Role Of Transesophageal Echocardiography Research Articles

Competing stroke mechanisms despite adequate oral anticoagulant therapy: the role of transesophageal echocardiography.

Ischemic strokes in patients on oral anticoagulant therapy (OAT) despite optimal adherence pose a therapeutic challenge. We assessed the utility of transesophageal echocardiography (TEE) in identifying potential competing cardiac causes for stroke that occurred despite adequate OAT. This retrospective observational study included patients admitted for acute ischemic stroke between January 2022 and June 2023 who were on OAT for an established long-term indication. Transthoracic and transesophageal echocardiography, along with assessment of OAT adherence, were conducted. Demographic data, OAT details, and stroke characteristics were analysed to determine the influence of TEE findings on therapeutic decisions. We included 26 patients. TEE identified potential cardiac competing stroke mechanisms in 88% of cases, with valvular thrombi and left atrial or appendage thrombus being predominant. Infective endocarditis, often asymptomatic, was unexpectedly prevalent. TEE significantly influenced therapeutic decisions, especially in cases where transthoracic echocardiography was inconclusive. TEE may be crucial for unravelling the mechanisms of ischemic stroke in patients on adequate OAT, guiding precise therapeutic strategies and potentially reducing the risk of recurrent embolic events. Our findings underscore the limitations of standard echocardiography in detecting cardiac embolic sources and emphasize the importance of tailored decision-making in secondary stroke prevention.

Complex aortic plaques: hidden danger in aortic stenosis. Role of transesophageal echocardiography.

Aortic stenosis is associated with aortic plaques in up to 85% of cases because they share risk factors and pathogenic pathways. Intrinsically, complex aortic plaques carry a high risk of stroke, which has also been demonstrated in the context of aortic stenosis, especially in patients who underwent percutaneous or surgical replacement. Transesophageal echocardiography (TEE) is the imaging test of choice to detect plaques in the thoracic aorta and classify them as complex plaques. Furthermore, the 3D modality allows us to better specify its dimensions and anatomical characteristics, such as added thrombi or the presence of ulcers inside. This review aims to evaluate the use of TEE to detect complex aortic plaques in patients with an indication for percutaneous or surgical aortic valve replacement. To highlight the association between aortic stenosis and complex aortic plaques, we attached to the review some TEE studies from our experience.

A gray zone: Role of transesophageal echocardiography before atrial tachycardia catheter ablation.

There is a lack of studies in the literature directly investigating the relationship between atrial tachycardia (AT) and left atrial (LA)/left atrial appendage (LAA) thrombus, and current guidelines do not provide strong recommendations regarding the use of transesophageal echocardiography (TEE) before AT catheter ablation. This study aims to elucidate the relationship between AT and the presence of LA/LAA thrombus and contribute to the literature on the use of TEE before AT catheter ablation. This single-center retrospective observational study screened patients who underwent TEE between February 10, 2019, and February 10, 2023. Patients were assigned to the AT patient and control groups. TEE was conducted to exclude thrombus in the AT ablation group. The control group included patients who underwent TEE for interatrial septum evaluation and had LA imaging during TEE but did not have atrial arrhythmia. To mitigate bias between the AT patient group and the control group, they were randomized 1:1 using propensity-score matching (PSM). Following randomization, each group consisted of 49 patients. All analyses were conducted after PSM. There were no statistically significant differences between the AT patient and control groups in terms of baseline clinical characteristics and echocardiographic features. Additionally, no significant differences were found between the blood viscosities calculated at low and high shear rates in both groups. The study revealed a significant difference between the two groups in the presence of LA spontaneous echo contrast (SEC) (24.5% in AT group vs 0% in Control group, p = .001), but not in the presence of thrombi (8.2% in AT group vs 0% in Control group, p = .117). Compared to the control group, the presence of SEC was significantly higher in the AT patient group. The increased frequency of SEC in AT patients suggests the hypothesis that AT may contribute to LA stasis. The routine use of TEE before AT catheter ablation remains controversial, despite the presence of LA thrombus and SEC in the AT patient group. The clinical assessment of thrombus presence before the procedure must be conducted on a patient-specific basis.

Role of Transesophageal Echocardiography in Differentiating Dynamic versus Fixed Left Ventricular Outflow Tract Obstruction in Complete Transposition of Great Arteries: A Rare Case Report

Role of Transesophageal Echocardiography in Differentiating Dynamic versus Fixed Left Ventricular Outflow Tract Obstruction in Complete Transposition of Great Arteries: A Rare Case Report

Abnormal Color Flow Jet in Left Ventricular Outflow Tract Mimicking a Ventricular Septal Defect: Establishing Differentials and Diagnosis and Role of Transesophageal Echocardiography.

Abnormal Color Flow Jet in Left Ventricular Outflow Tract Mimicking a Ventricular Septal Defect: Establishing Differentials and Diagnosis and Role of Transesophageal Echocardiography.

Role of Transesophageal Echocardiography in “Off-pump” Inferior Vena Cava Thrombectomy Associated with Renal Cell Carcinoma: A Case Report

Role of Transesophageal Echocardiography in “Off-pump” Inferior Vena Cava Thrombectomy Associated with Renal Cell Carcinoma: A Case Report

The role of echocardiography in management of patients with hypertrophic cardiomyopathy (review)

The presented contains the discussion about the role of echocardiography in management of patients with hypertrophic cardiomyopathy (HCM). The article provides general information about the role of echocardiography in the diagnosis of the disease, clarification of the specific etiology of hypertrophy and differential diagnosis with secondary hypertrophy and phenocopies of HCMP. The features of right and left ventricular (LV) hypertrophy, determination of its predominant localization, phenotype, and conventionally used parameters for assessing myocardial hypertrophy, including the maximum LV wall thickness, LV myocardial mass and LV myocardial mass index, are discussed in detail. Knowledge of phenotypic variants helps to diagnose HCMP, to differentiated approach the management of patients and to choose the optimal treatment strategy. Special attention is paid to the assessment of the structure and function of the mitral valve (MV), the subvalvular apparatus and the phenomenon of systolic anterior motion of the MV responsible for the development of obstruction of the LV outflow tract. The previously existing opinion that cardiac abnormality in HCMP is limited only by hypertrophy of ventricular myocardium has recently undergone changes. Approximately 60% of patients with HCMP have at least one MV anomaly as a direct consequence of genetic mutations. The most common abnormalities that can be detected with echocardiography include elongation of the valvular leaflets and chords, prolapse of the valvular leaflets, hypertrophy, disposition and change in the number of papillary muscles. The importance and significance of assessing LV systolic and diastolic functions using echocardiography is emphasized. The role of transesophageal echocardiography in visualization of hypertrophy features of the MV structure and in the perioperative period during surgical correction of hypertrophied septum and valvular defects is also discussed.

The role of transoesophageal echocardiography in diagnosis and management of patients with embolic stroke of undetermined source

Abstract Funding Acknowledgements Type of funding sources: None. Introduction About 25–30% of the cases of ischemic stroke have no established etiology after standard diagnostic evaluation and are classified as embolic strokes of undetermined source (ESUS). Transoesophageal echocardiography (TOE) may provide additional information in the evaluation of patients with ESUS and change the secondary prevention management. Purpose In this retrospective study we examined the role of TOE in diagnosis and further management of patients with ESUS. Methods Patients with ESUS (18 to 60 years old) with no comorbidities were examined at the echocardiography laboratory of our hospital, from April 2018 until August 2022. All patients were thoroughly assessed with transthoracic echocardiography and had no abnormal findings. Atrial fibrillation was excluded by ambulatory electrocardiography. All patients were examined for presence of patent foramen ovale (PFO), aortic atheromatosis and left atrial appendage thrombus. The size of PFO shunt was classified based on the number of microbubbles seen in the left atrium during the first three cardiac cycles after the infusion of agitated saline. The presence of 1–5 microbubbles was classified as small shunt, 6–25 as moderate and >25 as large. Patients with large shunts and RoPE score >6 were referred to occlusion. Τ - test was used to compare the means of the variables and a p value 0.05 was considered statistically significant. Results In this study, 200 patients with ESUS (134 males), of mean age 52.6 (SD=9.8 ears), were enrolled. In 52 of them TOE determined the etiology of stroke. The presence of PFO was found in 70 (35.0%) patients. Of those, 17 (24.3%) had a small shunt, 20(28.6%) a moderate and 32 (45.7%) had a large shunt and were referred to occlusion. Patients with PFO were younger (mean age 47.2 years, SD 11.2, p<0.001) than those without PFO (mean age 54.8 years, SD 8.6) (Diagram 1). Furthermore, 20 (10.0%) patients were diagnosed with atheromatosis of ascending aorta and aortic arch ≥grade 2. Patients with aortic atheromatosis were older (mean age 58.1 years SD 7.6) than those without atheromatosis (mean age 51.9 years, SD 9.8, p = 0.008) (Diagram 2). Finally, TOE did not reveal left atrial appendage thrombus in any of the examined patients. Conclusion TOE revealed the etiology of stroke in about 25% of our patients, which consequently changed their secondary prevention management.

A Rare Case Report of Ruptured Sinus of Valsalva in Pregnancy: Role of Transesophageal Echocardiography

A Rare Case Report of Ruptured Sinus of Valsalva in Pregnancy: Role of Transesophageal Echocardiography

1032 FEASIBILITY AND RELIABILITY OF COMPREHENSIVE THREE DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY SCREENING PROCESS FOR TRANSCATHETER MITRAL VALVE REPLACEMENT

Abstract The procedural planning of transcatheter mitral valve replacement (TMVR) requires a specific imaging assessment to establish patient eligibility. Computed tomography (CT) is considered the reference method. In this setting, data regarding the role of transesophageal echocardiography (TEE) are lacking. Aims To evaluate the feasibility and reliability of a comprehensive 3D-TEE screening in TMVR candidates. Methods we performed a retrospective observational study including 72 consecutive patients who underwent a pre-procedural CT and 3D-TEE for TMVR evaluation. The measurements of mitral annulus (MA), length of anterior mitral leaflet (AML), native left ventricular outflow tract (LVOT) and predicted neo-LVOT acquired with CT and 3DTEE were compared using a novel semi-automated software for post processing analysis (3mensio Structural Heart 10.1 - 3mSH, Pie Medical Imaging, Bilthoven, Netherlands). The final suitability decision was given by the valve manufacturer based on CT measurements and clinical conditions. Results Among 72 patients screened, all patients had adequate image quality for 3D-TEE analysis. 3D-TEE and CT measurements for AML length (r=0.97), MA area (r=0.90), perimeter (r=0.68), anteroposterior (r=0.88) and posteromedial-anterolateral (r=0.74) diameters were found highly correlated, as well as for native LVOT (r=0.86) and predicted neo-LVOT areas (r=0.96) (all P -values <0.0001). An almost perfect agreement among CT and 3d TEE was found in assessing the eligibility for TMVR implantation (Cohen Kappa 0.83, p<0.001). Conclusions 3D-TEE appraisements showed good correlations with CT measurements and high accuracy to predict TMVR screening success. Central Illustration. Mitral annulus segmentation and neo-LVOT area measurement performed by means of the 3mensio software (Pie Medical Imaging, Bilthoven, Netherlands) in a step-by-step fashion by TEE and CT imaging. After the virtual simulation of a valve implantation, the minimal systolic neo-LVOT area is manually measured by planimetry on a plane orthogonal to the centerline.

Corrected and Republished

Transesophageal echocardiography (TEE) has unique advantages over conventional transthoracic echocardiography (TTE). Compared with TTE, TEE generally provides excellent quality images, especially of the posteriorly situated cardiac structures, such as atria, pulmonary veins, mitral valve, and left atrial appendage. TEE also offers a useful alternative to TTE in patients in whom transthoracic acoustic windows are suboptimal. Furthermore, TEE is the most suited imaging modality for use in the operating rooms and cardiac catheterization labs for guiding cardiac surgical or interventional procedures. However, specific training and competence are required for performing TEE successfully, smoothly, safely and with minimum patient discomfort. This document describes the basic principles of TEE examination, including patient selection and preparation, periprocedural monitoring, and probe handling and maneuvers. Commonly recommended views and the techniques to obtain these views are described in detail, followed by evaluation of specific cardiac structures. Finally, the role of TEE in certain specific clinical settings, such as during advanced circulatory support, is also discussed.

The role of transesophageal echocardiography in guiding heart donation after circulatory death

Heart donation after circulatory death (DCD) can significantly expand the heart donor pool, helping to overcome the problem of organ shortage and the increase in waiting list mortality and morbidity. To improve the outcome of DCD heart transplantation, thoraco-abdominal normothermic regional perfusion (TA-NRP) can be performed by selectively restoring circulation followed by in vivo functional heart assessment. Here, we report on the use of periprocedural transoesophageal echocardiography (TOE) as a minimally invasive cardiac assessment tool during different stages of a DCD heart procurement procedure using TA-NRP. We conclude that TOE is a valuable method to assess the donor heart for transplantation eligibility before and after withdrawal of life-sustaining therapy and during subsequent TA-NRP.

Complications of the Percutaneous Mitral Valve Edge-To-Edge Repair: Role of Transesophageal Echocardiography

The use of transcatheter edge-to-edge repair for the treatment of mitral regurgitation has markedly increased in the last few years. The rate of adverse events related to the procedure is low; however, some of the complications that may occur are potentially dangerous. Due to the growing popularity of the technique, which is no longer limited to high-volume centers, knowledge of the complications related to the procedure is fundamental. Transesophageal echocardiography has a key role in the guidance of the intervention while allowing for the avoidance of most of these adverse events, as well as enabling us to diagnose them early. In this article, we review the main complications that might present during a transcatheter mitral edge-to-edge repair procedure (tamponade, thromboembolic events, single leaflet device attachment, device embolization, vascular injury…) while highlighting key aspects of transesophageal echocardiographic monitoring in the prevention and prompt diagnosis of these complications.

A Rare Case of Prolapsing Accessory Tricuspid Valve Tissue into the Ventricular Septal Defect in Patient Undergoing Tetralogy of Fallot Repair: Role of Transesophageal Echocardiography

A Rare Case of Prolapsing Accessory Tricuspid Valve Tissue into the Ventricular Septal Defect in Patient Undergoing Tetralogy of Fallot Repair: Role of Transesophageal Echocardiography

Is There a Role for Transesophageal Echocardiography in the Perioperative Trauma Patient?

Purpose of Review This review article summarizes the advantages and potential uses of focused transesophageal echocardiography (TEE) in the perioperative period for trauma patients. We suggest a locally developed TEE protocol for trauma and provide strategies to achieve widespread use of TEE in the anesthesia care of trauma patients.Recent FindingsIn recent years, TEE has gained interest as an additional modality as point-of-care ultrasound (POCUS) for the resuscitation of acutely ill patients in whom transthoracic echocardiography is not feasible or non-diagnostic. Nevertheless, its use among non-cardiac anesthesiologists is still limited compared to the more traditional POCUS applications.SummaryA goal-directed, focused TEE can be performed at the bedside in different locations and mechanically ventilated patients. TEE provides relevant diagnostic information to guide the resuscitation of acutely injured patients, particularly to identify life-threatening hidden thoracic injuries in the scenario of patients with multi-system trauma.

The role of transesophageal echocardiography in device closure of perimembranous ventricular septal defects with the hybrid approach.

The role of transesophageal echocardiography in device closure of perimembranous ventricular septal defects with the hybrid approach.

The role of transesophageal echocardiography in gastrointestinal bleeding

The role of transesophageal echocardiography in gastrointestinal bleeding

Role of Transesophageal Echocardiography in the Recurrent Biatrial Myxoma of Uncommon Origin

After surgical excision of myxoma recurrence usually happens adjacent to the initial origin site. We report a case of recurrent myxomas in a young male patient that had biatrial recurrence with one tumor originating very unusually from the base of the anterior mitral leaflet. Intraoperative transesophageal echocardiography was instrumental in localizing the site of the origin of left atrial myxoma from the base of the anterior mitral leaflet and in detecting an additional myxoma attached to the wall of the right atrium.

Acute Rupture of Sinus of Valsalva into Right Atrium: An Echocardiographic Halftone

AbstractA ruptured sinus of Valsalva is a rare and emergent cardiac abnormality, which can be acute and rapidly expanding to cause hemodynamic deterioration. Rupturing into right-sided heart chambers causes severe left-to-right shunt and sudden volume overload. Echocardiography especially transesophageal echocardiography (TEE) is the gold standard facility for early perioperative diagnosis and also to guide surgical technique. Medical stabilization followed by prompt surgical intervention is the treatment of choice.We hereby report a case of sinus of Valsalva rupturing into right atrium leading to severe left-to-right shunt and the role of TEE in its perioperative management.

Diagnostic Yield of TEE in Patients with Cryptogenic Stroke and TIA with Normal TTE: A Systematic Review and Meta-Analysis.

Introduction: The role of transesophageal echocardiography (TEE) in cryptogenic stroke and transient ischemic attack (TIA) with normal transthoracic echocardiography (TTE) remains controversial in the absence of definite guidelines. We aimed to perform a systematic review and meta-analysis to estimate an additional diagnostic yield and clinical impact of TEE in patients with cryptogenic stroke and TIA with normal TTE. Methods: We performed a systematic review of cohort studies on PubMed using the keywords ‘cryptogenic stroke’, cryptogenic TIA’, ‘TEE’, and ‘TTE’ with matching MeSH terms. We included studies with patients who had cryptogenic stroke or TIA and had normal TTE findings, where the study intended to obtain TEE on all patients and reported all TEE abnormalities. The studies containing patients with atrial fibrillation were excluded. All studies were evaluated for internal and external validity. Inverse variance random effects models were used to calculate the effect size, the number needed to diagnose, and the 95% confidence interval. Results: We included 15 studies with 2054 patients and found LA/LAA/aortic thrombus, valvular vegetation, PFO-ASA, valvular abnormalities, and complex aortic plaques on TEE. Of these, 37.5% (29.7%–45.1%) of patients had additional cardiac findings on TEE. Management of 13.6% (8.1%–19.1%) of patients had changed after TEE evaluation. Based on current guidelines, it should change management in 4.1% (2.1%–6.2%) of patients and could potentially change management in 30.4% (21.9%–38.9%) of patients. Sensitivity analysis was also performed with only class II studies to increase internal validity, which showed additional cardiac findings in 38.4% (28.5%–48.3%), changed management in 20.2% (8.7%–31.8%), should change management in 4.7% (1.5%–7.9%), and could potentially change management in 30.4% (17.8%–43.0%) of patients. Conclusions: The diagnostic yield of TEE to find any additional cardiac findings in patients with cryptogenic stroke or TIA is not only high, but it can also change management for certain cardiac abnormalities. TTE in cryptogenic stroke or TIA may mitigate future risks by tailoring the management of these patients.