| Abstract
| - Transesophageal echocardiography (TEE) has assumed an increasingimportance in cardiothoracic surgery, but its use in patients withmechanically assisted circulation is unclear. We performed TEE in 11patients: total artificial heart (TAH) 2, right ventricular assist device(RVAD) 2, left ventricular assist device (LVAD) 6, biventricular assistdevice (BVAD) 1. TEE was helpful in three areas. (1) selection of theassist device (AD): evaluation of left and right ventricular functionallows differentiation of left, right or biventricular failure. (2)management of patient and optimization of pump performance: in allpatients, correct cannula position and pump flow could be identified. Rightventricular failure in the presence of LVAD was found to cause hemodynamicinstability in 4 patients. In 1 patient with repeated RV dilation andhypotension despite RVAD, TEE allowed optimal pump settings to bedetermined. (3) weaning from AD: Recovery of ventricular function can beassessed prior to weaning and repeatedly monitored during weaning. TEE inTAH is limited to problems such as identification of atrial thrombus orinflow valve dysfunction. We conclude that TEE is useful in the setting ofmechanically assisted circulation for AD selection, improvement of patientmanagement, optimization of pump performance and during weaning fromAD.
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