Using transesophageal echocardiography to manage critically ill patients. What role in hemodynamic instability, MI, embolic disease, trauma?

When transthoracic echocardiographic images are suboptimal, transesophageal echocardiography offers a new window for visualization of the heart and thoracic aorta. It can be performed at bedside in 15 to 20 minutes. Complications (emesis, hypoxemia, hypotension) are rare and easily reversed or averted by administration of naloxone or flumazenil. Indications include evaluation of hemodynamic instability, ventricular function, mitral regurgitation, ventricular septal defects, aneurysm, endocarditis, intracardiac sources of embolus, valve pathology, aortic dissection, intra-aortic debris, and trauma. Results can be analyzed immediately and used to guide further evaluation, medical therapy, or surgery.