Hemodynamic Ultrasound for Surgeons
Dr. Ray Crouch MD, is a surgeon at Allegheny General in Pittsburgh. He says, “a quick examination with the hTEE can show you some things that are very easy to fix – or some life-threatening things that definitely need to be fixed.”
- Dr. Crouch says the hTEE shows how much RV failure there is and how much pulmonary hypertension they have to manage.
- hTEE shows when there’s an “easy fix” to volume with additional fluid resuscitation.
- Dr. Crouch most commonly uses the ImaCor method for patients with ventricular-assist devices.
Excerpts from our Interview
ImaCor: Can you identify a specific patient where hTEE made a significant difference in their outcome?
Dr. Crouch: Yeah, definitely and you can identify really even more than one.
There are a lot of situations we’ve encountered where people just aren’t responding to things the way that they should.
Specifically, one of the most common things we see is someone whose hemodynamics aren’t what they should be. So a quick examination with the hTEE can show you some things that are very easy to fix – or some life-threatening things that definitely need to be fixed.
For example, probably the most common situation is when you use the hTEE probe and we just see that somebody’s volume status is way behind. We see their left ventricle is very, very underfilled.
That’s an easy fix to change the management with additional fluid resuscitation that they usually respond to very well.
The flip side of that is sometimes we’ve had situations where people are struggling from a hemodynamic standpoint and you do a transesophageal echo with the ImaCor probe, and you realize that they have tamponade.
ImaCor: Thank you. Have you seen a specific patient case where you weren’t able to see on a surrogate monitor, and you needed hTEE to identify how to help that patient?
Dr. Crouch: Some of the most common people that we use it in are the ventricular assist device patients where their flows may be impacted or they’re filling pressures may not be exactly what we expect to see.
In those cases, it’s really a question of how much right ventricular failure they have, how much pulmonary hypertension we need to manage, and how that’s impacting their left ventricular filling.
The ImaCor hTEE method is helpful in those situations to coordinate all of those things.
See what Dr. Elapavaluru sees
Attending physician Subbarao Elapavaluru MD, CVICU says he knew how to help a clot-compressed patient “as soon as [he] inserted the hTEE probe.”