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Perioperative Use of the Imacor Hemodynamic Transesophageal Echocardiography Probe in Cardiac Surgery Patients: Initial Experience

Sarosiek, Konrad; Kang, Christopher Y.; Johnson, Caitlyn M.; Pitcher, Harrison; Hirose, Hitoshi; Cavarocchi, Nicholas C.

doi: 10.1097/MAT.0000000000000113
Clinical Critical Care

Echocardiography is the standard to assess heart function although obtaining transesophageal echocardiography (TEE) on an emergent basis may be limited by its availability. A transoral miniaturized hemodynamic TEE (hTEE) probe (ImaCor Inc.) was developed to provide direct visualization of the heart, and we hypothesized that the probe could provide hemodynamic information useful for patient management. Data from 2011 to 2012 was retrospectively collected. Four hundred ninety patients were treated in the cardiovascular intensive care unit of which 61 underwent hTEE monitoring and were divided into three groups: patients on extracorporeal membrane oxygenation (ECMO) (n = 25), ventricular assist device (VAD) (n = 6), and others (n = 30). Patient charts were reviewed to investigate the indications for the use of hTEE, findings, and the interventions performed. The indications for probe insertion were hemodynamic instability (n = 32), ECMO weaning (n = 10), VAD alarm (n = 1), tamponade (n = 14), pulmonary embolism (n = 2), and intra-aortic balloon pump wean (n = 2). In all 61 cases, we were successfully able to diagnose and treat the etiology of instability based on the hTEE findings. Utilization of the hTEE probe successfully diagnosed and aided therapy in all patients with hemodynamic instability refractory to initial therapy and provides a valuable tool to aid clinicians in the management of postoperative hemodynamics.

From the Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.

Submitted for consideration July 2013; accepted for publication in revised form June 2014.

Disclosure: The authors have no conflicts of interest to report.

Reprint Requests: Nicholas C. Cavarocchi, MD, Department of Surgery, Thomas Jefferson University Hospital, 1025 Walnut St., Ste. 605, Philadelphia, PA 19107. Email:

Copyright © 2014 by the American Society for Artificial Internal Organs