“…Currently, it is a rational instrument that may lead to changes in fluid administration and hemodynamic management during liver transplantation . However, the use of TEE should not be focused exclusively on the heart; a role may be also envisaged for the liver, lungs, and kidneys …”
Section: Resultsmentioning
confidence: 99%
“…Where feasible, TEU of the liver offers an opportunity to evaluate the intra‐operative patency of the surgical anastomosis through the liver window at the end of surgery . Transesophageal lung ultrasonography is also an invaluable tool by which to investigate “acute hypoxemia” in the intra‐operative setting where TEE is already in place . To our knowledge, no studies have been carried out into intra‐operative renal function with TEU.…”
Section: Resultsmentioning
confidence: 99%
“…The use of TELU in liver transplantation is justified by the fact that TEU is already in place. Furthermore, the sensitivity and specificity of this method for the detection of pleural effusion is high . The detection of atelectasis and/or lung consolidation is also possible due to the easier acoustic windows provided via the esophagus, from where a larger portion of the dorsal respiratory system can be rapidly examined.…”
“…Cavayas et al have recently introduced a systematic approach for the intra-operative study of hypoxia known as transesophageal lung ultrasound (TELU). 43,44 In TELU, the craniocaudal axis of each lung is divided into apical, middle, and basal regions; the left subclavian artery is used as a landmark to identify the apical regions; the superior pulmonary veins are used to mark the middle regions; and finally, the inferior vena cava and the right atrial junction are used to identify the basal segments. The lungs are scanned along the longitudinal axis from each of these landmarks by rotating the ultrasound plane at 0 and 90°.…”
Section: Tr Ans E Sophag E Al Lung Ultr a Sound ( Telu)mentioning
The first perioperative transesophageal echocardiography (TEE) guidelines published 21 years ago were mainly addressed to cardiac anesthesiologists. TEE has since expanded its role outside this setting and currently represents an invaluable tool to assess chamber sizes, ventricular hypertrophy, and systolic, diastolic, and valvular function in patients undergoing orthotopic liver transplantation (OLT). Right-sided microemboli, right ventricular dysfunction, and patent foramen ovale (PFO) are the most common intra-operative findings described during OLT. However, left ventricular outflow tract obstruction and left ventricular ballooning syndrome are more difficult to recognize and less frequent. Transesophageal ultrasonography (TEU) during OLT is also underused. Its applications are as follows: (1) assistance in the difficult placement of pulmonary arterial catheters; (2) help with catheterization of great vessels for external veno-venous bypass placement; (3) intra-operative evaluation of surgical liver anastomosis patency, if feasible, through the liver window; and (4) intra-operative investigation of "acute hypoxemia" due to pulmonary and cardiac issues using trans-esophageal lung ultrasound (TELU). The aims of this review are as follows: (1) to summarize the uses of TEE and TEU throughout all phases of OLT, and (2) to describe other new feasible applications.
“…Currently, it is a rational instrument that may lead to changes in fluid administration and hemodynamic management during liver transplantation . However, the use of TEE should not be focused exclusively on the heart; a role may be also envisaged for the liver, lungs, and kidneys …”
Section: Resultsmentioning
confidence: 99%
“…Where feasible, TEU of the liver offers an opportunity to evaluate the intra‐operative patency of the surgical anastomosis through the liver window at the end of surgery . Transesophageal lung ultrasonography is also an invaluable tool by which to investigate “acute hypoxemia” in the intra‐operative setting where TEE is already in place . To our knowledge, no studies have been carried out into intra‐operative renal function with TEU.…”
Section: Resultsmentioning
confidence: 99%
“…The use of TELU in liver transplantation is justified by the fact that TEU is already in place. Furthermore, the sensitivity and specificity of this method for the detection of pleural effusion is high . The detection of atelectasis and/or lung consolidation is also possible due to the easier acoustic windows provided via the esophagus, from where a larger portion of the dorsal respiratory system can be rapidly examined.…”
“…Cavayas et al have recently introduced a systematic approach for the intra-operative study of hypoxia known as transesophageal lung ultrasound (TELU). 43,44 In TELU, the craniocaudal axis of each lung is divided into apical, middle, and basal regions; the left subclavian artery is used as a landmark to identify the apical regions; the superior pulmonary veins are used to mark the middle regions; and finally, the inferior vena cava and the right atrial junction are used to identify the basal segments. The lungs are scanned along the longitudinal axis from each of these landmarks by rotating the ultrasound plane at 0 and 90°.…”
Section: Tr Ans E Sophag E Al Lung Ultr a Sound ( Telu)mentioning
The first perioperative transesophageal echocardiography (TEE) guidelines published 21 years ago were mainly addressed to cardiac anesthesiologists. TEE has since expanded its role outside this setting and currently represents an invaluable tool to assess chamber sizes, ventricular hypertrophy, and systolic, diastolic, and valvular function in patients undergoing orthotopic liver transplantation (OLT). Right-sided microemboli, right ventricular dysfunction, and patent foramen ovale (PFO) are the most common intra-operative findings described during OLT. However, left ventricular outflow tract obstruction and left ventricular ballooning syndrome are more difficult to recognize and less frequent. Transesophageal ultrasonography (TEU) during OLT is also underused. Its applications are as follows: (1) assistance in the difficult placement of pulmonary arterial catheters; (2) help with catheterization of great vessels for external veno-venous bypass placement; (3) intra-operative evaluation of surgical liver anastomosis patency, if feasible, through the liver window; and (4) intra-operative investigation of "acute hypoxemia" due to pulmonary and cardiac issues using trans-esophageal lung ultrasound (TELU). The aims of this review are as follows: (1) to summarize the uses of TEE and TEU throughout all phases of OLT, and (2) to describe other new feasible applications.
“…Inserting the probe beyond the bicaval view is helpful for assessing the IVC, the liver, and the hepatic veins. Furthermore, the literature contains many reports of TEE imaging of the pleura, the kidneys, and even the spinal cord [7–10]. Fig.…”
Intraoperative transesophageal echocardiography is a minimally invasive monitoring tool that can provide real-time visual information on ventricular function and hemodynamic volume status in patients undergoing liver transplantation. The American Association for the Study of Liver Diseases states that transesophageal echocardiography should be used in all liver transplant candidates in order to assess chamber sizes, hypertrophy, systolic and diastolic function, valvular function, and left ventricle outflow tract obstruction. However, intraoperative transesophageal echocardiography can be used to "visualize" other organs too; thanks to its proximity and access to multiple acoustic windows: liver, lung, spleen, and kidney. Although only limited scientific evidence exists promoting this comprehensive use, we describe the feasibility of TEE in the setting of liver transplantation: it is a highly valuable tool, not only as a cardiovascular monitoring, but also as a tool to evaluate lungs and pleural spaces, to assess hepatic vein blood flow and inferior vena cava anastomosis and patency, i.e., in cases of modified surgical techniques. The aim of this case series is to add our own experience of TEE as a comprehensive intraoperative monitoring tool in the field of orthotopic liver transplantation (and major liver resection) to the literature.
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