ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE INTRAOPERATIVE OF COMPLEX HEART SURGERY

CASE REPORT

Abstract

The combination of myocardial revascularization (CABG) and valve surgery is a viable strategy for patients with both comorbidities, avoiding multiple approaches and increasing survival. However, this method is related to a higher risk of postoperative morbidity and mortality. To guide hemodynamic management in a more rational way and to minimize unfavorable outcomes, the use of intraoperative transesophageal echocardiography (TEE) has emerged as an important tool in cardiac surgery. The case is a male patient, 75 years old, with a history of arterial hypertension, coronary atherosclerotic disease, mitral valve heart disease and the presence of prosthesis in the aortic valve was referred for surgical correction where he opted for intervention in a single session. The initial intraoperative TEE showed the significant mitral regurgitation seen in the preoperative period, paravalvular aortic leak in the right coronary leaflet of the prosthesis with calcification and reduced mobility of its components. Aortic valve was removed with long-term bioprosthesis implant (number 23) and mitral valve repair followed by CABG - saphenous vein to right coronary bypass. CPB time was 111 minutes and 76 minutes of aortic clamping. At the end of the correction, the TEE confirmed the absence of regurgitation and adequate opening of the mitral valve (indicating satisfactory result of the plasty) and absence of important paravalvular leaks in the aortic valve. The patient presented a favorable clinical evolution and was discharged seven days after the procedure, with adjunct medication and guidance for outpatient follow-up.