Department of clinical physiology and echocardiography, Heart Valve Clinic, Institut Cœur-Poumon, CHU de Lille, 59000 Lille, France.
Department of cardiology, Centre Cardiologique du Nord, 93200 Saint-Denis, France.
Arch Cardiovasc Dis. 2018 Dec;111(12):730-738. doi: 10.1016/j.acvd.2018.03.014. Epub 2018 Jul 4.
Few data are available on the application of transoesophageal echocardiography (TOE) recommendations in daily practice.
To evaluate TOE practice based on echocardiography societies' guidelines, and to determine complication rates and factors associated with patient feelings.
Between April and June 2017, we prospectively included all consecutive patients referred to 14 French hospitals for a transoesophageal echocardiogram (TOE). A survey was taken just after the examination, which included questions about pre-procedural anxiety, and any pain, unpleasant feeling or breathing difficulties experienced during the examination.
Overall, 1718 TOEs were performed, mainly for stroke evaluation. A standardized operating procedure checklist was completed in half of the patients before the examination. TOE was unpleasant for 62.4% of patients, but was stopped for agitation or intolerance in 3.5 and 1.4% of cases, respectively. We observed one severe complication (pulmonary oedema). The mean TOE duration was short (9.2±4.6minutes), but was longer with residents than with more experienced physicians (11±4.7 vs. 8.8±4.7minutes for junior physicians [P=0.0027]; vs. 8.9±4.8minutes for senior physicians [P=0.0013]; and vs. 7.5±4.1minutes for associate professors/professors [P<0.0001]). The visual analogue scale (VAS) score after TOE was good (8.3±1.7 out of 10), and was better in patients with general anaesthesia (GA) than in those without GA (9.3±0.9 vs. 8.1±1.7; P<0.0001). In patients without GA, the VAS score was similar with and without local anaesthesia (8.1±1.7 vs. 8.2±1.6; P=0.19). After multivariable adjustment, absence of anxiety before TOE and greater operator experience were consistently associated with a higher VAS score.
TOE is safe, with a low rate of complications and few stops for intolerance. A shorter TOE duration and better patient feelings were observed for experienced operators, highlighting the importance of the learning curve, and paving the way for teaching on a TOE simulator.
关于经食管超声心动图（TOE）建议在日常实践中的应用，目前仅有少量数据。
根据超声心动图学会的指南，评估 TOE 的应用情况，并确定并发症发生率和与患者感受相关的因素。
2017 年 4 月至 6 月，我们前瞻性地纳入了法国 14 家医院因经食管超声心动图（TOE）检查而转诊的所有连续患者。检查后立即进行问卷调查，内容包括检查前的焦虑程度，以及检查过程中是否有任何疼痛、不适或呼吸困难。
总体而言，共进行了 1718 次 TOE，主要用于评估中风。一半的患者在检查前完成了标准化操作程序检查表。62.4%的患者对 TOE 感到不适，但分别有 3.5%和 1.4%的患者因躁动或不耐受而停止检查。我们观察到一例严重并发症（肺水肿）。TOE 的平均持续时间较短（9.2±4.6 分钟），但在住院医师中时间较长，而在经验更丰富的医生中时间较短（初级医生 11±4.7 分钟 vs. 8.8±4.7 分钟[P=0.0027]；高级医生 8.9±4.8 分钟[P=0.0013]；副教授/教授 7.5±4.1 分钟[P<0.0001]）。TOE 后视觉模拟评分（VAS）良好（10 分中 8.3±1.7 分），全身麻醉（GA）患者的评分优于非 GA 患者（9.3±0.9 分 vs. 8.1±1.7 分；P<0.0001）。非 GA 患者中，局部麻醉与无局部麻醉的 VAS 评分相似（8.1±1.7 分 vs. 8.2±1.6 分；P=0.19）。多变量调整后，TOE 前无焦虑和操作者经验更丰富与更高的 VAS 评分相关。
TOE 是安全的，并发症发生率低，不耐受情况少。经验丰富的操作者进行的 TOE 持续时间更短，患者感受更好，这突出了学习曲线的重要性，为 TOE 模拟器教学铺平了道路。
