Limited transthoracic echocardiogram: “This is how I do it”

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Limited transthoracic echocardiogram (LTTE) has been introduced as a tool to help in the resuscitation of the hypotensive patient. Visualization of the heart as well as the inferior vena cava (IVC), can be useful in the evaluation of volume status and overall cardiac function when guiding treatment of the surgical and medical patient. The advantages over other methods such as central venous pressure measurement or arterial wave form stroke volume variation calculations is that LTTE is noninvasive, can be repeated, it gives a clear visualization of the heart, and allows for real-time interpretation. There is not a perfect method for hemodynamic monitoring. Each tool adds more information to help the clinician decide what the best therapy is for the hypotensive patient.1,2
Surgeons have already become familiar with the use of point-of care ultrasound with the focused assessment with sonography for trauma, and the extended version of this test. During this examination, the application is focused on the anatomic information visualized. The windows allow for finding blood in the abdominal and thoracic cavities as well as the pericardium. With the extended focused assessment with sonography for trauma, the surgeon can also learn how to diagnose pneumothorax.1 The main difference with LTTE is not only the additional cardiac windows obtained while performing this test but also the interpretation of the images. The clinician performing the examination now is required not only to understand the anatomy but also to interpret the physiologic information in the context of a clinical scenario.
The LTTE intends to give more visual information about the heart, global contractility, volume status, additionally to the presence of an effusion. It also gives information about both sides of the heart. It differs from a formal echocardiogram because it can be performed with a simple two-dimensional ultrasound machine because no measurements or calculations are required for its interpretation.1,3,4 A phased array probe is preferred to obtain the images, but a regular low-frequency probe (3–5 MHz) can also be used.
This examination can be performed rapidly; in our experience, the average time that takes an operator is 4 minutes.1,3
The present article will focus on how to perform the test. The following is a description of precisely how to do this test on a step by step fashion. A video has been created as a companion to the text.
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