Vetrugno Luigi, Barbariol Federico, Baccarani Umberto, Forfori Francesco, Volpicelli Giovanni, Della Rocca Giorgio
Department of Medicine, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy.
Anesthesia and Intensive Care Medicine IV, Pisa University Hospital, Pisa, Italy.
Crit Ultrasound J. 2017 Dec;9(1):15. doi: 10.1186/s13089-017-0067-y. Epub 2017 Jun 19.
Intraoperative transesophageal echocardiography is a minimally invasive monitoring tool that can provide real-time visual information on ventricular function and hemodynamic volume status in patients undergoing liver transplantation. The American Association for the Study of Liver Diseases states that transesophageal echocardiography should be used in all liver transplant candidates in order to assess chamber sizes, hypertrophy, systolic and diastolic function, valvular function, and left ventricle outflow tract obstruction. However, intraoperative transesophageal echocardiography can be used to "visualize" other organs too; thanks to its proximity and access to multiple acoustic windows: liver, lung, spleen, and kidney. Although only limited scientific evidence exists promoting this comprehensive use, we describe the feasibility of TEE in the setting of liver transplantation: it is a highly valuable tool, not only as a cardiovascular monitoring, but also as a tool to evaluate lungs and pleural spaces, to assess hepatic vein blood flow and inferior vena cava anastomosis and patency, i.e., in cases of modified surgical techniques. The aim of this case series is to add our own experience of TEE as a comprehensive intraoperative monitoring tool in the field of orthotopic liver transplantation (and major liver resection) to the literature.
术中经食管超声心动图是一种微创监测工具，可为肝移植患者的心室功能和血流动力学容量状态提供实时视觉信息。美国肝病研究协会指出，所有肝移植候选者均应使用经食管超声心动图，以评估腔室大小、肥厚、收缩和舒张功能、瓣膜功能以及左心室流出道梗阻情况。然而，术中经食管超声心动图也可用于“可视化”其他器官；这得益于其靠近并可利用多个声学窗口：肝脏、肺、脾脏和肾脏。尽管仅有有限的科学证据支持这种全面应用，但我们描述了经食管超声心动图在肝移植中的可行性：它是一种非常有价值的工具，不仅可作为心血管监测手段，还可作为评估肺部和胸腔、评估肝静脉血流以及下腔静脉吻合和通畅情况（即在改良手术技术的情况下）的工具。本病例系列的目的是将我们自身在原位肝移植（和肝大部切除术）领域中使用经食管超声心动图作为全面术中监测工具的经验补充到文献中。
