Changes in Surgical Conduct Due to the Results of Intraoperative Transesophageal Echocardiography

• Published in: Revista brasileira de anestesiologia 2010-03, Vol.60 (2), p.192-197
• Main Authors: Alves da Silva, Alexander, Silva, Enis Donizete, Segurado, Arthur Vitor Rosenti, Kimachi, Pedro Paulo, Simões, Claudia Marques
• Format: Article
• Language: English
• Subjects: Adult; CIRURGIA, Cardíaca: cardiopatia congênita, comunicação Interventricular; DISEASES, Congenital: cardiopathies; DOENÇAS, Congênita: cardiopatias; Echocardiography, Transesophageal; Female; Heart Defects, Congenital - diagnostic imaging; Humans; Intraoperative Care; MONITORING: transesophageal echocardiography; MONITORIZAÇÃO: ecocardiografia transesofágica; SURGERIES, Cardiac: congenital cardiopathy, interventricular communication
• ISSN: 0034-7094; 1806-907X
• DOI: 10.1016/S0034-7094(10)70025-8

Transesophageal echocardiography (TEE) is extremely useful in surgeries like valvuloplasty, of the thoracic aorta, and correction of congenital cardiopathies. The low degree of invasiveness and the capacity to aggregate information that can change the course of the surgery are among the advantages of TEE. The objective of this report was to present a case in which the surgical conduct was changed due to a new diagnosis provided by intraoperative transesophageal echocardiography, and to emphasize the importance of using the transesophageal echo in surgeries to correct congenital cardiopathies. A 28-year old female, ASA II, with a history of dyspnea progressing from medium to small efforts was referred by another department for elective surgical correction of stenosis of the pulmonary valve diagnosed by transthoracic echocardiography. Intraoperative transesophageal echocardiography showed patent foramen ovale, infundibular stenosis of the right ventricular outlet, and perimembranous subaortic interventricular communication (IVC) of 0.4 cm with left to right shunt. After beginning ECC, the above mentioned diagnoses were confirmed and the surgery included closure of the foramen ovale and IVC, and resection of the infundibular stenosis. Intraoperative intercurrences were not observed and the patient was intubated when she was transferred to the intensive care unit. Transesophageal echocardiography is extremely useful in patients undergoing surgical correction of congenital cardiopathies because, besides helping the hemodynamic management, it can provide new information capable of improving the final result of the surgery. A utilização da ecocardiografia transesofágica (ETE) é de valor indiscutível em procedimentos cirúrgicos como valvoplastias, cirurgias da aorta torácica e correções de cardiopatias congênitas. Entre as grandes vantagens da utilização da ETE destacam-se a pouca invasividade do método e a capacidade de agregar informações que podem alterar o curso da cirurgia. O objetivo deste relato foi apresentar um caso onde a condução cirúrgica da paciente foi alterada em decorrência de novos diagnósticos feitos pela ecocardiografia transesofágica no intraoperatório e ressaltar a importância da utilização do eco transesofágico em cirurgias para correção de cardiopatia congênita. Paciente do sexo feminino, 28 anos, ASA II, com história de dispneia progressiva aos médios e depois pequenos esforços, veio encaminhada de outro serviço para correção cirúrgica elet