Transesophageal Echocardiography and Cardiovascular Sources of Embolism

Abstract

Transesophageal echocardiography has become an invaluable investigation in patients with cardioembolic events because of its high sensitivity and specificity for defining detailed structure and function of the cardiovascular system. Patients who receive anesthesia and critical care may be at risk of systemic embolism from various cardiovascular sources. The main factors associated with embolism include intracardiac lesions such as thrombi, vegetations, and tumors; cardiac anomalies; and vascular disease, e.g., aortic atheroma. In this review article, the authors describe how transesophageal echocardiography may be used to identify various cardiovascular sources of embolism, provide risk stratification, influence medical therapy, and refine clinical decision making in patients receiving critical care and anesthesia. With these improvements, it is hoped that better patient outcomes may be achieved in the perioperative period.

Infiltrating Lipoma of the Right Ventricle Involving the Interventricular Septum and Tricuspid Valve

“…CDFI may be useful for evaluating the hemodynamic consequences of valvular dysfunction or obstructive changes caused by cardiac tumors. Transesophageal echocardiography (TEE), which should always be considered when the transthoracic study is suboptimal or confusing, 23 has the advantage of being able to detect small masses or unclear cardiac structure. CEUS may describe tumor vascularity.…”

Point of Care Cardiac Ultrasound Applications in the Emergency Department and Intensive Care Unit - A Review

“…Finally, TEE offers a relatively safe way to investigate an assortment of other common post-operative problems such as pleural effusions [106], diastolic dysfunction [107] localization of the source of embolic phenomenon [108], and the troubleshooting of misplaced pulmonary artery catheters [109]. …”

Echocardiographic Imaging of Intracardiac Thrombus and Evaluated its Underlying cause along Therapeutic Implications: A Review

“…In such cases, the diagnosis may be confirmed by the use of intravenous echo-contrast agent to improve the discrimination between blood and intra-cavitary masses. 3 Unless thrombi are very large and spreading to the body of the LA, they are hardly identified by means of TTE because the LA lies in the far field of the interrogating ultrasound beam.…”

“…However, LAA is best evaluated by TEE at mid-esophageal view with transducer between 0 and 150 degree along the LAA axis. 5 The ability to estimate blood flow velocity in the left atrium and atrial appendages offers a more quantifiable measure of stasis. LAA mechanical function can be evaluated with TEE utilizing PWD measurement of LAA emtying and filling velocites.…”