Rescue transesophageal echocardiography (rTEE) is an unplanned TEE examination performed on an urgent or emergent basis to diagnose causes of hemodynamic instability or cardiopulmonary arrest. Intraoperative causes of hemodynamic instability diagnosed with TEE can be categorized as hypovolemic, distributive (low SVR), cardiogenic or obstructive shock.
rTEE Views Compared to Three of the Four FATE TTE Views
Hemodynamic instability with hemorrhagic or other causes of hypovolemic shock is due to to reduced intravascular volume with subsequent reduced preload and cardiac output. Up to 42% of all shock is due to hypovolemic shock, the transgastric view is the best starting view and typically demonstrates a small LV cavity during systole and close proximity of the papillary muscles in the TG MP SAX view.
A rTEE examination that starts with a transgastric midpapillary short axis view qualitatively estimates filling ANF global function. Fractional area of change (FAC) may be used to estimate ejection fraction as well as assess wall function. As well, the midesophageal four chamber offers a view of the LV AND RV. Up to 50% and 29% of patients presenting with shock had LV and RV dysfunction respectively. Other key findings with rTEE include mitral regurgitation (ME 4), aortic stenosis (ME LAX) , HOCM (ME LAX) and myocardial ischemia (12%, TG SAX).
Hemodynamic instability with obstructive shock is due to reduced cardiac output caused by an extracardiac cause of cardiac pump failure. Findings consistent with cardiac tamponade, aortic dissection and pulmonary embolus were found in up to 9 and 16% of all rTEE examinations. Aortic dissection is also a key finding but only proximal aorta and descending thoracic aorta may be seen in rTEE.
Six Essential TEE Views in Focused and rTEE
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