Usefulness and growing need for intraoperative transthoracic echocardiography: a case series

BACKGROUND Physician-performed transthoracic echocardiography (TTE) is still seldom used during anesthesia. Despite its various advantages, there are only a few reports of intraoperative TTE. We report 3 cases in which intraoperative TTE was successfully used. CASE PRESENTATION A 75-year-old woman (Case 1) was scheduled for a posterior spinal fusion. When the wound was being closed, systolic blood pressure suddenly dropped to 30 mmHg. TTE revealed hypokinesis in the antero-septal region. Emergent coronary angiography showed 90% stenosis in left anterior descending artery (Segment 7), and a bare metal stent was implanted. A 71-year-old woman (Case 2) with hypertrophic cardiomyopathy was scheduled for brain tumor operation. During anesthesia induction, the patient developed hemodynamic instability. TTE showed systolic anterior motion of the mitral valve, and appropriate treatment was administered. A 78-year-old woman (Case 3) was scheduled for revision total hip arthroplasty. When the wound was closed, TTE revealed severe hypovolemia despite massive infusion. We insisted on reopening the wound and found additional massive hemorrhage. CONCLUSION Intraoperative TTE is a potent tool for quick hemodynamic evaluation because it is noninvasive and has sufficient diagnostic capabilities. The successful outcomes of our cases suggest the great usefulness of intraoperative TTE, and more frequent use is to be encouraged.