ABSTRACT
The ability to perform real-time cardiovascular imaging in the operating room using transesophageal echocardiography (TEE) has been the most important diagnostic advancement in cardiac surgery over the past 30 years. TEE was developed in the mid 1970s but did not enter widespread use until the early 1980s when flexible TEE probes with manipulatable tips became available. The early probes were only capable of imaging along a single plane (monoplane), which somewhat limited their utility. The technology behind ultrasound image acquisition has moved forward rapidly, however, to the point that modern TEE probes can image along a 180 degree axis, display multiple imaging planes simultaneously (x plane imaging) and acquire large pyramids of data that allow real-time, three-dimensional (3D) rendering of cardiac structures. As intraoperative TEE use has become commonplace, there has been a joint effort by the American Society of Echocardiography (ASE) and the Society of Cardiovascular Anesthesiologists (SCA) to standardize the perioperative TEE examination through the issuance of joint guideline statements as well as the establishment of a board certification process administered by the non-profit National Board of Echocardiography. The first set of guidelines on performing a comprehensive TEE exam was issued in 1999, and consisted of 20 standard echocardiographic views. This was expanded to 28 two-dimensional (2D) views and a focused 3D exam in the most recent 2013 update. Current recommendations state that an intraoperative TEE should be performed (barring a contraindication) in all patients undergoing open heart, thoracic aorta, or catheter-based cardiac surgery, in most patients having coronary artery bypass grafting (CABG), and in any patients having non-cardiac surgery with known or suspected cardiac pathology that may impact outcomes.
