Role of Intraoperative Transesophageal Echocardiography for Diagnosing and Managing Pulmonary Embolism in the Perioperative Period

Rosenberger, Peter; Sk, Shernan; Weissmüller, Thomas; Hk, Eltzschig

doi:10.1213/01.ane.0000141274.42848.40

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…7 The outcomes resulting from acute massive PE are poor, and prompt diagnosis and intervention are crucial for a successful outcome. 2,3 TEE is a useful tool to diagnose acute PE, but it is frequently unable to visualize emboli in the PA. 10 In this present case, TEE aided in the immediate diagnosis of acute massive PE by detecting large saddle emboli and severely dilated dysfunctional RV.…”

Section: Discussionmentioning

confidence: 63%

Acute Pulmonary Embolism Caused by Abdominal Pannus Retraction in an Awake Patient in the Operating Room: A Case Report

Rier¹,

Subramani²,

Ravindranath³

et al. 2022

A&A Practice

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We present a 67-year-old woman who was hemodynamically stable with radiographic evidence of saddle pulmonary embolism (PE) in the main pulmonary artery and mobile thrombus in the right heart. Endovascular thrombectomy was scheduled under general anesthesia. Before anesthesia induction, femoral vessel access was planned under local anesthesia in case emergent cardiopulmonary bypass (CPB) was needed. Immediately after abdominal pannus retraction was applied for better groin access, the patient developed cardiac arrest, and advanced cardiovascular life support (ACLS) protocol was initiated. Transesophageal echocardiography (TEE) confirmed acute massive PE. CPB was emergently established. Surgical embolectomy was conducted with successful outcome.

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Section: Discussionmentioning

confidence: 63%

Acute Pulmonary Embolism Caused by Abdominal Pannus Retraction in an Awake Patient in the Operating Room: A Case Report

Rier¹,

Subramani²,

Ravindranath³

et al. 2022

A&A Practice

View full text Add to dashboard Cite

show abstract

“…However, more distal thromboembolic burden is difficult to visualize via echocardiography, as evidenced by an intraoperative case series wherein PE was directly visualized in only 26% of cases [ 10 ]. However, TEE can often reveal extrapulmonary venous or intracardiac emboli, which can easily influence surgical planning [ 11 , 12 ]. As such, direct visualization of thrombus is specific but not sensitive.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Thrombolytic Management of Massive Intraoperative Pulmonary Embolism Guided by Point of Care Transthoracic Echocardiography

Dudaryk

Lopez

Louro

2018

Case Reports in Anesthesiology

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Perioperative pulmonary embolism can go undetected until the sudden onset of cardiopulmonary collapse. Point of care echocardiography in such setting can narrow the differential diagnosis of precipitous instability and facilitate tailored, rather than empiric, therapy in the event of a massive pulmonary embolism. We describe the diagnosis and successful multidisciplinary management of intraoperative massive pulmonary embolism aided by both transthoracic and transesophageal echocardiography. Key aspects regarding the classification and treatment of pulmonary embolism are subsequently reviewed.

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“…ECG changes can include sinus tachycardia, atrial dysrhythmia, RV strain, right bundle branch block, and SI Q3 T3 pattern (rare) [ 13 ]. Transesophageal echocardiography is an excellent tool to diagnose intraoperative pulmonary embolism [ 14 – 16 ]. While direct visualization of thrombus in the pulmonary artery is only sometimes possible (46% of patients in a study by Rosenberger et al [ 15 ]), the echocardiographer can search for evidence of right heart strain such as RV dilation or RV systolic dysfunction [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Complex Perioperative Decision-Making: Liver Resection in a Patient with Extensive Superior Vena Cava/Right Atrial Thrombus and Superior Vena Cava Syndrome

Kloesel

Lekowski

2016

Case Reports in Anesthesiology

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The perioperative management of patients suffering from extensive superior vena cava (SVC) thrombus complicated by SVC syndrome presents unique challenges. The anesthesiologist needs to be prepared for possible thrombus dislodgement resulting in pulmonary embolism and also has to assess the need for fluid resuscitation given the dangers of massive intravenous fluid application via the upper extremities. We present our perioperative approach in management of a patient scheduled for right hepatectomy who was previously diagnosed with extensive SVC and right atrial (RA) thrombus complicated by SVC syndrome.

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Role of Intraoperative Transesophageal Echocardiography for Diagnosing and Managing Pulmonary Embolism in the Perioperative Period

Cited by 6 publications

References 5 publications

Acute Pulmonary Embolism Caused by Abdominal Pannus Retraction in an Awake Patient in the Operating Room: A Case Report

Acute Pulmonary Embolism Caused by Abdominal Pannus Retraction in an Awake Patient in the Operating Room: A Case Report

Diagnosis and Thrombolytic Management of Massive Intraoperative Pulmonary Embolism Guided by Point of Care Transthoracic Echocardiography

Complex Perioperative Decision-Making: Liver Resection in a Patient with Extensive Superior Vena Cava/Right Atrial Thrombus and Superior Vena Cava Syndrome

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