Original Articles
The Role of Intraoperative Transesophageal Echocardiography in Patients Undergoing Cardiac Mass Removal*,**

https://doi.org/10.1067/mje.2000.107157Get rights and content

Abstract

To evaluate the role of intraoperative transesophageal echocardiography (IOTEE) during surgical removal of cardiac masses, we studied 75 consecutive patients (34 men, aged 56 ± 16 years, range 17 to 82 years) who underwent surgery primarily for cardiac mass removal with the adjunct of IOTEE for the years 1993 through 1998. The IOTEE provided new information before bypass in 6 patients (8%), altering the planned surgical procedure in all. A newly discovered patent foramen ovale was closed in 2 patients, a second myxoma discovered in one patient, a mitral valve repaired in one patient, inferior vena caval can-nulation site clarified in one patient, and in one patient the mass was no longer present and the surgery canceled. In 10 patients (13%), new post-bypass information was found, which prompted return to bypass for valve repair in 3 patients, altered nonsurgical management in 3 patients, and did not necessitate specific measures in 4 patients. Thus, in 75 patients coming to surgery for mass removal, IOTEE affected intraoperative management in 12 (16%). (J Am Soc Echocardiogr 2000;13:1080-3.)

Section snippets

Study Patients

Patients who were referred for cardiac surgery specifically for mass removal and had an IOTEE were identified from the Mayo Clinic IOTEE database for the period between January 1, 1993, and December 31, 1998. A total of 75 patients were identified. Information relating to clinical presentation, surgical procedure, complications, and outcome were obtained from the clinical records and our IOTEE database. All masses underwent pathologic examination after removal.

Echocardiographic Analysis

All patients had a preoperative

Patient Characteristics

The 75 patients (34 men and 41 women) were 17 to 82 years old (mean 56 ± 16 years). The presenting symptoms are outlined in Table 1.

. Intracardiac masses and clinical symptoms

SymptomNo. of patientsPercent
CHF/dyspnea2331
Asymptomatic1824
CVA/TIA1621
SVC/IVC obstruction68
Fever45
Chest pain34
Arrhythmia23
Weight loss11
Fatigue11
Peripheral emboli11
Total75100

CHF, Congestive heart failure; CVA, cerebrovascular accident; SVC/IVC, superior/inferior vena cava; TIA, transient ischemic attack.

Almost one third

Discussion

This study demonstrates the role of IOTEE in patients who undergo cardiac surgery for intracardiac mass removal. In addition to its value in identifying the anatomic extent and morphologic characteristics of various masses, in 9 patients IOTEE added diagnostic information that resulted in a modification of the surgical procedure. All 6 patients in whom new information was found before bypass had the surgical procedure modified, and in 3 patients, IOTEE after bypass prompted a return to bypass

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*

Karl S. Dujardin, MD, is supported by a fellowship from the Belgian American Educational Foundation.

**

Reprint requests: Roger L. Click, MD, PhD, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 (E-mail: [email protected] ).

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