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The evaluation of right ventricular (RV) kinesis by two-dimensional echocardiography represents a difficult task. Transthoracic echocardiography can visualize the RV in several projections, but the image quality and the variability of imaging views usually do not allow quantitative analysis. We investigated the potential of transesophageal echocardiography (TEE) for evaluating RV global function and regional kinesis, in 32 controls and in 16 patients with inferior myocardial infarction (MI) and asynergy involving the inferior wall of both ventricles. Good-quality images of at least one horizontal section of the RV were obtained in 73% of subjects by conventional, 90 degrees sector and in 100% of subjects by wide-angle, "panoramic" sector. Images of the RV in short-axis view at medium level were acquired and evaluated in 93% of cases, but at basal and apical levels only in 67% and 39%, respectively. The low percentage of successful detection and evaluation of the RV at apical level can be explained by prominent motion and trabeculation of the apex. Global systolic area changes (SAC) in controls attained similar values at apical and medium levels (60% and 59%, respectively), but were significantly lower (48%, P less than 0.05) at basal level. In patients with previous inferior MI and inferoposterior asynergy, global SAC were significantly (P less than 0.01) lower at medium and basal levels (32% and 27%, respectively) compared with controls. Regional kinesis of RV was assessed as segmental SAC in 12 different segments, by fixed and float system of center of cavity.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper reviews the present state and future perspectives of the peri-operative application of Transoesophageal Echocardiography (TEE) for early detection of myocardial ischaemia during general surgery. The increasing clinical relevance of this problem parallels the progressively higher frequency of surgery performed in patients at relatively high cardiovascular risk, due to a longer life-span and improved anaesthetic techniques. TEE potentially provides a powerful method for detailed cardiac monitoring in patients undergoing general surgery. The detection of a new regional asynergy during echocardiographic monitoring represents an early and reliable marker of myocardial ischaemia. The sensitivity, specificity and feasibility of TEE monitoring of intraoperative myocardial function and ischaemia will be outlined and compared with those of ECG and invasive monitoring. Problems related to the interpretation of intra-operative findings, with special reference to possible non-ischaemic mechanisms responsible for intra-operative regional asynergies--which can decrease the specificity of this method--are considered. Though still under investigation, the potential contribution of ultrasonic tissue characterisation of the asynergic ventricular wall as an additional, or even alternative, marker of myocardial ischaemia, is discussed. Finally, educational problems related to the new tasks facing the anaesthesiologist involved in intra-operative echo-Doppler evaluation of cardiac function are also foreseen.