Download PDF
Anästhesiol Intensivmed Notfallmed Schmerzther 2014; 49(11/12): 684-694
DOI: 10.1055/s-0040-100110
Fachwissen
Topthema Intensivmedizin: Echokardiografie
© Georg Thieme Verlag Stuttgart · New York

Echokardiografie – Eine Einführung in die transthorakale, transösophageale und 3D-Echokardiografie

“Introduction to transthoracic, transesophageal and real time 3Dimensional transesophageal echocardiography”
Joachim Erb
,
Chirojit Mukherjee
,
Fabian Knebel
,
Jörg Ender
Further Information

Publication History

Publication Date:
09 January 2015 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Echokardiografie erlaubt die Einschätzung der kardialen Anatomie und Funktion. Eine fallspezifischangepasste Herangehensweise an die echokardiografische Untersuchung ist besonders bei hämodynamisch instabilen Patienten essenziell. Standard-Schnittebenen erlauben eine vollständige Untersuchung und reduzieren die Wahrscheinlichkeit, etwas zu übersehen. Die transthorakale Echokardiografie (TTE) sollte in der Notfall- und Intensivmedizin die erste Wahl sein. Die transösophageale Echokardiographie (TEE) ist Standard im operativen Bereich. Die 3D-Echokardiografie dagegen ist in spezifischen Situationen sehr wertvoll. Eine schriftliche Dokumentation der Untersuchungsergebnisse ist obligatorisch.

Abstract

Abstract: Echocardiography allows assessment of cardiac anatomy and function. A tailored approachto echocardiographic assessment is essential in hemodynamic unstable patients. Standard views allow comprehensiveexamination and also reduce the chances to oversee unexpected findings. TTE should be first choice in emergency and intensive care medicine. TEE is standard of care in intraoperative setting. 3 D echocardiography is valuable in specific situations. Written reporting of examination is mandatory.

Kernaussagen

  • Die Echokardiografie ist eine ausgezeichnete Möglichkeit, die kardiale Füllung, myokardiale Kontraktilität und Funktion der Herzklappen zu untersuchen.

  • Es ist jederzeit eine vollständige Untersuchung des Herzens und der großen Gefäße anzustreben.

  • Ein sinnvoller, routinierter Untersuchungsgang unterstützt die vollständige Befunderhebung und verkürzt die Untersuchungsdauer.

  • Die TTE ist die zentrale bildgebende Modalität in der kardiovaskulären Notfall-und Intensivmedizin.

  • Bei allen Patienten, die sich mit Dyspnoe, Hypotension, thorakalen Schmerzen und Synkopen präsentieren, sollte rasch eine TTE angestrebt werden.

  • Eine TEE ist immer dann durchzuführen, wenn die TTE nicht mit ausreichender Qualität zu erzielen ist oder TEE in der Aussagekraft überlegen ist.

  • Absolute Kontraindikationen der TEE sind Veränderungen des Oropharynx, des Ösophagus und des Magens, die mit einem deutlich erhöhten Perforationsrisiko einhergehen.

  • Der Vorteil der 3D-Echokardiografie liegt in der besseren Darstellung der Anatomie der Herzklappen, insbesondere der Mitralklappe.

  • Jede durchgeführte Untersuchung muss sorgfältig dokumentiert werden.

  • Zur adäquaten und verantwortlichen Nutzung der vielfältigen diagnostischen Möglichkeiten der Echokardiografie ist – auch im Bereich der Notfallmedizin und der Intensivtherapie – eine entsprechende Untersucher-Qualifikation essenziell.

Schlüsselwörter:

transthorakale und transösophageale Echokardiografie - 3D-Echokardiografie

Key words:

transthoracic and transesophageal echocardiography - real time 3 dimensional echocardiography

* Joachim Erb und Chirojit Mukherjee haben zu gleichen Teilen zum Manuskript beigetragen.


Ergänzendes Material

 

  • Literatur

  • 1 Flachskampf FA, Badano L, Daniel WG et al. Recommendations for transoesophageal echocardiography: update 2010. Eur J Echocardiogr 2010; 11: 557-576
    CrossrefPubMedGoogle Scholar
  • 2 Flachskampf FA, Decoodt P, Fraser AG et al. Guidelines from the Working Group. Recommendations for performing transesophageal echocardiography. Eur J Echokardiogr 2001; 2: 8-21
    PubMedGoogle Scholar
  • 3 Flachskampf FA, Wouters PF, Edvardsen T et al. Recommendations for transoesophageal echocardiography: EACVI update 2014. European heart journal cardiovascular Imaging 2014; 15: 353-365
    CrossrefPubMedGoogle Scholar
  • 4 Hahn RT, Abraham T, Adams MS et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Journal of the American Society of Echocardiography 2013; 26: 921-964
    CrossrefPubMedGoogle Scholar
  • 5 Lang RM, Bierig M, Devereux RB et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography 2005; 18: 1440-1463
    CrossrefPubMedGoogle Scholar
  • 6 Labovitz AJ, Noble VE, Bierig M et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2010; 23: 1225-1230
    CrossrefPubMedGoogle Scholar
  • 7 Geldner G. Präoperative Evaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen. Kardiologe 2011; 5: 13-26
    CrossrefPubMedGoogle Scholar
  • 8 Authors/Task Force M. Kristensen SD, Knuuti J et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). European heartjournal 2014; 35: 2383-2431
    PubMedGoogle Scholar
  • 9 Holm JH, Frederiksen CA, Juhl-Olsen P et al. Perioperative use of focus assessed transthoracic echocardiography (FATE). Anesthesiaandanalgesia 2012; 115: 1029-1032
    PubMedGoogle Scholar
  • 10 Rudski LG, Lai WW, Afilalo J et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography quiz 2010; 23: 786-688
    CrossrefPubMedGoogle Scholar
  • 11 Lang RM, Badano LP, Tsang W et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. European heartjournalcardiovascular Imaging 2012; 13: 1-46
    PubMedGoogle Scholar
  • 12 Mor-Avi V, Jenkins C, Kuhl HP et al. Real-time 3-dimensional echocardiographic quantification of left ventricular volumes: multicenter study for validation with magnetic resonance imaging and investigation of sources of error. JACC. Cardiovascularimaging 2008; 1: 413-423
    PubMedGoogle Scholar
  • 13 Meris A, Santambrogio L, Casso G et al. Intraoperative three-dimensional versus two-dimensional echocardiography for left ventricular assessment. Anesthesiaandanalgesia 2014; 118: 711-720
    PubMedGoogle Scholar
  • 14 Plicht B, Buck T. [Current value of 3D echocardiography in international guidelines]. Herz 2013; 38: 33-41
    CrossrefPubMedGoogle Scholar
  • 15 Lancellotti P, Moura L, Pierard LA et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 2010; 11: 307-332
    CrossrefPubMedGoogle Scholar
  • 16 Grewal J, Mankad S, Freeman WK et al. Real-time three-dimensional transesophageal echocardiography in the intraoperative assessment of mitral valve disease. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2009; 22: 34-41
    CrossrefPubMedGoogle Scholar
  • 17 Hien MD, Rauch H, Lichtenberg A et al. Real-time three-dimensional transesophageal echocardiography: improvements in intraoperative mitral valve imaging. AnesthesiaandAnalgesia 2013; 116: 287-295
    PubMedGoogle Scholar
  • 18 Mukherjee C, Tschernich H, Kaisers UX et al. Real-time three-dimensional echocardiographic assessment of mitral valve: Is it really superior to 2D transesophageal echocardiography?. Annalsofcardiacanaesthesia 2011; 14: 91-96
    PubMedGoogle Scholar
  • 19 Holmes Jr. DR, Mack MJ, Kaul S et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collabration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. The Journal ofthoracicandcardiovascularsurgery 2012; 144: 29-84
    PubMedGoogle Scholar
  • 20 Mukherjee C, Hein F, Holzhey D et al. Is real time 3D transesophageal echocardiography a feasible approach to detect coronary ostium during transapical aortic valve implantation?. Journal ofcardiothoracicandvascularanesthesia 2013; 27: 654-659
    PubMedGoogle Scholar
  • 21 Otani K, Takeuchi M, Kaku K et al. Assessment of the aortic root using real-time 3D transesophageal echocardiography. Circulationjournal : officialjournaloftheJapaneseCirculation Society 2010; 74: 2649-2657
    PubMedGoogle Scholar
  • 22 Faletra FF, Pedrazzini G, Pasotti E et al. Role of real-time three dimensional transoesophageal echocardiography as guidance imaging modality during catheter based edge-to-edge mitral valve repair. Heart 2013; 99: 1204-1215
    CrossrefPubMedGoogle Scholar
  • 23 Guarracino F, Baldassarri R, Ferro B et al. Transesophageal echocardiography during MitraClip(R) procedure. AnesthesiaandAnalgesia 2014; 118: 1188-1196
    PubMedGoogle Scholar
  • 24 Vahanian A, Alfieri O, Al-Attar N et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European association of cardio-thoracic surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2008; 4: 193-199
    CrossrefPubMedGoogle Scholar
  • 25 Zamorano JL, Badano LP, Bruce C et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 2011; 12: 557-584
    CrossrefPubMedGoogle Scholar
  • 26 Ender A, Eibel S, Hasheminejad E et al. [Real-time 3 dimensional full volume data set : benefits in problem focused intraoperative transesophageal echocardiography]. Anaesthesist 2012; 61: 875-882
    CrossrefPubMedGoogle Scholar
  • 27 Ender J, Eibel S, Mukherjee C et al. Prediction of the annuloplasty ring size in patients undergoing mitral valve repair using real-time three-dimensional transoesophageal echocardiography. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 2011; 12: 445-453
    CrossrefPubMedGoogle Scholar
  • 28 Moore JT, Chu MW, Kiaii B et al. A navigation platform for guidance of beating heart transapical mitral valve repair. IEEE transactions on bio-medicalengineering. 2013; 60: 1034-1040
    PubMedGoogle Scholar
  • 29 Noack T, Kiefer P, Ionasec R et al. New concepts for mitral valve imaging. Annalsofcardiothoracicsurgery 2013; 2: 787-795
    PubMedGoogle Scholar
  • 30 Feneck R, Kneeshaw J, Fox K et al. Recommendations for reporting perioperative transoesophageal echo studies. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 2010; 11: 387-393
    CrossrefPubMedGoogle Scholar
  • 31 Neskovic AN, Edvardsen T, Galderisi M et al. Focus cardiac ultrasound: the European Association of Cardiovascular Imaging viewpoint. European heartjournalcardiovascular Imaging Epub ahead of print 2014;
    PubMedGoogle Scholar
  • 32 Popescu BA, Andrade MJ, Badano LP et al. European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology 2009; 10: 893-905
    CrossrefPubMedGoogle Scholar