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Anesth Analg 2005;100:601
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000144083.84034.46

LETTER TO THE EDITOR

Visualization of Pulmonary Thromboemboli Using Epicardial Ultrasound

Aaron A. Tebbs, MD, and Paul F. Lennon, MD

Department of Anesthesia and Pain Management, Maine Medical Center, Portland, ME, plennon{at}maine.rr.com

To the Editor:

A recent study by Rosenberger et al. (1) reported a relatively low sensitivity (26%) for direct visualization of pulmonary thromboemboli using intraoperative transesophageal echocardiograpy (TEE). The authors conclude that "TEE is not reliable for directly visualizing pulmonary emboli in the intraoperative setting of pulmonary embolectomy." In such cases, we suggest an additional, complimentary technique: examination of the proximal pulmonary vasculature with an epicardial echocardiographic probe placed directly on the proximal pulmonary arterial system. Such use of an epicardial echocardiographic probe may permit visualization of pulmonary thromboemboli that are not visualized by TEE and may be used to guide surgery (2). It is important that anesthesiologists providing intraoperative care for cardiac surgical patients be cognizant that intraoperative epicardial and epiaortic echocardiographic examination yield information in addition to that obtained by TEE and can be accomplished in a reasonably timely fashion (3).

References

  1. Rosenberger P, Shernan SK, Body SC, Eltzschig HK. Utility of intraoperative transesophageal echocardiography for diagnosis of pulmonary embolism. Anesth Analg 2004;99:12–6.[Abstract/Free Full Text]
  2. Zlotnick AY, Lennon, PF, Goldhaber SZ, Aranki SF. Intraoperative Detection of pulmonary thromboemboli with epicardial echocardiography. Chest 1999;115:1749–51.[Abstract/Free Full Text]
  3. Eltzschig HK, Kallmeyer IJ, Mihaljevic T, et al. A practical approach to a comprehensive epicardial and epiaortic echocardiographic examination. J Cardiothorac Vasc Anesth 2003;17:19–21.




This Article
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press