ABC | Volume 113, Nº1, July 2019

Statement Position Statement on Indications of Echocardiography in Adults – 2019 Arq Bras Cardiol. 2019; 113(1):135-181 Table 44 – Recommendations of the intraoperative echocardiography in cardiac and thoracic aorta surgeries Recommendation Class of recommendation Level of evidence Adults submitted to cardiac or thoracic aorta open-chest surgery (e.g., valve plasty replacement, structural, mass resection, correction of aortic dissection or aortic aneurysm) I B Adults undergoing minimally invasive cardiac surgery I B In young children undergoing open or minimally invasive cardiac surgery, the indication should be considered case by case according to the risks of intraoperative echocardiography in the pediatric population (e.g., bronchial obstruction) I B Placement and adjustment of ventricular assist devices I B Myocardial revascularization surgery when there is left ventricular systolic dysfunction IIa B In case there is a trained professional available, three-dimensional echocardiography should always be used for valvular (aortic and mitral regurgitation), structural and mass resection procedures I B Table 45 – Recommendations of the intraoperative echocardiography in non-cardiac surgeries Recommendation Class of recommendation Level of evidence Intraoperative echocardiography may be indicated for the monitoring of non-cardiac surgeries if the patient is suffering from severe cardiovascular disease and/or the planned procedure may result in severe hemodynamic, myocardial, pulmonary or neurological impairment I B Large vascular surgery (usually in open abdominal aortic repair surgeries) I B Liver transplantation IIa B Pulmonary transplantation IIa B Renal tumor resection IIb B Surgery of trauma IIb B Neurosurgery IIa B Orthopedic Surgeries IIb B Laparoscopic surgeries IIb B 12.4. Recommendations in Non-Cardiac Surgeries The main objectives of intraoperative echocardiography in non-cardiac surgeries are: to assess volume status and fluid response; to estimate vascular resistance and cavitary pressures; to evaluate function of the ventricles (global and segmental) and valves; and to investigate special issues according to the clinical status and the type of intervention. 244,245,249 The main recommendations in this scenario are found in Table 45. 13. Echocardiography in Percutaneous Interventions 13.1. Introduction In general, cardiac interventions through cardiac catheterization have developed with the support of the echocardiographic image, especially by the transesophageal route. Its use in daily practice is increasingly frequent, in view of the development of techniques and technologies for the treatment of diseases previously only corrected by the conventional surgical procedure. In addition, there was remarkable progress in the diagnostic capacity of echocardiography, mainly due to the improvement of the image quality and the advent of the 3D image, obtained by TTE and TEE. The examination has practically no contraindication and allows the early identification of potential complications. There is no randomized study for non-use of echocardiography during procedures, and some are limited to the use of thoracic, esophageal or intracardiac modalities. Therefore, in relation to interventional procedures, indication of echocardiography use is in principle class I, level of evidence C, a fact already recognized in the literature. 234 In some examinations, it becomes necessary as well as essential, since the X-ray (XR) image is insufficient to perform the procedure, and sometimes even expendable. The role of echocardiography in major interventional procedures follows below. 13.2. Follow-up of Interventions in Congenital Heart Diseases A) Atrial septostomy: also known as Rashkind procedure. The septostomy is performed by balloon in a population in which the TTE allows an optimal visualization of the atrial septum and of the catheter, guiding in an appropriate way and evaluating the immediate result and eventual complications. The use of TEE is usually unnecessary, and also impracticable, 170