Chapter 29: TEE in Non-Cardiac Surgery

Assessment of pericardial diseases using TEE is described, including effusion, tamponade, and constriction. Differences between constriction and restriction are highlighted. Imaging and video will depict topics.

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Figures

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Videos

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Tables

eTable 29.1 TEE views for non cardiac surgery and rescue TEE

TEE View	View- Technique	Role	Rescue & trauma TEE
	ME 4C Angle: 0-10° (See Figure 4.7)	LV and RV function, WMA MV, TV abnormalities IVS, IAS shunts Pericardial effusion	Rescue view #1 combine with CFI of MV and TV Trauma view #1
	ME MC Angle: 50-70° (See Figure 4.10)	LV function, WMA MV abnormal
	ME 2C view Angle: 80-100° (See Figure 4.11)	LV function, WMA MV abnormal LAA thrombus	Rescue view #2 combine with CFI of MV
	ME LAX Angle: 50-70° (See Figure 4.12)	LV and RV function, WMA MV, AoV abnormal LVOTO, RVOTO IVS shunt Aortic root pathology CPR quality	Rescue view #3 combine with CFI of MV and AoV Trauma view #2
	ME AoV LAX Angle: 120-140° (See Figure 4.13)	MV, AoV abnormal LVOTO IVS shunt Aortic root pathology	Rescue view #4 combine with CFI of AoV
	ME Ascending aorta SAX Angle: 0-30° (See Figure 4.15)	Asc Ao, PA and SVC pathology
	ME AoV SAX Angle: 25-45° (See Figure 4.34)	AoV abnormal IVS, IAS shunt	Rescue view #5 combine with CFI of AoV
	ME RV inflow-outflow Angle: 50-70° (See Figure 4.28)	RV function, RVOTO AoV, PV, TV abnormal IVS, IAS shunt PA pathology Pericardial effusion	Rescue view #6 combine with CFI of IAS, TV and PV
	ME Modified bicaval TV Angle: 50-70° (See Figure 4.30)	TV abnormality IAS shunt IVC SVC pathology and cannulation
	ME Bicaval Angle: 90-110° (See Figure 4.29)	TV abnormality IAS shunt VC SVC pathology and cannulation Coronary sinus canulation	Rescue view #7 combine with CFI of IAS Trauma view #3
	TG Basal SAX Angle: 0-20° (See Figure 4.17)	LV and RV function, WMA MV, TV abnormal IVS shunt Pericardial effusion
	TG Mid papillary SAX Angle: 0-20° (See Figure 4.16)	LV and RV function, WMA IVS shunt Pericardial effusion	Rescue view #8 Trauma view #4
	DTG 5C Angle: 0-20° (See Figure 4.24)	MV, AoV abnormal LVOTO IVS shunt Aortic root pathology CO calculation
	TG 2C LAX Angle: 90-110° (See Figure 4.19)	LV function, WMA MV abnormal
	Descending aorta SAX Angle: 50-70° (See Figure 4.25)	Aortic pathology and injury Left thorax pathology	Trauma view #5
	Descending aorta LAX Angle: 90-100° (See Figure 4.25)	Aortic pathology and injury Left thorax pathology	Trauma view #6
Abbreviations: 2C, two-chamber; 4C, four-chamber; 5C, five-chamber; AoV, aortic valve; Asc Ao, ascending aorta; CFI, color flow imaging; CO, cardiac output; CPR, cardiopulmonary resuscitation; DTG, deep transgastric; IAS, interatrial septum; IVS, interventricular septum; LAA, left atrial appendage; LAX, long-axis; LV, left ventricle; LVOTO, left ventricular outflow tract obstruction; MC, mitral commissural; ME, mid-esophageal; MV, mitral valve; PA, pulmonary artery; PV, pulmonic valve; RVOTO, right ventricular outflow tract obstruction; SAX, short-axis; SV, splenic vein; SVC, superior vena cava; TEE, transesophageal echocardiography; TG, transgastric; TV, tricuspid valve; WMA, wall motion abnormalities. Adapted from Reeves⁹⁴ , Fayad¹, Giron-Arango et al.⁹⁵

eTable 29.4 Relative risk of vascular air embolism in common neurosurgical procedures

Common neurosurgical procedures	Relative risk*
Sitting position craniotomy Posterior fossa/neck surgery Craniosynostosis repair Spinal fusion Cervical laminectomy Peripheral nerve procedures Anterior neck surgery Burr hole neurosurgery	High High High Medium Medium Low Low Low
*Approximate expected reported incidences: high, > 25%; medium 5 to 25%; low, < 5%. Adapted from Mirski MA, et al.71