Review article
Intraoperative Transesophageal Echocardiography and Anesthetic Considerations in Patients with Ventricular Assist Devices
Darko Kristović
; Department of Anesthesiology and Intensive Care, University Hospital Dubrava, Zagreb, Croatia
Abstract
A ventricular assist device (VAD) is inserted to provide mechanical circulatory support. A VAD can rest the myocardium and allow it to recover from stunning or hibernation, while maintaining vital organ perfusion (bridge-to-recovery). If myocardial recovery cannot occur, the goal is to support the patient to transplantation (bridge-to-transplantation), or, if the patient is not a transplant candidate, to enhance the quality of life for a limited period of time (destination therapy). Perioperative transesophageal echocardiography is a major component of patient management, and it is important for surgical and anesthetic decision-making. In addition to the standard examination, device-specific pre-, intra-, and postoperative considerations are essential to the echocardiographic evaluation. These include: (a) the pre-VAD insertion examination of the heart and large vessels, in order to exclude significant aortic regurgitation, tricuspid regurgitation, mitral stenosis, patent foramen ovale or other cardiac abnormality that could lead to right-to-left shunt after the left VAD placement, intracardiac thrombi, ventricular scars, pulmonic regurgitation, pulmonary hypertension, pulmonary embolism and atherosclerotic disease in the ascending aorta; and to assess the right ventricular function; and (b) the post-VAD insertion examination of the device and reassessment of the heart and large vessels. The examination of the device aims to confirm the completeness of the device and heart deairing, cannulas alignment and patency, and the competency of the device valves using two-dimensional, and color, continuous and pulsed wave Doppler modalities. The goal of the heart examination after the implantation should be to exclude the aortic regurgitation or an uncovered rightto- left shunt, and to assess the right ventricular function, the left ventricular unloading, and the effect of the device settings on the global heart function.
Keywords
transesophageal echocardiography; ventricular assist device; right-to-left shunt; cardiopulmonary bypass
Hrčak ID:
66345
URI
Publication date:
11.3.2011.
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