TEE-Guided Rapid Weaning from Pressors in a Post Cardiac Surgery Patient with an Ischemic Gut

This is a looped version of Dr. Jiri Horak’s cineloop from the Hospital of the University of Pennsylvania. This case report describes the use of a miniaturized transesophageal echo probe (ClariTEE®, ImaCor Inc., Garden City, NY) to diagnose and monitor hemodynamic instability in a patient following surgery for an occluded superior mesenteric artery due to aortic dissection. Hemodynamic TEE (hTEE™) management revealed the specific cause of hemodynamic instability as severe diastolic dysfunction. Continued hTEE management allowed the physician to confidently and rapidly wean down pressors. This was particularly important as excessive pressors in this patient could have caused further gut ischemia, inflammatory mediator release, and further diastolic dysfunction.