ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN HEMODYNAMICALLY UNSTABLE PATIENTS

Objective: To evaluate the clinical impact of transesophageal echocard iography on subsequent management and outcome in hemodynamically unsta ble patients with suspected cardiovascular pathologic conditions. Desi gn: We reviewed data on patients with hemodynamic instability (hypoten sion, shock, or pulmonary edema) who underwent transesophageal echocar diography between December 1987 and May 1994. Material and Methods: A total of 127 patients (70 male and 57 female patients with a mean age of 68 years) underwent transesophageal echocardiography at our institu tion as part of the diagnostic procedures used to evaluate unstable he modynamics. Results: No clinically significant complication was encoun tered during the procedure; transesophageal echocardiographic imaging was inadequate in three patients (2%). Of the 124 patients with adequa te images, transesophageal echocardiography disclosed a severe cardiov ascular abnormality responsible for the unstable hemodynamics in 65 pa tients (52%), and 26 patients (21%) underwent urgent pericardiocentesi s or a cardiac surgical procedure, primarily based on transesophageal echocardiographic findings. Conclusion: Transesophageal echocardiograp hy can be safely performed in hemodynamically unstable patients, it pr oduces a high diagnostic yield, and it provides important information for prompt therapeutic decision making. Therefore, we recommend transe sophageal echocardiography as one of the initial diagnostic procedures in critically ill patients suspected of having an underlying cardiova scular disorder.