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Table 1 Hemodynamic monitoring using the single-use 72-h indwelling transesophageal echocardiography probea

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

  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
  1. SVC superior vena cava, LV left ventricle, RV right ventricle, PEEP positive end-expiratory pressure
  2. 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)