Key result
Routine use of intraoperative transesophageal echocardiography in major thoracic surgery is not yet advocated, though automated techniques may provide objective assessment of right ventricular function.
Why the study?
Does transesophageal echocardiography improve the detection of right ventricular dysfunction in patients with pulmonary hypertension undergoing thoracic surgery?
Does transesophageal echocardiography improve the detection of right ventricular dysfunction in patients with pulmonary hypertension undergoing thoracic surgery?
While newer echocardiographic techniques like strain and 3D imaging show promise for assessing RV dysfunction in pulmonary hypertension patients during thoracic surgery, they require further validation before routine use.
Does not support routine intraoperative TEE in major thoracic surgery; leaves open whether automated RV techniques merit prospective validation in pulmonary hypertension.
PURPOSE OF REVIEW: Pulmonary hypertension is associated with increased postoperative morbidity and mortality. Early diagnosis and echocardiographic detection of right ventricular (RV) dysfunction are paramount in perioperative management. The goal of this review is to provide an overview of the recent literature on this topic. RECENT FINDINGS: Doppler interrogation of pulmonary artery flow may provide an insight into the severity and mechanism of pulmonary hypertension. Established echocardiographic techniques of RV assessment have multiple limitations. Newer echocardiographic technologies (strain and three-dimensional imaging) are promising, but require further validation in the perioperative setting before they are adopted. SUMMARY: More pulmonary hypertension patients are presenting for noncardiac surgery, creating a challenge for the anesthesiologist. Echocardiographic detection of RV dysfunction can be difficult. Routine use of intraoperative transesophageal echocardiography in major thoracic surgery is not advocated yet, but the development of automated techniques may provide an objective assessment of RV function.
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Ashes et al. (2014) conducted a review in Pulmonary hypertension in thoracic anesthesia. Transesophageal echocardiography was evaluated. Routine use of intraoperative transesophageal echocardiography in major thoracic surgery is not yet advocated, though automated techniques may provide objective assessment of right ventricular function.
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