Abstract

TIBALDI, Miguel; LEMA, Luis; COLL, Marcelo  and  BOCCARDO, Daniel. Utilidad del ecocardiograma transesofágico en el intra y post operatorio de cirugía cardíaca. Rev. costarric. cardiol [online]. 2001, vol.3, n.1, pp.5-20. ISSN 1409-4142.

Objetives: To analize how useful is the TEE to assist the surgeon and recover-room cardiologist in decision making. M. and M.: 147 patients who required TEE were analysed. 110 p (75%) were male, with a mean ages of 63 (21-88). The surgical procedures were: coronary artery by pass 70p, valvular replacement (VR) 26p, valvular plastic repair (vpl) 24p, combined procedures 5p, aortic disection 8p, cardiac transplant 5p, closure of ventricular septal defect 2p, aneurysmectomy 2p, myxoma resection 2p, myectomy 1p, thromboendarterectomy 1p and bicavo pulmonary anastomosis 1p. The patients were divided into 2 groups: Group A: intraoperative TEE 1-4p (70.7%) and Group B: postoperative TEE 43p (29.3%). The indications were: Group A p unable to wind them off from extracorporeal circulation (ECC) (A1) 49p, and p who needed procedure control (A2) 55p. Group B: p with low cardiac output syndrome (B1) 25p, 12 of whom presented signs of tamponade and 18p with perioperative ischemia (B2). The chi square test has used to compare categorical variables. Results: Group A1 regional or global wall motion abnormalities (WMA) were detected in 41p, prosthetic dysfuntion in 4p, mitral insuffiency in 1 p and mid ventricular obstruction in 3p.  Group A2: 5 valvular replacement were indicated post vpl, 4 replacement were non programmed and the other procedures were correctly controlled.  Group B1: out of 12p with signs of tamponade, the TEE confirmed 6 (50%) and detected 3 in p with low cardiac output.  Group B2: WMA were seen in 15p, who required re-operation and more complete revascularization.  The TEE was considered useful if the findings produced a change in attitude, wich was the case in 67% of the cases. The mortality was less than 10% (10p out of 98p) in the group were there was a change in attitude due to findings of the TEE, while 11p out of 39p died in the group where there was no change due to the TEE findings. (p=0.04).  Conc: the intra and post operative TEE is a valuable tool in surgical and post operation decision making, improving the prognosis in this high risk population.

Keywords : Transesophageal Echocardiogram; Cardiac Surgery; Intraoperative Echocardiogram.