Diagnostic Value Of Transesophageal Echocardiography Research Articles

Mode Vibrations of a Matrix Transducer for Three-Dimensional Second Harmonic Transesophageal Echocardiography

Transesophageal echocardiography (TEE) uses the esophagus as an imaging window to the heart. This enables cardiac imaging without interference from the ribs or lungs and allows for higher frequency ultrasound to be used compared with transthoracic echocardiography (TTE). TEE facilitates the successful imaging of obese or elderly patients, where TTE may be unable to produce images of satisfactory quality. Recently, three-dimensional (3-D) TEE has been introduced, which greatly improves the image quality and diagnostic value of TEE by adding an extra dimension. Further improvement could be achieved by optimizing 3-D TEE for harmonic imaging. This article describes the optimal geometry and element configuration for a matrix probe for 3-D second harmonic TEE. The array concept features separated transmit and receive subarrays. The element geometry was studied using finite element modeling and a transmit subarray prototype was examined both acoustically and with laser interferometry. The transmit subarray is suitable for its role, with a 3 MHz resonance frequency, a 40%–50% −3 dB bandwidth and crosstalk levels <−27 dB. The proposed concept for the receive subarray has a 5.6 MHz center frequency and a 50% −3 dB bandwidth.

503 The diagnostic value of transoesophageal echocardiography in patients with discrete subvalvular aortic stenosis (DSAS) and hypertrophic obstructive cardiomyopathy (HOCM)

503 The diagnostic value of transoesophageal echocardiography in patients with discrete subvalvular aortic stenosis (DSAS) and hypertrophic obstructive cardiomyopathy (HOCM)

Iatrogenic aortic haematoma during primary PTCA: Diagnostic value of transesophageal echocardiography in cath lab

A 60-year-old woman with severe chest pain and ECG diagnostic for acute transmural ischemia was transferred to cath lab for primary PTCA. After procedure, transesophageal echocardiography (TEE) views revealed an intramural haematoma extending from the ostium of the RCA throughout the sino-tubular junction. These findings and the stable clinical conditions of patient guided us to a conservative therapeutic approach. A TEE study, performed 5 days after admission, showed a complete resolution of intramural haematoma. A waiting strategy can be a valid therapeutic option in selected patients with iatrogenic haematoma and TEE is a useful diagnostic tool for clinical decision making.

Diagnostic Value of Transesophageal Echocardiography in the Assessment of Congenitally Corrected Transposition of the Great Arteries in Adult Patients

Diagnostic Value of Transesophageal Echocardiography in the Assessment of Congenitally Corrected Transposition of the Great Arteries in Adult Patients

A case report of Budd-Chiari syndrome : Diagnostic value of transesophageal echocardiography

A case report of Budd-Chiari syndrome : Diagnostic value of transesophageal echocardiography

Diagnostic value of transesophageal echocardiography in the assessment of congenitally corrected transposition of the great arteries in adult patients

This study was designed to evaluate the relative diagnostic values of transthoracic (TTE) and transesophageal (TEE) echocardiography in the assessment of congenitally corrected transposition of the great arteries in adult patients. Twelve patients (mean age 29 years, range 21 to 39 years) with congenitally corrected transposition of the great arteries underwent both TTE and TEE examinations to assess this complex cardiac lesion. Of the 12 patients evaluated, situs solitus and inversus were present in 8 and in 4 patients, respectively. TTE correctly identified atrial situs in only 10 patients, whereas TEE, directly evaluating the morphologic features of either appendage, correctly determined situs in every patient. In all 11 patients with intact inlet ventricular septum, the spatial relationship between the septal leaflets of atrioventricular valves was correctly evaluated by both techniques. However, the chordal attachments of both valves were clearly elucidated by TEE in all patients, whereas TTE could obtain images of these in only three patients. TTE was able to evaluate the discordant connection between the right ventricle and the anterior vessel (aorta) in 10 patients, whereas the connection between the left ventricle and the posterior vessel was clearly shown only in 7 patients. Transesophageal longitudinal planes better elucidated these two discordances in all patients irrespective of the position of the heart in the chest and atrial situs. Four patients had an associated ventricular septal defect (inlet defect in one, perimembranous in two, and muscular in one); the inlet defect was unrestrictive and could be easily detected by either imaging technique, whereas the membranous was detected by TTE and by the horizontal transesophageal planes; the muscular defect was recognized only by TTE. Three patients had an associated pulmonary stenosis; Doppler transthoracic echocardiography showed a left outflow peak gradient of 100 mm Hg in two patients and of 80 mm Hg in one but failed to adequately assess the morphologic features of the stenosis, whose features were clearly visualized by transesophageal longitudinal planes in all patients. In conclusion, in our experience TEE is superior to transthoracic imaging in studying congenitally corrected transposition of the great arteries in adult patients; the horizontal plane is best suited to the evaluation of atrial situs and the atrioventricular junction, whereas the longitudinal plane is most valuable in the study of the morphologic features of the ventriculoarterial connections. These findings should be equally applicable to multiplane transesophageal studies. (Am Heart J 1998;135:43-50.)

Diagnosis and Treatment of Shock Due to Massive Pulmonary Embolism: Approach With Transesophageal Echocardiography and Intrapulmonary Thrombolysis

To evaluate the diagnostic value of transesophageal echocardiography (TEE) as an initial diagnostic tool in shocked patients. The second objective was to study therapeutic impact of intrapulmonary thrombolysis in patients with diagnosed massive pulmonary embolism. Prospective observational study. Medical ICU in 800-bed general hospital. Twenty-four consecutive patients with unexplained shock and distended jugular veins. In 18 patients, right ventricular dilatation with global or segmental hypokinesis was documented. In addition, central pulmonary thromboemboli (12 patients), reduced contrast flow in right pulmonary artery (one patient), and right ventricular free wall akinesis (one patient) were found. No additional echocardiographic findings were apparent in four patients. According to pulmonary scintigraphy or autopsy, sensitivity of TEE for diagnosis of massive pulmonary embolism (MPE) in patients with right ventricular dilatation was 92% and specificity was 100%. In patients without right ventricular dilatation, left ventricular dysfunction (four patients) or cardiac tamponade (two patients) was confirmed. Intrapulmonary thrombolysis was evaluated in 11 of 13 patients with MPE. Two patients died prior to attempted thrombolysis. Three patients received streptokinase and eight received urokinase. Twenty-four hours after beginning of treatment, total pulmonary resistance index significantly decreased for 59% and mean pulmonary artery pressure for 31%. Cardiac index increased for 74%. Nine of 11 patients receiving thrombolysis survived to hospital discharge. Bedside TEE is a valuable tool for diagnosis of MPE. It enables immediate intrapulmonary thrombolysis, which seems to be an effective therapeutic alternative in our group of patients with obstructive shock.

Transesophageal echocardiography.

During the past two decades, cardiovascular ultrasonography has benefited from technical innovations that have allowed it to become a cornerstone of the modern diagnosis of cardiac disease. Transesophageal echocardiography (TEE) is one of the more recent developments. In the past few years clinical applications of TEE have grown explosively. In this article, we summarize the present status and diagnostic value of TEE as compared with transthoracic echocardiography, emphasizing in particular the effect of TEE on diagnostic decision making and patient care.In 1976, Frazin et al. described their initial experience with a single-crystal ultrasound transducer attached to a coaxial cable . . .

805-3 Diagnostic Value of Transesophageal Echocardiography During Cardiopulmonary Resuscitation

Transesophageal echocardiography (TEE) permits the visualisation of the heart and great vessels without disturbing resuscitation attempts. Early information about the cause of the circulatory arrest can help in reestablishing spontaneous circulation. We investigated the diagnostic value of TEE during resuscitation. TEE was performed in adult patients with either in-hospital or out-of-hospital onset of a circulatory arrest, after endotracheal intubation. 30 patients were included, 17 with in-hospital arrest, and 13 with out-of-hospital arrest (initial rhythm: asystole 7, elektromechanical dissociation 7, bradycardia 11, ventricular fibrillation 3, sinus tachcycardia 2). Mean time between code call and start of TEE was 15 minutes, Return of spontaneous circulation (ROSC) was observed in 15 patients, 26 patients eventually died, 4 survived to discharge. The TEE diagnoses made were cardiac tamponade (CT) 6, myocardial infarction (MI) 10, pulmonary embolism (PE) 4, aortic aneurysm rupture (AAR) 3, papillary muscle rupture (PMR) 1, none 5. In 11 out of 12 post-mortem examinations and 1 out of 1 surgical procedure the TEE diagnosis was confirmed. CT MI PE AAR PMR none other TEE diagnosis 6 10 4 3 1 5 1 ROSC 2 7 1 3 1 0 1 Died 5 9 4 3 1 2 1 Diagnosis confirmed 3/3 7/7 1/1 0/1 0/0 3/3 0/0 TEE is helpful in establishing the cause of a circulatory arrest, thereby contributing to the early institution of specific therapeutic measures.

Comparative Diagnostic Value of Transesophageal Echocardiography and Retrograde Aortography in the Evaluation of Thoracic Aortic Dissection

Comparative Diagnostic Value of Transesophageal Echocardiography and Retrograde Aortography in the Evaluation of Thoracic Aortic Dissection

O82 Diagnostic value of transoesophageal echocardiography during cardiopulmonary resuscitation

O82 Diagnostic value of transoesophageal echocardiography during cardiopulmonary resuscitation

Comparative diagnostic value of transesophageal echocardiography and retrograde aortography in the evaluation of thoracic aortic dissection

The aim of this study was to assess the comparative diagnostic value of transesophageal echocardiography (TEE) and retrograde aortography for morphologic evaluation and anatomic mapping of aortic dissection. Seventy patients (aged 18 to 79 years) were prospectively evaluated with both techniques for suspected aortic dissection. In 64 patients, findings on aortography and TEE could be validated against intraoperative (n = 53) and postmortem (n = 11) findings. Examination time was significantly shorter for TEE (9 ± 6 vs 48 ± 25 minutes; p < 0.001). For the detection of aortic dissection, aortography showed lower sensitivity (87.5% vs 97.5%) and negative predictive value (85.3% vs 96.7%; both trends did not reach statistical significance) due mostly to the inability to identify noncommunicating dissection (dissection without intimal tears). For the epiphenomena of aortic dissection, aortography was significantly more accurate (97.2% vs 78%; p < 0.05) in assessing the site of entry, and TEE was more accurate in identifying thrombus formation (90% vs 65%; p < 0.05). There was no significant difference between aortography and TEE with regard to assessing secondary tears, aortic regurgitation, coronary dissection, and extension of the dissection. Thus, both TEE and aortography offer detailed anatomic mapping for guided surgical interventions. In elective patients, integration of both techniques seems the best approach; in unstable patients, TEE may be preferential because it is less invasive, requires no contrast injection, and provides accurate diagnosis in a short time at the bedside.

Communicating versus Noncommunicating Acute Thoracic Aortic Dissection: Two Case Reports and Diagnostic Value of Transesophageal Echocardiography and Alternative Imaging Modalities

Two patients, with communicating and noncommunicating Stanford type A acute aortic dissection each, are reported with anatomic and hemodynamic features diagnosed by single-plane transesophageal echocardiography (TEE) with color flow imaging. TEE demonstrated a communicating dissection, more in detail than aortography and computed tomography, with an intimai flap, the extent of dissection, the dissecting intimai flap prolapse through the aortic valve during diastole, flow patterns in the true and false lumina, presence and absence of aortic valvular regurgitation, and absence of pericardial effusion. TEE showed the presence of a noncommunicating (variant) dissection, which was nondiagnostic by magnetic resonance imaging and aortography before surgery, with intramural thrombus (hematoma) formation and its extent and location, accurate measurement of aortic wall thickness, and the presence of an intimai flap or intramural blood flow. In addition, TEE also permitted evaluation of global and regional systolic performance. Therefore, TEE can be recommended as the first-line modality of choice for an early diagnosis of an acute thoracic aortic dissection.

Usefulness of Transesophageal Echocardiography in Patients With Hemodynamic Deterioration Late After Cardiac Surgery

Two patients with large pericardial thrombi following cardiac surgery presented as having right cardiac tamponade. Transesophageal echocardiography (TEE) identified a large pericardial hematoma compressing the right atrium and was well tolerated by these critically ill patients. These case reports demonstrate the diagnostic value of TEE in the identification of this severe complication in the late postoperative period.

Transesophageal echocardiography in right-sided endocarditis

Objectives. Our aim was to determine the diagnostic value of transesophageal echocardiography in right-sided endocarditis.Background. Recentstudies have demonstrated that transesophageal echocardiography is superior to transthoracic echocardiography in the detection of vegetations associated with left-sided endocarditis. Its diagnostic value in right-sided endocarditis has not been established.Methods. Transthoracic and transesophageal echocardiography were prospectively performed in 48 patients who met specific criteria for the suspicion of right-sided endocarditis. All were intravenous drug abusers.Results. Vegetations were found in 22 of 48 patients by both transthoracic and transesophageal echocardiography. The vegetations were more precisely characterized by transesophageal echocardiography in 14 (63%) of 22 patients. In the remaining 26 patients, no vegetations were found by either transthoracic or transesophageal echocardiography. No statistically significant differences were found between the two techniques in the assessment of tricuspid regurgitation, which was detected in 21 (44%) of 48 patients.Conclusions. We conclude that transesophageal echocardiography does not improve the diagnostic accuracy of transthoracic echocardiography in the detection of vegetations associated with right-sided endocarditis in intravenous drug abusers. Transesophageal echocardiography may not be indicated as a routine procedure in patients suspected of having right-sided endocarditis.

Diagnostic value of transesophageal echocardiography in atrial septal aneurysm.

Transthoracic and transesophageal echocardiography was performed in 40 consecutive adult patients with an atrial septal aneurysm. In 11 (27%) of 40 patients transthoracic echocardiography failed to demonstrate the lesion and the diagnosis was established by the transesophageal approach only. Interatrial shunting, assessed by echocardiographic contrast study and/or color flow mapping, was detected in 13 (54%) of 24 patients on transthoracic imaging and in 29 (76%) of 38 patients during transesophageal echocardiography. Identification of multiple fenestrations (n = 9) and thrombi within the aneurysm (n = 2) could be achieved only by transesophageal ultrasound. A cerebrovascular event of suspected embolic origin occurred in 20 (50%) of 40 patients; 11 (55%) of the 20 patients had repeated cerebral events. Except for mitral valve prolapse in 2 patients and spontaneous left atrial contrast phenomenon in 1 patient no other potential cardiac source of embolism could be identified by transesophageal echocardiography. A marked thickening of the aneurysm was present in 14 (70%) of 20 patients with a cerebrovascular event versus only 4 (20%) of 20 patients without a cerebrovascular event (p less than 0.01). The mechanism of embolization may be both primary thrombus formation within the aneurysm and paradoxical embolization through an interatrial communication as suggested by the findings on transesophageal ultrasound in 2 patients. Although the patients of this study represent a highly selected group it may be concluded that atrial septal aneurysm is a cardiac abnormality with embolic potential. Transesophageal echocardiography has to be regarded the imaging method of choice for evaluation of this lesion.

Prediction of Rapid versus Prolonged Healing of Infective Endocarditis by Monitoring Vegetation Size

The diagnostic value of transesophageal echocardiography in monitoring the clinical course has been evaluated in 83 patients with echocardiographic evidence of infective endocarditis. A total of 103 vegetations attached to the aortic or mitral valves were detected by use of the transesophageal approach. The patients were monitored for a mean of 74 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations. Group A included patients with increasing or remaining constant size of vegetation (8.2 +/- 1.5 to 11.2 mm, p less than 0.05) during 4 to 8 weeks of antimicrobial therapy, whereas group B was formed by patients with decreasing vegetation size (8.3 +/- 0.8 to 4.9 +/- 0.8 mm, p less than 0.05). The incidences of complications after diagnosis and onset of therapy was higher in group A than in group B: valve replacement (45% versus 2%, p less than 0.05), embolic events (45% versus 17%, p less than 0.05), perivalvular abscess formation (13% versus 2%, p less than 0.05), and mortality (10% versus 0%, respectively, p less than 0.05). Staphylococcus aureus was the most frequent organism isolated in group A (44% versus 11% in B, p less than 0.05) and Streptococcus viridans in group B (33% versus 18% in A, p less than 0.05). Blood cultures were negative in nearly 50% of the patients in each group. There was no difference in the incidences of complications in patients with positive or negative blood cultures. We conclude that an increase in vegetation size during antibiotic therapy predicts a prolonged healing phase of infective endocarditis. This prolonged healing period is associated with a significantly increased risk of complications, independent of blood culture results. Monitoring vegetation size contributes important information concerning prognosis and stage of risk, and it aids in the choice of patient management in infective endocarditis. Because embolic events after diagnosis and onset of treatment are less frequent in rapid-healing endocarditis, surgery cannot be recommended to prevent further events taking into account the high risk of surgery.

Diagnostic Value of Transesophageal Echocardiography in Cardiac Surgery

The aim of this study was to assess the diagnostic value of intraoperative 2-D color Doppler transesophageal echocardiography (ITEE) for the surgeon and anesthesiologist in patients undergoing coronary bypass surgery or heart valve replacement. Information given by ITEE in 100 cardiac operations was documented. We judged the ITEE information, considering to what extent it was not to be obtained by other methods and to what extent it influenced the operation itself. The value was classified as dispensable (0), informative (1), valuable (2), or essential (3). In 50 consecutive patients with heart-valve replacement (25 aortic valve prostheses, 25 mitral valve prostheses) ITEE was 38 x (0), 8 x (1), 4 x (2). In 50 consecutive patients undergoing coronary artery bypass graft surgery it was 33 x (0), 11 x (1), 4 x (2), 2 x (3). The two essential diagnoses referred to undetected vein graft occlusions. Information classified as valuable mainly referred to left and right ventricular function or valvular and prosthetic valve function when difficulties occurred during and after extracorporeal circulation. In conclusion, information given by ITEE, although generally regarded as dispensable in the procedures considered, was valuable in 10% of cases and in 2% even essential.

Risk of transesophageal echocardiography in awake patients with cardiac diseases

Recent studies described the diagnostic value of transesophageal echocardiography in patients with different diseases of the heart and the thoracic aorta.1–8 However, the risk and potential complications of the transesophageal approach are still under discussion. Schlueter et al6 reported no major side effects during the transesophageal approach in 300 consecutive patients. In accordance with these results, Engberding et al7 also observed no complications using the transesophageal technique in patients with aortic dissection or aortic aneurysm. More recently and in a similar patient population, Erbel et al8 described a 1% incidence of side effects (namely, 1 patient with an attack of asthma and another who experienced a transient atrioventricular heart block). In a prospective study in 54 consecutive patients with different heart diseases undergoing transesophageal echocardiography, we evaluated the presence and severity of “side effects” such as cardiac arrhythmias, marked changes in blood pressure or heart rate and evidence of myocardial ischemia during the diagnostic procedure.