEE; however, in certain situations, the expertise of a senior cardiologist specializing in TEE is required, which incurs additional costs. The purpose of this study is to determine the indications for specialized perioperative TEE based on its utility and the correlation between intraoperative TEE diagnoses and surgical findings, compared with routine TEE performed by an anesthesiologist.
Materials and Methods: We conducted a three-year prospective study involving 499 patients with MV disease undergoing cardiac surgery. Patients underwent intraoperative and early postoperative TEE and at least one other perioperative echocardiographic evaluation. A computer application was dedicated to calculating the utility of each type of specialized TEE indication depending on the type of MV disease and surgical intervention.
Results: The indications for performing specialized perioperative TEE identified in our study can be categorized into three groups: standard, relative, and uncertain. Standard indications for specialized intraoperative TEE included establishing the mechanism and severity of MR (mitral regurgitation), guiding MV valvuloplasty, diagnosing associated valvular lesions post MVR (mitral valve replacement), routine evaluations in triple-valve replacements, and identifying the causes of acute, intraoperative, life-threatening hemodynamic dysfunction. Early postoperative specialized TEE in the intensive care unit (ICU) is indicated for the suspicion of pericardial or pleural effusions, establishing the etiology of acute hemodynamic dysfunction, and assessing the severity of residual MR post valvuloplasty.
Conclusions: Perioperative TEE in MV surgery can generally be performed by a trained anesthesiologist for standard measurements and evaluations. In certain cases, however, a specialized TEE examination by a trained senior cardiologist is necessary, as it is indirectly associated with a decrease in postoperative complications and early postoperative mortality rates, as well as an improvement in immediate and long-term prognoses. Also, for standard indications, the correlation between surgical and TEE diagnoses was superior when specialized TEE was used.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje