3D Transesophageal Echocardiography Research Articles

Pediatric 3D transesophageal echocardiography reveals prolapse of accessory mitral valve tissues into the left atrium in a neonate.

Pediatric 3D transesophageal echocardiography reveals prolapse of accessory mitral valve tissues into the left atrium in a neonate.

Standardized 3D Transoesophageal Echocardiography Manoeuvre for Enhanced Tenting Height Evaluation During Transcatheter Mitral Valve Edge-to-Edge Repair.

Background: Transcatheter treatments for structural heart disease, including edge-to-edge mitral valve repair (mTEER), heavily rely on transoesophageal echocardiography (TOE) for pre-procedural assessment and guidance. Trans-septal puncture (TSP) is one of the first key steps of such procedures, with two-dimensional (2D) TOE often providing suboptimal imaging. Three-dimensional (3D) echocardiography could overcome the limitations of 2D TOE and improve the assessment of tenting height. Methods: This single-centre, retrospective study included 64 patients who underwent mTEER between October 2023 and April 2024. Tenting height during TSP was assessed by 2D TOE in mid-oesophageal (ME) four-chamber view and by 3D TOE after the acquisition of a 3D volume, including the interatrial septum, aortic valve, and mitral valve, and subsequent multiplanar reconstruction (MPR). A total of 100 TSP attempts with 2D and 3D TOE were evaluated. Results: Procedural success was obtained in 92.2% of cases. There was a statistically significant difference between 2D and 3D measurements (2D: 4.36 ± 0.61 cm, MPR: 4.59 ± 0.63 mm2, p < 0.001), despite good correlation (r = 0.880, p < 0.001). The difference between 2D and 3D tenting height measurements differed significantly between patients with optimal and suboptimal 2D image windows (p < 0.001). There was no significant difference in septal puncture success between optimal 2D and 3D data (p = 0.942). Conclusions: Adopting 3D TOE with multiplanar reconstruction for assessing tenting height in mTEER procedures offers significant advantages over traditional 2D TOE. Enhanced visualization, accuracy, and potential for standardization improve procedural outcomes and patient safety, making 3D TOE integration into routine practice highly beneficial and recommended.

Tricuspid regurgitation in rheumatic heart valve disease. New insights from 3D transthoracic echocardiography

Abstract Background The assessment of tricuspid valve (TV) and functional tricuspid regurgitation (FTR) in left side valvular disease is crucial in assessing the need for surgical intervention. Despite the declining incidence of rheumatic disease, it remains a a common cause of valvulopathy. According to current guidelines, TV surgery is recommended in presence of severe TR or non-severe with annulus dilatation assessed by two-dimensional echo (2DE). Objectives To assess tricuspid annulus (TA) 3D dimensions in relation to the severity of tricuspid regurgitation (TR) and to identify new parameters associated with the presence of severe TR in this scenario. Methods Fifty patients (Age: 69±9, 82% women) with rheumatic heart disease without previous valve replacement and functional tricuspid regurgitation (FTR) were prospectively included. Two-dimensional echocardiography (2DE) and three-dimensional transthoracic full-volume datasets of the tricuspid valve (TV) were acquired. Two orthogonal planes corresponding to the anatomical antero-posterior (APD), septum-lateral (SLD), long intercommisural (LID), and area (A3D) of the TA were analyzed by 3D transesophageal echocardiography (3DTE) (Figure 1), in addition to 2D diameter. TR was graded into two groups: severe (n=14) or non-severe (n=26). The area under the curve (AUC), sensitivity (Se), and specificity (Sp) to identify the presence of severe FTR were calculated. Results All parameters differed significantly (p&amp;lt;0.05) between the two groups (2D: 18.6±1.9 vs. 23.3±2.0 mm/m2; APD 17.0±3.3 vs. 21.5±3.0 mm/m2; SLD: 18.9±2.0 vs. 22.5±2.0 mm/m2; LID: 20.9±2.6 vs. 26.1±3.5 mm/m2; A: 5.6±1.3 vs. 7.6±1.4 cm2/m2). 2D diameter (Cut-off point: 20.6 mm/m2, AUC: 0.850, Se: 86%, Sp: 72%), A3D (Cut-off point: 6.5 cm2/m2, AUC: 0.835, Se: 86%, Sp: 78%), and LID (Cut-off point: 23.3 mm/m2, AUC: 0.833, Se: 78.6%, Sp: 77.8%) were the parameters with the best performance for severe FTR detection. Conclusions New 3D-derived parameters provide relevant information in the assessment of TA and offer good diagnostic performance for identifying severe FTR in this subgroup of patients.2D/3D Echo TA measurements

Comparative Assessment of Aortic Annulus Diameters between 3D Transesophageal Echocardiography and Cardiac MDCT in Patient with Sclerocalcific Aortic Stenosis

Comparative Assessment of Aortic Annulus Diameters between 3D Transesophageal Echocardiography and Cardiac MDCT in Patient with Sclerocalcific Aortic Stenosis

Left atrial appendage orifice morphology in sickness and in health.

The left atrial appendage (LAA) is the primary site of embolism in individuals with atrial fibrillation (AF). We aimed to evaluate the morphological features of the LAA orifice in patients with sinus rhythm, paroxysmal AF, and persistent AF using three-dimensional (3D) transesophageal echocardiography (TOE). We also intended to identify morphometric parameters of the LAA orifice that may be potentially associated with an increased risk of ischemic stroke. We prospectively enrolled 106 patients undergoing TOE. Patients were divided into three groups: group1 (sinus rhythm), group2 (persistent AF), and group3 (paroxysmal AF). All patients underwent acomprehensive evaluation through transthoracic echocardiography (TTE) and TOE. Off-line analyses were performed of the recorded images. The LAA minor orifice area and minimal orifice diameter were greater in patients with persistent AF compared with individuals in sinus rhythm. Patients with persistent AF also had deeper LAAs compared with those in sinus rhythm. None of the LAA orifice morphometric measures were related to ischemic stroke risk. The only independent predictors of ischemic stroke were heart rhythm and the CHA2DS2VASc score. Persistent AF is associated with LAA dilation, increased depth, and larger orifice size. To our knowledge, this is the first study to demonstrate LAA orifice structural remodeling in patients with AF using 3D TOE.

Determination of Inoue Balloon Size by Analysis of Mitral Valve Geometry Using Three-Dimensional Transesophageal Echocardiography in Patients with Mitral Stenosis

In percutaneous mitral balloon commissurotomy (PMBC) for patients with mitral stenosis (MS), the size of the balloon has traditionally been determined using a crude method based on the patient's height or body surface area. We aimed to evaluate the clinical value of balloon size selection by quantitatively analyzing mitral valve (MV) geometry using 3D transesophageal echocardiography (TEE). In 184 consecutive patients who underwent PMBC, the geometry of the MV annulus was analyzed during mid-diastole, including the measurement of lateral-medial diameters obtained from dedicated 3D software (LMD-3d) or from analysis using multiplanar reconstruction images (LMD-mpr). Patients were categorized into three groups: those with successful results after PMBC (SU group), those with residual mitral stenosis (MS, group), and those with significant MR (MR group). The SU, MS, and MR groups included 110, 50, and 17 patients, respectively. We compared three conventional formulas (Formula 1, 2, 3) based on the patient's height or body surface area with two new formulas derived from data in the SU group: balloon size = 0.0684 × LMD-3d + 24.309 (Formula 4) and 0.061 × LMD-mpr + 24.573 (Formula 5). Compared with the calculated balloon sizes using Formula 4, the inflated balloon sizes were significantly smaller (-0.78±1.02; p<0.001) in the MS group, while they were significantly larger (0.56±1.05; p=0.04) in the MR group. This pattern was also consistent in Formula 5. In conclusion, selecting the Inoue balloon inflation size based on the mitral annulus diameter determined by 3D TEE might be a reasonable approach.

TCT-80 Accuracy of Annular Sizing Using Semiautomated 4D Transesophageal Echocardiography for Transcatheter Mitral Valve Replacement

TCT-80 Accuracy of Annular Sizing Using Semiautomated 4D Transesophageal Echocardiography for Transcatheter Mitral Valve Replacement

Findings from transoesophageal echocardiographic follow-up after mitral transcatheter edge-to-edge repair.

Transoesophageal echocardiography (TOE) provides accurate evaluation of mitral valve (MV) function following mitral transcatheter edge-to-edge repair (M-TEER) and may better detect complications in case of suboptimal result. We aimed to evaluate midterm anatomical changes and structural complications after M-TEER using TOE and investigate their association with clinical outcomes at 2 years. A follow-up TOE at 6 months was systematically recommended to all patients included in our institutional prospective M-TEER registry until December 2021. We assessed changes in the incidence of mitral regurgitation (MR), MV stenosis (≥5 mmHg), and partial or complete single leaflet device attachment (SLDA) between the index procedure and follow-up and evaluated MV area and annular dimensions in a subset of patients with available three-dimensional (3D) datasets. The clinical endpoint was a composite of mortality and heart failure (HF) rehospitalisation at 2 years. Among the 373 patients included in the registry between February 2012 and December 2021, 128 patients (34%) underwent elective TOE at 6 months. Using TOE, severe MR was observed in 13.3% (n=17) of the patients. The number of patients with an elevated MV gradient increased from 17 (13.3%) after the procedure to 23 (18%) at 6 months, and a new partial or complete SLDA was detected in 7.8% (n=10). Based on 3D TOE measurements, significant increases in MV area, annular area, annular perimeter, and intercommissural (but not anteroposterior) diameter were observed compared to intraprocedural images. A mean MV gradient ≥5 mmHg (hazard ratio [HR] 2.30, 95% confidence interval [CI]: 1.10-4.81; p=0.023) and the presence of severe MR at 6 months (HR 3.26, 95% CI: 1.18-8.99; p=0.023) were associated with the primary endpoint, which was met in 34 (26.6%) patients at 2 years. TOE follow-up allowed the detection of complications that would not be diagnosed using transthoracic echocardiography only and should therefore be used liberally in the patients presenting with a suboptimal result. A mean MV gradient ≥5 mmHg and severe MR, diagnosed at the 6-month TOE follow-up, were associated with adverse clinical outcomes.

A case of a huge aortic pseudo-aneurysm following aortic bioprosthetic endocarditis: the key role of 3D echocardiography

Infective endocarditis (IE) is a life-threatening condition with high morbidity and mortality rates, making early diagnosis and intervention crucial. This report details the case of a 47-year-old male with a history of mechanical prosthetic aortic valve replacement, presenting with pyrexia and diagnosed with aortic bioprosthetic endocarditis leading to a massive aortic pseudoaneurysm. This shows that 3D transesophageal echocardiography is much more useful than regular 2D imaging for finding problems with IE, which makes surgical planning and intervention more precise.

3D Transesophageal Echocardiography in the Selection of Occluder Size for Left Atrial Appendage Occlusion: A Meta-Analysis

Background: Left atrial appendage occlusion (LAAO) can effectively reduce the risk of stroke in atrial fibrillation (AF) patients. However, the structure of left atrial appendage (LAA) varies greatly among individuals, and the size of the occluder influences the surgical success rate and prognosis. This study used a meta-analysis to investigate whether three dimensional-transesophageal echocardiography (3D-TEE) can prompt physicians to select the appropriate size of the occluder, thereby improving prognosis in patients with LAAO. Methods: Studies on 3D-TEE-assisted selection of occluder sizes in the treatment of LAAO were searched in pubmed, cochrane, Web of Science, CNKI, Wanfang, and Weipu public databases from the inception of each database to June 10, 2024. The QUADAS-2 tool was used to assess the quality of the studies. Results: 10 studies published between 2016 and 2024 were finally included, with a total sample size of 552 cases. The maximum opening of the LAA obtained by 3D-TEE, coronary angiography (CAG) and video-assisted thoracic surgery (VATS) significantly correlated with the size of the occluder (p &lt; 0.05). 3D-TEE was superior to 2D-TEE in measuring the maximum (p = 0.04) and minimum diameters (p = 0.01) of LAA openings, and to DSA in measuring depth (p = 0.01). Conclusion: 3D-TEE can be applied to obtain LAA opening data close to the size of the occluder with minimal side effects and to assist physicians in selecting the appropriate occluder.

Perioperative Assessment and Clinical Outcomes of Percutaneous Atrial Septal Defect Closure with Three-Dimensional Transesophageal Echocardiography.

To close the atrial septal defect (ASD) with the transcatheter method, correctly defining the defect and selecting the appropriate closure device size are the most critical steps for the procedure's success. Although ASD can be successfully closed under the guidance of three-dimensional (3D) transesophageal echocardiography (TEE) and two-dimensional (2D) TEE, measurement comparisons between different types of defects are still needed. Our study was designed retrospectively. Sixty-one patients who underwent transcatheter ASD closure with 2D TEE and 3D TEE between 2020 and 2024 were included. The patients were divided into three groups according to the defect shape: circular, oval, and complex; and the measurement results, perioperative process, and clinical outcomes were compared in each group. The average age of the patients was 35.05 ± 13.87 years, and 41 (67.2%) were women. The average follow-up period of the patients was 15.3 ± 9.18 months. No statistical significance was observed in the comparison of measurements obtained with 3D TEE and 2D TEE in the circular and oval defect groups. The differences between the minimum defect diameters of complex defects measured by 2D TEE and 3D TEE (p: 0.037), IVC rims (p < 0.001), aortic rims (p: 0.012), and the differences between implanted device dimensions and the maximum defect diameters measured by both methods were compared; statistical significance was observed (p: 0.025). In circular and non-complex oval defects, it has been observed that the size of the closure device selected with 2D TEE or 3D TEE is optimal, and the procedure is practical and feasible. While the closure of complex ASDs with 3D TEE provides reliable and optimal results, using only 2D TEE in complex ASDs may lead to selecting a smaller-sized device.

Accuracy of mitral valve annulus measurements by two-and three-dimensional transesophageal echocardiography, compared to intraoperative measurements in patients undergoing mitral valve replacement surgery

Introduction: Transthoracic echocardiography (TTE) is the most beneficial diagnostic modality for mitral valve (MV) diseases. However, it is not accurate enough for MV annular sizing. Recent evidence has demonstrated the superiority of transesophageal echocardiography (TEE) over TTE. The present study aimed to evaluate the accuracy of two-dimensional TEE (2D-TEE) and three-dimensional TEE (3D-TEE) in preoperative measuring of MV size and specifications. Methods: This cross-sectional study evaluated patients with mitral valve replacement (MVR) surgery at Shahid Madani Heart Center of Tabriz university of Medical Sciences, Tabriz, Iran, in 2020. Thirty-eight patients admitted for MVR surgery were enrolled in this study. Demographic, electrocardiogram (ECG), and echocardiographic studies -including TTE, 2D, and 3D TEE- were performed preoperative for each patient. The accurate size and the specifications of the studied structure were measured by a surgical gauge caliper during the surgery, which was considered the gold standard value. The correlations between obtained parameters were evaluated using Pearson’s correlation coefficient. The data obtained from individual were entered into the SPSS software. Significance was set at P&lt;0.05. Results: The mean age of patients was 55.89±11.81 years, and 65.8% were male. Most patients (68.4%) had sinus rhythm. The strongest correlation with the gold standard was observed in mitral annulus circumference measured by the three-dimensional multiplanar reconstruction (3D MPR) method in all patients (r=0.758, P&lt;0.001), [(r=0.723, P&lt;0.001) for patients with sinus rhythm, and (r=0.825, P=0.001) for patients with atrial fibrillation (AF)]. The minor difference between the echocardiographic measurements and the surgical rule was related to the short axis (SA) in the 3D MPR method (3.3 mm). Conclusion: This study illustrated a high correlation between 3D-MPR TEE measured MV annulus and intra-operative measurements using a surgical gauge caliper as the gold standard.

Indexed aortic valve area using multimodality imaging for assessing the severity of bicuspid aortic stenosis

BackgroundThe impact of various imaging modalities on discordance/concordance between indexed aortic valve area (iAVA) and catheterization-derived mean transaortic pressure gradient (mPGcath) is unclear in patients with bicuspid aortic valve (BAV). This study aimed to compare iAVA measurements obtained using four different methodologies in BAV and tricuspid aortic valve (TAV) patients, using mPGcath as a reference standard. MethodsWe retrospectively reviewed patients who underwent comprehensive assessment of AS, including two-dimensional (2D) transthoracic echocardiography (TTE), three-dimensional (3D) transesophageal echocardiography (TEE), multidetector computed tomography (MDCT), and catheterization, at our institution between 2019 and 2022. iAVA was measured using the continuity eq. (CE) with left ventricular outflow tract area obtained by 2D TTE, 3D TEE, and MDCT, as well as planimetric 3D TEE. Results and ConclusionsAmong 564 patients (64 with BAV and 500 with TAV), 64 propensity-matched pairs of patients with BAV and TAV were analyzed. iAVACE(2DTTE) led to overestimation of AS severity (BAV, 23.4%; TAV, 28.1%) and iAVACE(MDCT) led to underestimation of AS severity (BAV, 29.3%; TAV, 16.7%), whereas iAVACE(3DTEE) and iAVAPlani(3DTEE) resulted in a reduction in the discordance of AS grading. A moderate correlation was observed between mPGcath and iAVACE(3DTEE) (BAV, r = −0.63; TAV, r = −0.68), with iAVACE(3DTEE) corresponding to the current guidelines' cutoff value (BAV, 0.58 cm2/m2; TAV, 0.60 cm2/m2). Discordance/concordance between iAVA and mPGcath in evaluating AS severity varies depending on the methodology and imaging modality used. The use of iAVACE(3DTEE) is valuable for reconciling the discordant AS grading in BAV patients as well as TAV.

3D transoesophageal echocardiography as a new diagnostic tool for precise quantitative assessment of the thoracic aorta atherosclerotic plaques

3D transoesophageal echocardiography as a new diagnostic tool for precise quantitative assessment of the thoracic aorta atherosclerotic plaques

Measurements of the Interventricular Septum and Mitral Leaflet Length in Hypertrophic Cardiomyopathy Patients Who Underwent Surgical Myectomy: A Prospective Comparative Multimodality Imaging Study

Transesophageal echocardiography (TEE) plays an important role for real-time procedural guidance during surgical myectomy (SM) for hypertrophic obstructive cardiomyopathy (HOCM). We aimed to compare a) IVS thickness using two (2D) and three-dimensional (3D) intraoperative TEE and pre-operative cardiac magnetic resonance (CMR) and b) mitral valve (MV) leaflet length using 2D, 3D TEE, automatic quantification of mitral valve (AMVQ) and pre-operative CMR. We prospectively studied 50 HOCM patients (age 59 ±12, 44% men) undergoing SM during 2018-2019. Maximal basal, mid, and distal anteroseptum (AS) and inferoseptum (IS) were measured by multiplanar 3D reconstruction on TEE and by short axis imaging on pre-operative CMR, and classified as mild (≤18mm), moderate (18-25mm) or severe (≥ 25 mm) groups, based on AS and IS thickness on CMR. MV leaflet lengths were evaluated by pre-operative CMR and intra-procedural 2D TEE, zoom 3D TEE and AMVQ (EchoPAC, General Electric, Wi). There was a moderate correlation between AS and IS thickness on 3D TEE and CMR (R2=0.46, p<0.01 and R2=0.41, p<0.01 respectively), with 3D TEE showing an average overestimation of 3.8 and 4.7 mm vs. CMR. 3D TEE over-estimated 14 (56%) patients with mild thickness as moderate, and 5 (22%) patients with moderate thickness as severe. Assuming 3D TEE as the gold standard, the closest correlation for anterior mitral leaflet length was with CMR (average overestimation by CMR of 0.5 mm [root mean square deviation or RMSE% 17]), intermediate correlation with 2D TEE (average deviation of 0.6 mm [RMSE%:21]) and no correlation with AMVQ (average deviation of 0.7mm [RMSE% 24]). In conclusion, 3D TEE overestimates IVS thickness vs. CMR in HOCM patients undergoing SM, with greater discrepancy in those with thinner IVS. There are significant differences in MV lengths measured using different imaging techniques.

Modern 3D Transoesophageal Echocardiography—Providing Improved Diagnostic Accuracy for Prosthetic Valve Dysfunction

Modern 3D Transoesophageal Echocardiography—Providing Improved Diagnostic Accuracy for Prosthetic Valve Dysfunction

Role of 3D transoesophageal echocardiography in the study of infective endocarditis. Demonstration in a case collection.

Infective endocarditis (IE) is a condition that predominantly affects native or prosthetic heart valves, which is currently on the rise due to the increase in invasive cardiology procedures, such as the utilization of cardiac implantable electronic devices and transcatheter interventions. The recommended imaging tests for diagnosis are 2D transthoracic echocardiography (2D TTE) and 2D transoesophageal echocardiography (2D TOE). However, these modalities present limitations in detecting vegetations and estimating their dimensions. These disadvantages can be overcome by 3D transoesophageal echocardiography (3D TOE), particularly with the multiplanar reconstruction tool, which allows for the visualization of infinite valve planes, thus optimizing the detection of lesions and precise measurements. Furthermore, the volume rendering provides insight into the anatomical relationships between lesions, which is particularly useful for surgical planning. In this review, we aim to discuss the role of this recent imaging modality in the diagnosis, prognosis, and therapeutic of IE. Finally, we present a collection of images that illustrate the use of 3D TOE tools.

3-Dimensional Echocardiographic Prediction of Left Ventricular Outflow Tract Area Prior to Transcatheter Mitral Valve Replacement

BackgroundNew postprocessing software facilitates 3-dimensional (3D) echocardiographic determination of mitral annular (MA) and neo–left ventricular outflow tract (neo-LVOT) dimensions in patients undergoing transcatheter mitral valve replacement (TMVR). ObjectivesThis study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT). MethodsA total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients. ResultsThere was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm2, limit of agreement: −92.2 mm2 to 143.3 mm2; P < 0.001; mean bias pre/post CT: 28.3 mm2, limit of agreement: −65.8 mm2 to 122.4 mm2; P = 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r2 = 0.481; P < 0.001 for TEE and r2 = 0.401; P < 0.001 for CT). ConclusionsTEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR.

Influence of Meteorological Parameters on the Prevalence of TEE Detected Left Atrial Appendage Thrombi.

(1) Background: Meteorological factors seem to exert various effects on human health, influencing the occurrence of diseases such as thromboembolic events and strokes. Low atmospheric pressure in summer may be associated with an increased likelihood of ischemic stroke. The aim of this study was to investigate the potential impact of meteorological conditions on left atrial appendage (LAA) thrombus formation. (2) Methods: A total of 131 patients were included, diagnosed with a first instance of thrombus via 3D transesophageal echocardiography (TEE) between February 2009 and February 2019. Months with frequent thrombus diagnoses of at least 10 thrombi per month were categorized as frequent months (F-months), while months with fewer than 10 thrombus diagnoses per month were labelled as non-frequent months (N-months). The analysis focused on differences in meteorological parameters in two-week and four-week periods before the diagnosis. (3) Results: F-months were predominantly observed in spring and summer (April, May, June, and July), as well as in February and November. During F-months, a higher absolute temperature difference, lower relative humidity, longer daily sunshine duration, and greater wind speed maximum were observed in the two- and four-week periods rather than for N-months. In the two-week period, average temperatures, equivalent temperatures, and temperature maxima were also significantly higher during F-months than N-months. (4) Conclusion: Thrombi in the left atrial appendage are more prevalent during periods characterized by high absolute temperature differences, low relative humidity, and long daily sunshine duration.

TransFusion: Efficient Vision Transformer based on 3D transesophageal echocardiography images for the left atrial appendage segmentation

3D transesophageal echocardiography (TEE) is widely used in the preoperative guidance of left atrial appendage closure (LAAC), and is the preferred imaging examination recommended by expert consensus. The precise extraction of the left atrial appendage (LAA) is the essential initial step for establishing an automated predictive procedure of the LAAC. However, due to the inherent limitations of the ultrasound images and the unique morphological features of the LAA, segmenting the LAA in TEE images is a challenging task. In this paper, we propose a novel Transformer-based dual feature fusion network (TransFusion) for LAA segmentation in TEE images. Our TransFusion includes both intra-stage and inter-stage multi-scale feature fusions. Specifically, in each stage of the encoder, we introduce a Multi-Scale Vision Transformer (MSViT) block for extracting and enhancing multi-scale feature representations. Additionally, we use a Feature Fusion module (FFM) to fuse the features across different stages in parallel and alleviate the semantic gap and better recovering the spatial details. Finally, the convolutional neural network (CNN) as the decoder is used to output the results of LAA segmentation. We compare our method with several state-of-the-art methods on our private clinical dataset. Experimental results demonstrate the superior robustness and segmentation performance of our method and its capability to accurately extract the LAA.