Intra-operative echocardiography assessment of ventricular function

Abstract

Quantification of ventricular function, and in particular contractility, is the holy grail of intraoperative haemodynamic assessment. Over the past twenty-five years echocardiography technology has improved tremendously and intra-operative transoesophageal echocardiography (TOE) has become the gold standard cardiac monitor and diagnostic tool. There is a perception that intra-operative TOE provides valuable information that significantly influences clinical management and improves patient outcome. A TOE examination may provide vital information quicker and less invasive than the pulmonary artery catheter or any other haemodynamic monitor. Systolic and diastolic function of the left and right ventricles can visually be evaluated. Many echocardiography indices have been validated to also quantify function in a more objective way. Valvular and any other cardiac pathology can be excluded during a routine TOE examination. Ventricular wall motion abnormalities have been shown to be a highly sensitive indicator of regional myocardial ischaemia. A regional wall motion abnormality appears almost instantly after the onset of ischaemia in a specific segment and is detectable by echocardiography. As with many interventions, a full understanding of the limitations and possible artefacts is required. In future newer modalities like tissue Doppler imaging, strain rate, and contrast echocardiography will play an important role in the intraoperative assessment of ventricular function. 3D TOE is another brand new and exciting introduction to our perioperative practice. Perioperative echocardiography is here to stay and will fulfil a vital role for today's anaesthetist.