ROLE OF EMERGENCY INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Transesophageal echocardiography (TEE) has a definitive role in the di agnosis and management of critically ill patients with cardiovascular disease and patients undergoing cardiac operations. The diagnostic rol e of emergency intraoperative TEE and the impact on clinical outcome h ave not been evaluated. We reviewed the indications, findings, and imp act of emergency intraoperative TEE in 66 patients over a 4-year perio d. The indications for emergency TEE were unexplained hemodynamic inst ability (36 patients), preoperative evaluation of patients having emer gency surgery (19 patients), cardiac evaluation of trauma cases (6 pat ients), and unexplained intraoperative hypoxemia (5 patients). New fin dings were disclosed in 53 (80%) patients, with an alteration of the p lanned surgical procedure in 15 (23%). Despite the therapeutic impact, 24 patients (36%) did not survive to hospital dismissal. We recommend that TEE be considered as the diagnostic tool of choice when surgical patients have unexplained hemodynamic instability, when time does not permit complete preoperative evaluation, when cardiovascular injury i s suspected in a trauma patient, and to evaluate unexplained hypoxemia .