Guias ETE estandarizadas

1. Guidelines for Performing a
Comprehensive Transesophageal
Echocardiographic Examination in
Children and All Patients with
Congenital Heart Disease
ASE guidelines
standards
LUIS GERARDO RODRIGUEZ ORTEGA

3. • In the intraoperative setting, TEE can be used to assess cannula
position and venous drainage during cardiopulmonary bypass,
facilitate intra-cardiac deairing, and characterize rhythm disturbances.
• An important role of the post-intervention TEE is to evaluate the
adequacy of the surgical repair and assess ventricular function.
• Decisions to return to bypass, therefore, should consider not only the
TEE findings, but also clinical information, hemodynamics, and the
risk versus benefit of a re-intervention.

5. • TEE serves an important role in the cardiac catheterization laboratory:
• During placement of septal closure devices, TEE provides precise
identification of the location, geometry, and number of defects, allowing the
interventionalist to develop clear strategies for closure.
• TEE use during catheter-based procedures limits fluoroscopy time, decreases
contrast load, and improves the overall safety of the interventions.

8. Patient Selection and
Complications
• 1-3% complication rate in the pediatric age group
• When intraoperative TEE imaging is performed, the imaging probe
ideally should be inserted before placement of sterile drapes.
• The incidence of oropharyngeal dysphagia after TEE has been
estimated at 18% in children undergoing open heart procedures.
• Risk factors included age < 3 years, preoperative endotracheal intubation, longer
duration of endotracheal intubation, and interventions for leftsided obstructive lesions.

9. • Although a high incidence (64%) of abnormal findings (erythema,
edema, and hematoma; less frequently, mucosal erosion and
petechiae) were found by flexible endoscopy after TEE for pediatric
cardiac surgery, no long-term feeding or swallowing difficulties were
identified.
• Critically ill infants with total anomalous pulmonary venous anomalies
who might develop hypotension and hypoxemia from compression of
the pulmonary venous confluence by the imaging probe.

11. • TEE probe selection for infants and children relies primarily on two
factors: the weight of the patient and the size of the probe.