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**8** 

**Intraoperative Transesophageal** 

Transesophageal echocardiography (TEE) has gained its role in perioperative use for congenital heart disease patients, especially with technology improvements in the past decades. It helps with diagnosis confirmation, real-time hemodynamic monitoring, evaluation the successfulness of surgical repair, and surgical planning. The use of intraoperative TEE has major impacts on surgery for congenital heart defects (Randolph et al., 2002). Even with conservative estimates, the financial benefits of TEE in pediatric patients with congenital heart disease are substantial and outweigh its costs (Bettex et al., 2005). In most of the modern cardiac centers, the TEE exam is an essential part of anesthetic

TEE has proven to be an invaluable tool for patients underwent cardiac surgery and cardiac catheterization for congenital heart disease. More than that, TEE is useful for high risk congenital heart disease patients who will have non-cardiac surgeries. It can help with hemodynamic monitoring, and provide real-time detailed anatomic information. In addition, it can help assess ventricular volume and function, intracardiac shunt, valvular disease, right ventricle (RV) or pulmonary artery (PA) systolic pressure, and pericardial effusions. It is reasonable to use intraoperative TEE routinely in congenital heart surgery (Randolph et al., 2002). According to the "practice guidelines for perioperative TEE", TEE should be used in all adult open heart procedures (Thys et al., 2010). The task force of American Society of Echocardiography also described surgery for congenital heart disease is

Perioperative TEE exam cannot replace the preoperative diagnostic exam. A thorough imaging study must be performed before the operation. Each imaging study has its limitation. TEE performed before surgical incision may disclose a different diagnosis and

However, there are some situations that TEE is contraindicated. Patients with unrepaired tracheoesophageal fistula, esophageal obstruction or stricture, perforated hollow organ, or

**1. Introduction** 

management in congenital heart disease surgery.

**2. Indication, contraindication, and complications** 

an indication for performance of TEE (Ayres et al., 2005).

even result in cancellation of the operation (Huang et al., 2009).

**Echocardiography for** 

*National Taiwan University Hospital* 

*Taiwan, R.O.C.* 

**Congenital Heart Disease** 

Yi-Chia Wang and Chi-Hsiang Huang

Nomenclature and Standards Committee of the American Society of Echocardiography. *J Am Soc Echocardiogr.* 2002; 15:167–184.

