Hemodynamic monitoring using a single-use indwelling transesophageal echocardiography probe in an unstable patient after open-heart surgery

Table 1 Hemodynamic monitoring using the single-use 72-h indwelling transesophageal echocardiography probe^a

	H0	H5	H14	H22	H28	H37	H46	H50
Variations of SVC size	Moderate	Moderate	Moderate	None	None	None	None	None
LV fractional area change	Normal	Normal	Normal	Normal	Normal	Normal	Decreased	Normal
RV dilatation	Absence	Absence	Absence	Absence	Absence	Absence	Absence	Absence
Paradoxical septal motion	Absence	Absence	Absence	Absence	Absence	Absence	Absence	Absence
Severe left-sided valvular regurgitation	Absence	Absence	Absence	Absence	Absence	Absence	Absence	Absence
Other relevant abnormality	No	No	No	No	No	PFO shunting	Posterior mediastinal hematoma compressing the left atrium	No
Therapeutic impact	Vaso-pressor	Vaso-pressor	Vaso-pressor	Vaso-pressor	Vaso-pressor	Reduce PEEP Nitric oxide	Emergency surgical evacuation of left atrial hematoma	Vaso-pressor

SVC superior vena cava, LV left ventricle, RV right ventricle, PEEP positive end-expiratory pressure
^aIn the presence of a circulatory failure, the following therapeutic algorithm based on the analysis of three transverse views (great vessels, transesophageal long-axis four-chamber view of the heart, transgastric short-axis view of the heart) was used: large respiratory variations of superior vena cava size (inspiratory collapse) in the transverse view of the great vessel were indicative of preload-dependence (fluid loading); a right ventricular end-diastolic area exceeding the left ventricular end-diastolic area in the transesophageal long-axis four-chamber view of the heart was indicative of a marked dilatation of a failing right ventricle, potentially associated with an acute cor pulmonale; left ventricular fractional area change < 45 % in the transgastric short-axis view of the heart was indicative of systolic dysfunction in the absence of preload-dependence (administration of inotropes), while a paradoxical septal motion with a restrained left ventricle in this view was indicative of acute cor pulmonale (protective ventilation, reduced PEEP level, prone ventilation, nitric oxide administration, vasopressor support)

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