Transesophageal ECHO in anesthesia lecture usama Elsayed

TEE IN TEE IN ANESTHESIAANESTHESIA(Introduction)(Introduction)

BYBY

USAMA ELSAYEDUSAMA ELSAYEDLECTURER OF ANESTHESIA AND INTENSIVE LECTURER OF ANESTHESIA AND INTENSIVE

CARECARE

OBJECTIVESOBJECTIVES

EquipementsEquipementsIndicationsIndicationsContraindicationsContraindicationsViewsViewscomplicationscomplications

EQUIPEMENTEQUIPEMENT

Ultrasound transducerUltrasound transducer Flexible endoscopeFlexible endoscope Piezoelectric crystals Piezoelectric crystals Two-dimensional (2D) video image Two-dimensional (2D) video image Anteflexion, retroflexionAnteflexion, retroflexion

EQUIPEMENTS cont.EQUIPEMENTS cont.

MonoplaneMonoplane

BiplaneBiplane

MultiplaneMultiplane

Probe insertionProbe insertion

Blindly with jaw thrustBlindly with jaw thrust

Laryngoscopic visualisationLaryngoscopic visualisation

Assisstant supportAssisstant support

Bite guardBite guard

IndicationsIndications

Cardiac surgeriesCardiac surgeries

Noncardiac surgeriesNoncardiac surgeries

ContraindicationsContraindications

Esophageal pathologyEsophageal pathology

Gastric pathologyGastric pathology

InexperienceInexperience

ComplicationsComplications

Esophageal injury…….perforationEsophageal injury…….perforation

Upper GIT hemorrhageUpper GIT hemorrhage

Dental injuryDental injury

Endotracheal Endotracheal

ProbeProbe

FailureFailure

TEE viewsTEE views

ME 4 Chamber ViewME 4 Chamber ViewAdvance probe to mid esophageal Advance probe to mid esophageal

position(35 cm) (0 angle)position(35 cm) (0 angle) Left atriumLeft atriumLeft ventricleLeft ventricleRight atriumRight atriumRight ventricleRight ventricleMitral valveMitral valveTricuspid valveTricuspid valve

Mid esophageal 4 chambres Mid esophageal 4 chambres viewview

Mid esophageal 4 chambres Mid esophageal 4 chambres viewview

Chamber sizeChamber size Ventricular functionVentricular function Mitral Valve diseaseMitral Valve disease Tricuspid Valve diseaseTricuspid Valve disease Atrial Septal Defect Atrial Septal Defect Pericardial EffusionPericardial Effusion

ME 2 Chamber ViewME 2 Chamber View

Advance probe to mid esophageal position(35 Advance probe to mid esophageal position(35 cm) (80-100 angle)cm) (80-100 angle)

Left Atrium (LA)Left Atrium (LA) Left Atrial Appendage (LAA)Left Atrial Appendage (LAA) Mitral Valve: Posterior (PMVL) + Anterior Mitral Valve: Posterior (PMVL) + Anterior

(AMVL) (AMVL) Left Ventricle (LV) Left Ventricle (LV) Coronary Sinus (CS)Coronary Sinus (CS) ““Coumadin ridge”(CR) tissue that separates Coumadin ridge”(CR) tissue that separates

the LAA and LUPV the LAA and LUPV

ME 2 Chamber ViewME 2 Chamber View

LAA mass/thrombusLAA mass/thrombus

LV size and functionLV size and function

MV diseaseMV disease

MV annulus measureMV annulus measure

ME LAX ViewME LAX View

ME 4 chambres + 120- 130 angleME 4 chambres + 120- 130 angle Left ventricle (LV)Left ventricle (LV) Left ventricular outflow tract (LVOT)Left ventricular outflow tract (LVOT) Aortic Valve (AV)Aortic Valve (AV) Mitral Valve: Anterior(AMVL) + Mitral Valve: Anterior(AMVL) +

Posterior(PMVL) LeafletsPosterior(PMVL) Leaflets

ME LAX ViewME LAX View

LV functionLV function

MV diseaseMV disease

AV and Aortic Root diseaseAV and Aortic Root disease

Interventricular Septum pathologyInterventricular Septum pathology

ME LAX ViewME LAX View

ME Aortic Valve SAX View ME Aortic Valve SAX View

Probe ME + 45 angleProbe ME + 45 angle Aortic Valve: (RCC), (LCC) and (NCC) Aortic Valve: (RCC), (LCC) and (NCC)

Inter-atrial Septum (IAS)Inter-atrial Septum (IAS)

Left Atrium (LA)Left Atrium (LA)

Right Atrium (RA)Right Atrium (RA)

ME Aortic Valve SAX ViewME Aortic Valve SAX View

Aortic Valve diseaseAortic Valve disease

Atrial septal defect (ASD) Atrial septal defect (ASD) (secundum)(secundum)

LA size LA size

ME Aortic Valve SAX ViewME Aortic Valve SAX View

ME Bicaval ViewME Bicaval View

ME, ME, angle 90-100°, turn entire probe rightangle 90-100°, turn entire probe right RA, RAARA, RAA Eustachian valve (EV) (at the border of the Eustachian valve (EV) (at the border of the

IVC / RA)IVC / RA) Crista Terminalis (CT)(at the border of the Crista Terminalis (CT)(at the border of the

SVC / RA)SVC / RA) SVCSVC IASIAS LALA IVCIVC

ME Bicaval ViewME Bicaval View

ASD (secundum, sinus venosus)ASD (secundum, sinus venosus)

Atrial pathologyAtrial pathology

Lines/wiresLines/wires

Venous Cannula (SVC, IVC)Venous Cannula (SVC, IVC)

ME Bicaval ViewME Bicaval View

TG midpapillary viewTG midpapillary view

Insert the probe to the stomach, sector depth 12cm, Insert the probe to the stomach, sector depth 12cm, angle 0° , Anteflex to contact stomach wallangle 0° , Anteflex to contact stomach wall

LV Cavity LV Cavity

LV WallsLV Walls

Papillary Muscles: (ALPM), (PMPM) Papillary Muscles: (ALPM), (PMPM)

Right Ventricle Right Ventricle

TG midpapillary viewTG midpapillary view

Left Ventricle: size, functionLeft Ventricle: size, function

Interventricular Septal motion, thicknessInterventricular Septal motion, thickness

Ventricular Septal Defect (VSD)Ventricular Septal Defect (VSD)

HypovolemiaHypovolemia

TG midpapillary viewTG midpapillary view

ConclusionConclusion

Introduction to use of TEE IN Introduction to use of TEE IN anesthesiaanesthesia

as regard equipements, indications, as regard equipements, indications, contraindications, complications and contraindications, complications and some important viewssome important views