Perioperative Evaluation of Regional Wall Motion by Transesophageal Two-Dimensional Echocardiography

Abstract

With the introduction of transesophageal two-dimensional echocardiography into the operating room the subject of regional left ventricular (LV) wall motion presents itself to the clinical anesthesiologist. Overwhelming evidence of the sensitivity of regional wall motion as a marker of regional myocardial perfusion suggests that it will find a place for the monitoring of patients at risk for ischemia. In this review, we define regional wall motion, normal and abnormal, and examine its relationship to regional myocardial perfusion. The practical aspects of recognizing, describing, and treating regional wall motion abnormalities will be addressed, with emphasis on transesophageal two-dimensional echocardiographic techniques. The development of transesophageal imaging techniques has taken place only during the past 10 yr. Frazin and co-workers in 1976 reported the use of an M-mode esophageal transducer for patients in whom conventional imaging techniques failed (1). Generally, transthoracic images are technically poor when excessive adipose or lung tissue lies between the external transducer and the heart. Thus, the esophagus provided better access to the heart. Matsumoto and co-workers employed esophageal transducers in subjects performing supine bicycle exercise and also in anesthetized patients (2,3). The incorporation of the transducer into a flexible gastroscope from which the fiber optics had been removed permitted the operator to direct the ultrasound beam in multiple planes from any position within the esophagus. With the development of miniature phased array transducers, excellent two-dimensional imaging became feasible from the esophagus. Schlüter and co-workers reported their use of such a transducer in 1982 (4), and it is this type of esophageal transducer that has been used by most investigators and that has produced the images presented in this review.