Skip to main content
Erschienen in: Die Anaesthesiologie 1/2022

25.11.2021 | Transösophageale Echokardiografie | CME

Intraoperative transösophageale Echokardiographie als Notfalldiagnostik bei nichtkardiochirurgischen Patienten

verfasst von: Dr. C. Dumps, DESA, V. Umrath, B. Rupprecht, J. Schimpf, J. Benak

Erschienen in: Die Anaesthesiologie | Ausgabe 1/2022

Einloggen, um Zugang zu erhalten

Zusammenfassung

Durch die Entwicklung von kompakten und mobileren Geräten ist der Einsatz der transösophagealen Echokardiographie (TEE) als Point-of-care-Diagnostikum in Notaufnahmen, auf Intensivstationen oder im OP in den Fokus gerückt. Im ersten Teil dieses Weiterbildungsartikels wurden allgemeine Aspekte der Untersuchungsmethode, der Untersuchungsablauf, Indikationen und Kontraindikationen erläutert. Einsatzbereiche außerhalb der Kardiochirurgie, in denen die TEE zum Monitoring des Patienten oder zur Assistenz des operativen Vorgehens genutzt wird, wurden behandelt. Im vorliegenden zweiten Teil werden die wesentlichen Befunde dargestellt, die mithilfe der intraoperativen TEE bei hämodynamischer Instabilität erhoben werden können. Als Hilfestellung zur strukturierten Untersuchung wird auf den verkürzten Untersuchungsgang nach Reeves et al. verwiesen. Ein Ausblick auf semiautomatische Interpretationssoftware und computergestützte Bildakquise schließt den Beitrag ab.
Literatur
1.
Zurück zum Zitat Reeves ST et al (2013) Special article: basic perioperative transesophageal echocardiography examination: a consensus statement of the American society of echocardiography and the society of cardiovascular anesthesiologists. Anesth Analg 117(3):543–558PubMed Reeves ST et al (2013) Special article: basic perioperative transesophageal echocardiography examination: a consensus statement of the American society of echocardiography and the society of cardiovascular anesthesiologists. Anesth Analg 117(3):543–558PubMed
2.
Zurück zum Zitat Hahn RT et al (2013) Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American society of echocardiography and the society of cardiovascular anesthesiologists. J Am Soc Echocardiogr 26(9):921–964PubMed Hahn RT et al (2013) Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American society of echocardiography and the society of cardiovascular anesthesiologists. J Am Soc Echocardiogr 26(9):921–964PubMed
4.
Zurück zum Zitat Fayad A, Shillcutt SK (2018) Perioperative transesophageal echocardiography for non-cardiac surgery. Can J Anaesth 65(4):381–398PubMed Fayad A, Shillcutt SK (2018) Perioperative transesophageal echocardiography for non-cardiac surgery. Can J Anaesth 65(4):381–398PubMed
5.
Zurück zum Zitat Brederlau J et al (2006) Transesophageal echocardiography for non-cardiac surgery patients: superfluous luxury or essential diagnostic tool? Anaesthesist 55(9):937–943PubMed Brederlau J et al (2006) Transesophageal echocardiography for non-cardiac surgery patients: superfluous luxury or essential diagnostic tool? Anaesthesist 55(9):937–943PubMed
6.
Zurück zum Zitat Hofer CK et al (2004) Therapeutic impact of intra-operative transoesophageal echocardiography during noncardiac surgery. Anaesthesia 59(1):3–9PubMed Hofer CK et al (2004) Therapeutic impact of intra-operative transoesophageal echocardiography during noncardiac surgery. Anaesthesia 59(1):3–9PubMed
7.
Zurück zum Zitat Nagueh SF et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22(2):107–133PubMed Nagueh SF et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22(2):107–133PubMed
8.
Zurück zum Zitat Lang RM et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 28(1):1–39.e14PubMed Lang RM et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 28(1):1–39.e14PubMed
9.
Zurück zum Zitat Gudmundsson P et al (2005) Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol 101(2):209–212PubMed Gudmundsson P et al (2005) Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol 101(2):209–212PubMed
10.
Zurück zum Zitat Shahgaldi K et al (2009) Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography. Cardiovasc Ultrasound 7:41PubMedPubMedCentral Shahgaldi K et al (2009) Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography. Cardiovasc Ultrasound 7:41PubMedPubMedCentral
11.
Zurück zum Zitat Grossgasteiger M et al (2013) Assessment of left ventricular size and function during cardiac surgery. An intraoperative evaluation of six two-dimensional echocardiographic methods with real time three-dimensional echocardiography as a reference. Echocardiography 30(6):672–681PubMed Grossgasteiger M et al (2013) Assessment of left ventricular size and function during cardiac surgery. An intraoperative evaluation of six two-dimensional echocardiographic methods with real time three-dimensional echocardiography as a reference. Echocardiography 30(6):672–681PubMed
12.
Zurück zum Zitat Cowie B, Kluger R, Kalpokas M (2013) Left ventricular volume and ejection fraction assessment with transoesophageal echocardiography: 2D vs 3D imaging. Br J Anaesth 110(2):201–206PubMed Cowie B, Kluger R, Kalpokas M (2013) Left ventricular volume and ejection fraction assessment with transoesophageal echocardiography: 2D vs 3D imaging. Br J Anaesth 110(2):201–206PubMed
13.
Zurück zum Zitat Leung JM, Levine EH (1994) Left ventricular end-systolic cavity obliteration as an estimate of intraoperative hypovolemia. Anesthesiology 81(5):1102–1109PubMed Leung JM, Levine EH (1994) Left ventricular end-systolic cavity obliteration as an estimate of intraoperative hypovolemia. Anesthesiology 81(5):1102–1109PubMed
14.
Zurück zum Zitat Porter TR et al (2015) Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American society of echocardiography. J Am Soc Echocardiogr 28(1):40–56PubMed Porter TR et al (2015) Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American society of echocardiography. J Am Soc Echocardiogr 28(1):40–56PubMed
15.
Zurück zum Zitat Vignon P et al (2017) Comparison of echocardiographic indices used to predict fluid responsiveness in ventilated patients. Am J Respir Crit Care Med 195(8):1022–1032PubMed Vignon P et al (2017) Comparison of echocardiographic indices used to predict fluid responsiveness in ventilated patients. Am J Respir Crit Care Med 195(8):1022–1032PubMed
16.
Zurück zum Zitat Cerqueira MD et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American heart association. Circulation 105(4):539–542PubMed Cerqueira MD et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American heart association. Circulation 105(4):539–542PubMed
17.
Zurück zum Zitat Sanfilippo F et al (2017) Mitral regurgitation grading in the operating room: a systematic review and meta-analysis comparing preoperative and intraoperative assessments during cardiac surgery. J Cardiothorac Vasc Anesth 31(5):1681–1691PubMed Sanfilippo F et al (2017) Mitral regurgitation grading in the operating room: a systematic review and meta-analysis comparing preoperative and intraoperative assessments during cardiac surgery. J Cardiothorac Vasc Anesth 31(5):1681–1691PubMed
18.
Zurück zum Zitat Vegas A (2018) Perioperative two-dimensional transesophageal echocardiography: a practical handbook. Springer, Vegas A (2018) Perioperative two-dimensional transesophageal echocardiography: a practical handbook. Springer,
19.
Zurück zum Zitat De Backer O et al (2011) Tako-tsubo cardiomyopathy with left ventricular outflow tract (LVOT) obstruction: case report and review of the literature. Acta Clin Belg 66(4):298–301PubMed De Backer O et al (2011) Tako-tsubo cardiomyopathy with left ventricular outflow tract (LVOT) obstruction: case report and review of the literature. Acta Clin Belg 66(4):298–301PubMed
20.
Zurück zum Zitat Butz T et al (2008) Significant obstruction of the right and left ventricular outflow tract in a patient with biventricular hypertrophic cardiomyopathy. Eur J Echocardiogr 9(2):344–345PubMed Butz T et al (2008) Significant obstruction of the right and left ventricular outflow tract in a patient with biventricular hypertrophic cardiomyopathy. Eur J Echocardiogr 9(2):344–345PubMed
21.
Zurück zum Zitat Rochon AG, L’Allier PL, Denault AY (2009) Always consider left ventricular outflow tract obstruction in hemodynamically unstable patients. Can J Anaesth 56(12):962–968PubMed Rochon AG, L’Allier PL, Denault AY (2009) Always consider left ventricular outflow tract obstruction in hemodynamically unstable patients. Can J Anaesth 56(12):962–968PubMed
22.
Zurück zum Zitat McConnell MV et al (1996) Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol 78(4):469–473PubMed McConnell MV et al (1996) Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol 78(4):469–473PubMed
23.
Zurück zum Zitat Tuzovic M et al (2016) Regional right ventricular dysfunction in acute pulmonary embolism: relationship with clot burden and biomarker profile. Int J Cardiovasc Imaging 32(3):389–398PubMed Tuzovic M et al (2016) Regional right ventricular dysfunction in acute pulmonary embolism: relationship with clot burden and biomarker profile. Int J Cardiovasc Imaging 32(3):389–398PubMed
24.
Zurück zum Zitat Rudski LG et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American society of echocardiography endorsed by the European association of Echocardiography, a registered branch of the European society of cardiology, and the Canadian society of echocardiography. J Am Soc Echocardiogr 23(7):685–713 (quiz 786–8)PubMed Rudski LG et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American society of echocardiography endorsed by the European association of Echocardiography, a registered branch of the European society of cardiology, and the Canadian society of echocardiography. J Am Soc Echocardiogr 23(7):685–713 (quiz 786–8)PubMed
25.
Zurück zum Zitat MacGowan SW et al (1993) Atrial myxoma: national incidence, diagnosis and surgical management. Ir J Med Sci 162(6):223–226PubMed MacGowan SW et al (1993) Atrial myxoma: national incidence, diagnosis and surgical management. Ir J Med Sci 162(6):223–226PubMed
26.
Zurück zum Zitat Yazigi G et al (2019) Left atrial myxoma associated with malignant anomalous course of right coronary artery: a rare concurrent incidence of two rare diseases. Cureus 11(4):e4561PubMedPubMedCentral Yazigi G et al (2019) Left atrial myxoma associated with malignant anomalous course of right coronary artery: a rare concurrent incidence of two rare diseases. Cureus 11(4):e4561PubMedPubMedCentral
27.
Zurück zum Zitat Sveinsson O, Herrman L, Ivert T (2013) Cardiac myxomas may debut as TIA or stroke. Echocardiography provides tumor diagnosis. Lakartidningen 110(27–28):1285–1287PubMed Sveinsson O, Herrman L, Ivert T (2013) Cardiac myxomas may debut as TIA or stroke. Echocardiography provides tumor diagnosis. Lakartidningen 110(27–28):1285–1287PubMed
28.
Zurück zum Zitat Ghaleb S, Roosevelt B, Cnota J (2018) Ping-pong ball, tumor or thrombus in the right atrium? A case report. World J Pediatr Congenit Heart Surg 9(3):350–351PubMed Ghaleb S, Roosevelt B, Cnota J (2018) Ping-pong ball, tumor or thrombus in the right atrium? A case report. World J Pediatr Congenit Heart Surg 9(3):350–351PubMed
29.
Zurück zum Zitat Lotto AA, Earl UM, Owens WA (2006) Right atrial mass: thrombus, myxoma, or cardiac papillary fibroelastoma? J Thorac Cardiovasc Surg 132(1):159–160PubMed Lotto AA, Earl UM, Owens WA (2006) Right atrial mass: thrombus, myxoma, or cardiac papillary fibroelastoma? J Thorac Cardiovasc Surg 132(1):159–160PubMed
30.
Zurück zum Zitat Mahdhaoui A et al (2004) The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis. Echocardiography 21(4):333–336PubMed Mahdhaoui A et al (2004) The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis. Echocardiography 21(4):333–336PubMed
31.
Zurück zum Zitat Erbel R et al (2014) 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC). Eur Heart J 35(41):2873–2926PubMed Erbel R et al (2014) 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC). Eur Heart J 35(41):2873–2926PubMed
32.
Zurück zum Zitat Evangelista A et al (2010) Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 11(8):645–658PubMed Evangelista A et al (2010) Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 11(8):645–658PubMed
33.
Zurück zum Zitat Ristic AD et al (2014) Triage strategy for urgent management of cardiac tamponade: a position statement of the European society of cardiology working group on myocardial and pericardial diseases. Eur Heart J 35(34):2279–2284PubMed Ristic AD et al (2014) Triage strategy for urgent management of cardiac tamponade: a position statement of the European society of cardiology working group on myocardial and pericardial diseases. Eur Heart J 35(34):2279–2284PubMed
34.
35.
Zurück zum Zitat Fisher DC et al (1995) The incidence of patent foramen ovale in 1,000 consecutive patients. A contrast transesophageal echocardiography study. Chest 107(6):1504–1509PubMed Fisher DC et al (1995) The incidence of patent foramen ovale in 1,000 consecutive patients. A contrast transesophageal echocardiography study. Chest 107(6):1504–1509PubMed
36.
Zurück zum Zitat Hagen PT, Scholz DG, Edwards WD (1984) Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 59(1):17–20PubMed Hagen PT, Scholz DG, Edwards WD (1984) Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 59(1):17–20PubMed
37.
Zurück zum Zitat Handke M et al (2007) Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med 357(22):2262–2268PubMed Handke M et al (2007) Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med 357(22):2262–2268PubMed
38.
Zurück zum Zitat Jaffe RA et al (1992) Aspects of mechanical ventilation affecting interatrial shunt flow during general anesthesia. Anesth Analg 75(4):484–488PubMed Jaffe RA et al (1992) Aspects of mechanical ventilation affecting interatrial shunt flow during general anesthesia. Anesth Analg 75(4):484–488PubMed
39.
Zurück zum Zitat Sukernik MR, Mets B, Bennett-Guerrero E (2001) Patent foramen ovale and its significance in the perioperative period. Anesth Analg 93(5):1137–1146PubMed Sukernik MR, Mets B, Bennett-Guerrero E (2001) Patent foramen ovale and its significance in the perioperative period. Anesth Analg 93(5):1137–1146PubMed
40.
Zurück zum Zitat Belkin RN et al (1994) Comparison of transesophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale. Am Heart J 128(3):520–525PubMed Belkin RN et al (1994) Comparison of transesophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale. Am Heart J 128(3):520–525PubMed
41.
Zurück zum Zitat Mojadidi MK et al (2014) Diagnostic accuracy of transesophageal echocardiogram for the detection of patent foramen ovale: a meta-analysis. Echocardiography 31(6):752–758PubMed Mojadidi MK et al (2014) Diagnostic accuracy of transesophageal echocardiogram for the detection of patent foramen ovale: a meta-analysis. Echocardiography 31(6):752–758PubMed
42.
Zurück zum Zitat Schneider B et al (1996) Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy findings. Am J Cardiol 77(14):1202–1209PubMed Schneider B et al (1996) Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy findings. Am J Cardiol 77(14):1202–1209PubMed
43.
Zurück zum Zitat Hoole SP, Falter F (2007) Evaluation of hypoxemic patients with transesophageal echocardiography. Crit Care Med 35(8):S408–13PubMed Hoole SP, Falter F (2007) Evaluation of hypoxemic patients with transesophageal echocardiography. Crit Care Med 35(8):S408–13PubMed
45.
Zurück zum Zitat Benson MJ et al (2020) Strain imaging: an everyday tool for the perioperative echocardiographer. J Cardiothorac Vasc Anesth 34(10):2707–2717PubMed Benson MJ et al (2020) Strain imaging: an everyday tool for the perioperative echocardiographer. J Cardiothorac Vasc Anesth 34(10):2707–2717PubMed
46.
Zurück zum Zitat Kalam K, Otahal P, Marwick TH (2014) Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 100(21):1673–1680PubMed Kalam K, Otahal P, Marwick TH (2014) Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 100(21):1673–1680PubMed
47.
Zurück zum Zitat Voigt JU et al (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 16(1):1–11PubMed Voigt JU et al (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 16(1):1–11PubMed
48.
Zurück zum Zitat Farsalinos KE et al (2015) Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE inter-vendor comparison study. J Am Soc Echocardiogr 28(10):1171–1181.e2PubMed Farsalinos KE et al (2015) Head-to-head comparison of global longitudinal strain measurements among nine different vendors: the EACVI/ASE inter-vendor comparison study. J Am Soc Echocardiogr 28(10):1171–1181.e2PubMed
49.
Zurück zum Zitat Negishi T et al (2017) Effect of experience and training on the concordance and precision of strain measurements. JACC Cardiovasc Imaging 10(5):518–522PubMed Negishi T et al (2017) Effect of experience and training on the concordance and precision of strain measurements. JACC Cardiovasc Imaging 10(5):518–522PubMed
50.
Zurück zum Zitat Abuelkasem E et al (2019) Perioperative clinical utility of myocardial deformation imaging: a narrative review. Br J Anaesth 123(4):408–420PubMed Abuelkasem E et al (2019) Perioperative clinical utility of myocardial deformation imaging: a narrative review. Br J Anaesth 123(4):408–420PubMed
51.
Zurück zum Zitat Labus J et al (2021) Perioperative course of three-dimensional-derived right ventricular strain in coronary artery bypass surgery: a prospective, observational, pilot trial. J Cardiothorac Vasc Anesth 35(6):1628–1637PubMed Labus J et al (2021) Perioperative course of three-dimensional-derived right ventricular strain in coronary artery bypass surgery: a prospective, observational, pilot trial. J Cardiothorac Vasc Anesth 35(6):1628–1637PubMed
Metadaten
Titel
Intraoperative transösophageale Echokardiographie als Notfalldiagnostik bei nichtkardiochirurgischen Patienten
verfasst von
Dr. C. Dumps, DESA
V. Umrath
B. Rupprecht
J. Schimpf
J. Benak
Publikationsdatum
25.11.2021
Verlag
Springer Medizin
Erschienen in
Die Anaesthesiologie / Ausgabe 1/2022
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-021-01034-2

Weitere Artikel der Ausgabe 1/2022

Die Anaesthesiologie 1/2022 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.