INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURING LIVER-TRANSPLANTATION

Objective: To investigate the safety, value, and impact of transesopha geal echocardiography during liver transplantation. Design: Retrospect ive. Setting: University teaching hospital. Participants and Intervent ions: The medical records of 346 patients and the videotapes of 100 in traoperative transesophageal echocardiography examinations were review ed. Measurements and Main Results: Transesophageal echocardiography wa s indicated for intraoperative monitoring in 62 patients, 41 of whom h ad pertinent findings, and for diagnostic purposes in 38 patients, 14 of whom had the expected diagnosis verified. Thirty-one patients had n o intraoperative findings. Information that would not have been detect ed intraoperatively by other means included intracardiac defects, the potential for transpulmonary air passage, valvular regurgitation, the presence or absence of ventricular dysfunction, and embolization occur ring at allograft reperfusion. Unanticipated findings during the initi al transesophageal echocardiography examination as well as evaluation of intraoperative events resulted in a major impact on patient managem ent in 11% of patients. Preoperatively, 64 patients had a prothrombin time greater than 14 seconds; 56 had a platelet count less than 100,00 0/mm(3); and 23 had esophageal varices, 7 of whom had not had variceal sclerotherapy. Two patients had a complication possibly caused by tra nsesophageal echocardiography (sinus bradycardia and upper gastrointes tinal bleeding). No patient experienced documented variceal hemorrhage , esophageal or gastric perforation, and/or oropharyngeal trauma. Conc lusions: It appears that transesophageal echocardiography can be perfo rmed safely in patients undergoing liver transplantation, is efficacio us in rapidly disclosing new information and monitoring during periods of hemodynamic instability, and may have a significant impact on intr aoperative patient management during liver transplantation. Copyright (C) 1996 by W.B. Saunders Company