THE SURGEON'S USE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Transesophageal echocardiography (TEE) was first reported two decades ago, but not until recently has this important diagnostic modality been widely accepted. 16 Advances in technology have reduced transducer size and allowed for multiplanar imaging to be achieved. These advances have improved the functionality and usefulness of TEE in many areas pertinent to surgeons. Although TEE initially remained exclusively the domain of the cardiologist, the recognition of its value in other areas has expanded its use by anesthesiologists and surgeons. Transesophageal echocardiography has become an essential diagnostic modality for assessing cardiac and aortic anatomy and function in a variety of settings, including the emergency department, the operating room, and the intensive care unit. Probably the most significant advance in the use of TEE has been the intraoperative role it serves during cardiac and, to a lesser extent, noncardiac procedures. The portability, ease of use, and excellent visualization of anatomy and function have made TEE an essential tool for on-line intraoperative evaluation of the heart and aorta. Although a full description of TEE applications in cardiovascular anesthesiology is beyond the intent or scope of this article, it is important to note that many of the issues in training and credentialing that are being addressed by anesthesiologists also apply to other specialties, including surgery. The purpose of this article is to provide surgeons and nonsurgeons with a foundation of essential concepts and principles for the application of TEE in their practices. This article includes an overview of echocardiographic principles and images, advantages of TEE versus transthoracic echocardiography (TTE), comparisons of single-plane, biplane, and multiplane TEE, and how TEE can be of benefit to general, trauma, and critical care surgeons in various clinical situations.