Transesophageal and contact ultrasound echographic assessments of pulmonary vessels in bilateral lung transplantation.

Abstract

Intraoperative transesophageal echocardiographic visualization of the vascular anastomosis of lung grafts can be difficult. The goal of this prospective study was to compare intraoperative transesophageal echocardiography and contact ultrasound. Vessel imaging and Doppler analysis obtained before chest closure by both techniques were compared in 18 bilateral lung transplant recipients. Twenty-four arteries in 36 and 45 pulmonary veins in 72 were recorded using transesophageal echocardiography versus 34 and 60 by contact ultrasound (p = 0.05). Views of the left pulmonary artery (p = 0.04) and of the left superior and inferior pulmonary veins (p = 0.04 and p = 0.02, respectively) were more often obtained with contact ultrasound. Measurements of vessel diameters were similar by both methods except for the left superior vein, which was smaller by the transesophageal approach (p = 0.002). In 1 patient, inferior venous diameters could not be obtained by either method. Nine arterial and 47 venous velocities were recorded by transesophageal echocardiography versus 21 and 33 by contact ultrasound (p = 0.001). Contact ultrasound produced better left pulmonary artery recordings (p = 0.02), whereas transesophageal echocardiography was more effective on venous velocities. Left inferior vein velocity was twofold higher using transesophageal echocardiography (p < 0.001). These results suggest clinicians should exercise caution when making treatment decisions when using transesophageal echocardiography alone.