Additional Cross-sectional Transesophageal Echocardiography Views Improve Perioperative Right Heart Assessment

Background: Right heart failure is an important cause of perioperative morbidity and mortality, and transesophageal echocardiography (TEE) is crucial for its diagnosis. However, only four of the 20 cross-sectional views recommended in current guidelines for intraoperative TEE focus on the right heart. This study analyzed whether incorporating additional views into the standard TEE examination improves assessment of the right heart. Methods: Sixty patients underwent standard TEE examination after induction of anesthesia. In addition, five views focusing on the right heart were acquired. Offline analysis tested: (1) whether the additional TEE views can be acquired as reliably as standard views including parts of the right heart; whether incorporating additional views improves the assessment of (2) eight or more right ventricular wall segments based on a predefined nine-segment model; (3) the tricuspid or pulmonary valve in two or more planes; and (4) transvalvular tricuspid and pulmonary flow in orthograde fashion. Results: Additional views could be imaged as reliably (88%) as standard views (90%). Incorporating some of the additional views allowed the assessment of eight or more right ventricular segments in 59 (98%) versus 18 patients (30%) by the standard views alone, and of the pulmonary valve in two or more planes in 60 (100%) versus 15 patients (25%). Several additional views improved orthograde assessment of transvalvular pulmonary flow, but not of tricuspid flow. Conclusions: The additional TEE views focusing on the right heart can be acquired as reliably as standard views. Incorporating three of them into the standard TEE examination improves comprehensive assessment of the right heart.