Document Detail

Utility of intraoperative transesophageal echocardiography for diagnosis of pulmonary embolism.
MedLine Citation:
PMID:  15281493     Owner:  NLM     Status:  MEDLINE    
Pulmonary embolism (PE) is associated with significant perioperative morbidity and mortality. Transesophageal echocardiography (TEE) may permit direct visualization of PE or secondary signs of pulmonary artery (PA) obstruction. However, its utility in diagnosing PE in the intraoperative setting has yet to be defined. Therefore, we performed intraoperative TEE examinations in 46 patients immediately before pulmonary embolectomy. TEE examinations were reviewed for signs of thromboemboli within the right, left, and main PA, and secondary signs of acute PA obstruction (right ventricular dysfunction, moderate-to-severe tricuspid regurgitation, leftward bowing of the interatrial septum). The definitive location of thromboemboli was determined from the surgical record. Echocardiographic evidence for the presence of PE was correctly demonstrated in 46% of all patients (n = 21 of 46). However, the sensitivity for direct visualization of thromboemboli at any specific location was only 26%. TEE was least sensitive for thromboemboli in the left PA (17%). TEE evidence of right ventricular dysfunction was observed in 96%, tricuspid regurgitation in 50%, and leftward interatrial septal bowing in 98% of examinations. Therefore, the use of intraoperative TEE to diagnose acute PE via direct visualization is limited. Indirect TEE evidence of PA obstruction may be helpful in supporting a diagnosis of PE.
Peter Rosenberger; Stanton K Shernan; Simon C Body; Holger K Eltzschig
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  99     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-29     Completed Date:  2004-08-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  12-6     Citation Subset:  AIM; IM    
Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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MeSH Terms
Aged, 80 and over
Echocardiography, Transesophageal*
Hypotension / complications,  physiopathology
Intraoperative Complications / ultrasonography*
Middle Aged
Pulmonary Embolism / surgery,  ultrasonography*
Pulmonary Surgical Procedures
Comment In:
Anesth Analg. 2005 Feb;100(2):601; author reply 601   [PMID:  15673913 ]
Anesth Analg. 2006 Sep;103(3):789-91   [PMID:  16931712 ]

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