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Dr. Martin Swaans
TEE before, during and after surgery is necessary to check indications, verify operative success and monitor long-term follow-up.
It was my honour to co-chair this interesting session on intraoperative TEE in structural heart disease with Dr. Regina Ribeiras from Lisbon, chair of the Cardiovascular Ultrasound Working Group in Portugal. Given that it was one of the latest sessions on the final day of this excellent congress. it was nice to see that a large audience was still eager to learn and joined us for this session. The session started with a presentation of Prof. Wouters from Ghent. He showed in a systematic review he is currently performing that it is not rare to have new findings when a TEE is performed when the patient is in the operation room, making it necessary to adjust the operation plan. Furthermore, he emphasized the fact that certification of the doctors who perform these intraoperative TEEs, whether they are cardiologists or anaesthesiologists, is very important due to the impact of their decisions. Dr. Faletra from Lugano continued the session showing the additional value of TEE in the setting of mitral valve repair, and by showing some fantastic examples the additional value of 3D TEE. He showed that with 3D TEE, it is much easier to identify the location and extent of a prolapse, providing the surgeon with important information for estimating the likelihood of repair. Prof. Pasquet from Leuven discussed the value of intraoperative TEE in patients with planned aortic valve repair. She showed, with some nice examples, the importance of determining the mechanism of the aortic regurgitation prior to surgery. However, she also pointed out that we have to be critical on the result after an aortic valve repair, because a “nice” result now, does not necessarily mean a “nice” result in the long term. Therefore, we have to carefully check, even if there is no AR, for residual prolapse, but we also should measure the coaptation length between the leaflets and check if this coaptation is at the annular level. Furthermore, she emphasized the importance of repeating the echo completely at the end of the surgical procedure, because during closure of the chest and achieving haemostasis, events can occur that can influence the heart and the result of the repair.Finally, Dr. Hirsch from Petah Tikva showed with some interesting cases the importance of intraoperative TEE in congenital heart disease, also pointing out that due the complexity of the pathology, other imaging modalities are also frequently necessary prior to surgery.
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