Transesophageal Echocardiography In Diagnosis Research Articles

Multiplane Transesophageal Echocardiographic Detection and Differential Diagnosis of Isolated Right Pulmonary Artery Agenesis.

We present a case report of isolated right pulmonary artery agenesis detected by multiplane transesophageal echocardiography (TEE). A special emphasis is placed on its important role in the differential diagnosis and hemodynamic and functional evaluation of patients with unilateral pulmonary oligemia on chest radiograph. We also present a case report of pulmonary embolism with complete obstruction of the right pulmonary artery for better understanding and for comparison of TEE images in patients with pulmonary artery agenesis. (ECHOCARDIOGRAPHY, Volume 13, July 1996)

Transesophageal Echocardiographic Diagnosis of Thoracic Aortic Dissection with the Completely Thrombosed False Lumen: Differentiation from True aortic Aneurysm with Mural Thrombus

Transesophageal Echocardiographic Diagnosis of Thoracic Aortic Dissection with the Completely Thrombosed False Lumen: Differentiation from True aortic Aneurysm with Mural Thrombus

Transesophageal Color Doppler Echocardiographic Diagnosis of Cardiac Rupture Following Acute Myocardial Infarction.

This report describes a case of cardiac rupture following acute myocardial infarction accurately diagnosed by transesophageal color Doppler echocardiography, which showed a very narrow transmural tract from the left ventricle into the pseudoaneurysm cavity. Such a small, slitlike rupture would most likely have been missed by an otherwise routine transesophageal examination, and we stress the importance of color Doppler interrogation in its accurate diagnosis. (ECHOCARDIOGRAPHY, Volume 13, May 1996)

Diagnosis of patent foramen ovale by contrast versus color Doppler by transesophageal echocardiography: Relation to atrial size

To ascertain the factors related to the transesophageal echocardiographic diagnosis of patent foramen ovale, the primary echocardiographic data were reviewed from 74 patients with that diagnosis. Similar detection rates were observed with contrast echocardiography (82%) and color flow mapping (78%), but contrast was more sensitive in patients with normal-sized atria (94%) and isolated right atrial enlargement (100%) than in those with enlarged left atria, all but three of whom had biatrial enlargement (52%) ( p < 0.001 by chi-square test). Doppler flow mapping was less sensitive for normal-sized atria (66%) than for isolated enlarged right atria (81%) and left (bi-) atrial enlargement (96%) ( p = 0.024). Patent foramen ovale was directly visualized by two-dimensional echocardiography in 80%, with close agreement to the size of the color flow jet ( r = 0.90, Δ = 0.1 ± 0.4 mm); foramen ovale size was related to right atrial area ( r = 0.31, p = 0.015). Thus both saline contrast and color flow imaging are necessary to exclude the diagnosis of patent foramen ovale.

Transesophageal echocardiographic diagnosis of thoracic aortic dissection with the completely thrombosed false lumen: Differentiation from true aortic aneurysm with mural thrombus

The conventional criteria of aortic dissection with a completely thrombosed false lumen by transesophageal echocardiography is separation of the intima from the layer of thrombus; however, it is not always easy to distinguish from true aortic aneurysm with mural thrombus. Thus we proposed a new transesophageal echocardiographic diagnostic criteria. Seventeen operative patients with suspected subacute or chronic thoracic aortic dissection in whom it was difficult to exclude true aortic aneurysm with mural thrombus underwent transesophageal echocardiography. In thoracic aortic dissection with a completely thrombosed false lumen, the inner lesion surface composed of intima may be smooth and crescent-shaped thrombus may appear inside the wall surface. Therefore our criteria were on the basis of any two of the following: (1) high-echogenic lesion surface, suggesting intima, over the thrombus, (2) smooth lesion surface, and (3) crescent-shaped thrombus. Imaging data were referenced to intraoperative findings. According to the present criteria only two out of 17 patients were misdiagnosed, whereas according to the conventional criteria six patients were misdiagnosed. The sensitivity was significantly higher than when the conventional criteria were used (90% versus 40%; p < 0.05), whereas the specificity was similar. We conclude that the present transesophageal echocardiographic criteria for detection of thoracic aortic dissection with a completely thrombosed false lumen is clinically useful.

Transesophageal echocardiographic diagnosis of right atrial thrombi associated with the antiphospholipid syndrome

Thromboembolic disorders are a hallmark of the antiphospholipid antibody syndrome. We describe a patient with IgM antiphospholipid antibodies associated with pulmonary emboli and in situ thrombosis within an otherwise normal right atrium. Echocardiography, particularly the transesophageal study, proved invaluable in providing a diagnosis and guiding our patient's evaluation and treatment.

Coronary artery compression caused by a large pseudoaneurysm of the mitral-aortic intervalvular fibrosa

An unusual late complication of bacterial endocarditis is described. Four years after diagnosis and treatment, a patient is seen with coronary artery compression caused by a large pseudoaneurysm of the mitral-aortic intervalvular fibrosa. The utility of transesophageal echocardiography in diagnosis and surgical management is emphasized.

Transesophageal Echocardiographic Diagnosis of Aortic Graft Dehiscense at Coronary Anastomoses and Pseudonaneurysm Rupture into Right Atrium

We describe a case of aortic graft dehiscence at coronary anastomoses with rupture into the right atrium of the pseudoaneurysm complicating aortic graft replacement. These were diagnosed by intraoperative transesophageal echocardiography.

Transesophageal echocardiographic diagnosis of sinus venosus-type atrial septal defect associated with partial anomalous venous connections during cardiac surgery in adults

T RANSESOPHAGEAL echocardiography (TEE) is useful for intraoperative monitoring of cardiac function 1,z and for evaluating valve repair. 3 Recently, TEE has been proposed as a useful intraoperative tool improving diagnostic accuracy and assisting in surgical repair of pediatric congenital heart malformations. 4 Its role in the diagnosis of congemtal cardiac malformations in adults has not been widely discussed. The sinus venosus variant of atrial septal defect (SVASD) occurs in up to 20% of adults with an atrial septal defect (ASD) and is the most difficult to Identify. 5 This defect is frequently associated with anomalous connection of the right pulmonary veins to the junction of the right atrium and the superior vena cava. 6 The authors describe two cases of adult cardmc surgery where intraoperative TEE helped to diagnose previously unsuspected SVASD associated with partial anomalous pulmonary venous connections (PAPVC) and discuss how the echocardiography results led to modification of the planned operation.

Transesophageal Echocardiographic Diagnosis of Periaortic Abscess Extending into Interatrial Septum

A case of native aortic valve endocarditis is presented in which a vegetation originated a supra‐annular abscess with extension into the inferior portion of the atrial septum. This was diagnosed in vivo by transesophageal echocardiography and confirmed at surgery.

Transesophageal echocardiography predicts mortality in critically III patients with unexplained hypotension

This study sought to determine the prognostic yield and utility of transesophageal echocardiography in critically ill patients with unexplained hypotension. Transesophageal echocardiography is increasingly utilized in the intensive care setting and is particularly suited for the evaluation of hypotension; however, the prognostic yield of transesophageal echocardiography in these patients is unknown. We prospectively studied 61 adult patients in the intensive care unit with sustained (> 60 min) unexplained hypotension. Both transthoracic and transesophageal echocardiography were performed, and results were immediately disclosed to the primary physician, who reported any resulting changes in management. Patients were classified on the basis of transesophageal echocardiographic findings into one of three prognostic groups: 1) nonventricular (valvular, pericardial) cardiac limitation to cardiac output; 2) ventricular failure; and 3) noncardiac systemic disease (hypovolemia or low systemic vascular resistance, or both). Primary end points were death or discharge from the intensive care unit. A transesophageal echocardiographic diagnosis of nonventricular limitation to cardiac output was associated with improved survival to discharge from the intensive care unit (81%) versus a diagnosis of ventricular disease (41%) or hypovolemia/low systemic vascular resistance (44%, p = 0.03). Twenty-nine (64%) of 45 transthoracic echocardiographic studies were inadequate compared with 2 (3%) of 61 transesophageal echocardiographic studies (p < 0.001). Transesophageal echocardiography contributed new clinically significant diagnoses (not seen with transthoracic echocardiography) in 17 patients (28%), leading to operation in 12 (20%). Transesophageal echocardiography makes a clinically important contribution to the diagnosis and management of unexplained hypotension and predicts prognosis in the critical care setting.

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.

980-90 Superior Vena Cava Versus Right Atrium Central Venous Catheter Placement Avoids Thrombosis: The Role of Transesophageal Echocardiography in Diagnosis and Evaluation — A Prospective Study

Intravenous central line (Hickman type) catheters (CL) are routinely used in the management of chronically ill patients. These CLs are placed in the superior vena cava (SVC) or right atrium (RA) and are often associated with complications, mainly thrombosis or infection. The introduction of transesophageal echo (TEE) has significantly improved the imaging of intracardiac structures, especially left atrial thrombi and right atrial masses. We explored the use and importance of TEE (and compared to transthoracic echo (ITTE)) for early evaluation of CL placement and detection of related masses. We prospectively studied fifty-five (55) bone marrow transplantation (BMT) patients by TTE and TEE at an asymptomatic stage within a week post-Hickman catheter (CL) implantation and on a follow-up study after 6–8 weeks. We looked for the exact CL tip placement and searched for possible presence of any related abnormalities. Of the fifty-five patients in the first study, the CL tips could be demonstrated in 48 (87%) of them by TEE compared to only 4 (8%) by TTE. 13 were placed in the right atrium (RA), 8 at he superior vena cave-right atrium junction (SVC-RA), and 27 in the s superior vena-cava (SVC). An abnormal mass was found in six patients (12.5%) . All of these presumed thrombi were seen in patients in whom the CL tip was placed in the RA (Table) No. of Patients CL location Thrombi 27 SVC 0 8 SVC-RA 0 13 RA 6 (p &lt; 0.001 TEE studies performed in an asymptomatic setting of BMT patients within a week post-routine CL implantation demonstrated unexpected, asymptomatic catheter-tip related masses, consistent with thrombosis, in the RA of 12.5% of patients . These findings suggest that: (1) CL should be placed in the SVC or SVC-RA junction, in contrast to the RA. (2) TEE is a useful tool for guiding CL’s placement in severely immunocompromised, chronically ill patients, to avoid formation of thrombi.

Clinical Usefulness of Transesophageal Echocardiography in Diagnosis of Aortic Dissection

Clinical Usefulness of Transesophageal Echocardiography in Diagnosis of Aortic Dissection

Transesophageal Echocardiographic Diagnosis of a Congenital Circumflex Coronary Artery to Coronary Sinus Fistula in an Adult

We report a congenital circumflex coronary artery to coronary sinus arteriovenous fistula diagnosed by transesophageal echocardiography in a 38‐year‐old asymptomatic male. The coronary arteriovenous fistula was suggested by two‐dimensional transthoracic color Doppler. A first nondiagnostic angiography was performed, and it was during the second one, that the fistula could finally be visualized after a special dye technique was used. The high fistula flow rate prevented us from seeing it with regular dye concentration. Transesophageal echocardiography was precise in the anatomical and hemodynamic evaluation and it was essential in guiding the angiographic examination and surgical repair.

Transthoracic and transesophageal echocardiographic diagnosis of severe subaortic obstruction produced by an abscess cavity

1. Hollander JE, Quick G. Aortoesophageal fistula: a comprehensive review of the literature. Am J Med 1991;91:279-8’7. 2. Bogey, WM Jr, Thomas JH, Hermreck AS. Aortoesophageal fistula: report of a successfully managed case and review of the literature. J Vast Surg 1992;16:90-5. 3. von Oppell UO, de Groot M, Thierfelder C, Zilla P, Ode11 JA. Successful management of aortoesophageal fist& due to thoracic aortic aneurysm. Ann Thorac Surg 1991;52:1168-70. 4. West AB, Nolan N, O’Briain DS. Benign peptic ulcers penetrating pericardium and heart: clinicopathological features and factors favoring survival. Gastroenterology 1988;94:1478-87. 5. Fmelli FC, Piasio M, Mahfood S, Keshishian JM, Golocovsky M. Esophageal rupture complicated by a gastrocardiac fistula: review of the literature and report of a successfully treated case. Ann Thorac Surg 1989;48:582-3. 6. Grande JP, Pelliika PA, Edwards WD, Puga FJ. Cardiogastric fistula occurring 9 years after resection of left ventricular aneurysm. Int J Cardial 1990;27:327-31. 7. Bell MD, Tate LG, Hensley GT. Esophageal-atrial fistula resulting in systemic “meat and vegetable” emboli. Am J Forensic Med Path01 1992;13:137-41. 8. Mott JM, Austin GE. Cerebral embolization resulting from esophageal-atrial fistula. Arch Intern Med 1976;136:718-20. Transthoracic and transesophageal echocardiographic diagnosis of severe subaortic obstruction produced by an abscess cavity

Transesophageal echocardiographic diagnosis of massive pulmonary embolism during cardiopulmonary resuscitation

Transesophageal echocardiographic diagnosis of massive pulmonary embolism during cardiopulmonary resuscitation

Accuracy of color Doppler transesophageal echocardiography for diagnosis of patent foramen ovale.

This study assessed the sensitivity of color Doppler as compared with contrast study during transesophageal echocardiography for detection of a patent foramen ovale. We also evaluated the incidence of patent foramen ovale in younger (less than age 50, group 1) as compared with older (greater than age 50, group 2) patients. A total of 114 patients were studied. A patent foramen ovale was found in 17 patients: 7 of 39 (17.9%) in group 1 and 10 of 75 (13.3%) in group 2 (NS). The sensitivity of color Doppler as compared with contrast study was 33%. Our data suggest that color Doppler is a poor method of assessment for the presence of a patent foramen ovale and that patent foramen ovale remains prevalent in older as well as younger patients.

Transesophageal Echocardiographic Diagnosis of Pulmonary Arteriovenous Malformation: Role of Contrast and Pulsed Doppler Echocardiography

Contrast echocardiography produced by peripheral injection of agitated saline solution is widely used for detecting intracardiac and intrathoracic extracardiac shunts, like pulmonary arteriovenous malformation (PAVM). Currently, localization of PAVM requires pulmonary angiography even after detection by computed tomography of the chest. Pulsed Doppler along with contrast echocardiography of the pulmonary veins performed during transesophageal echocardiography may aid in the localization of PAVM and in its diagnosis.

Transesophageal Echocardiographic Diagnosis of a Ruptured Tricuspid Valve Chordae Tendinae as the Etiology for Cardiogenic Shock

Acute tricuspid insufficiency is an uncommon cause of cardiogenic shock. Previous reported cases have involved patients with right ventricular infarction. We report a case of acute tricuspid insufficiency causing cardiogenic shock in a patient without evidence of right ventricular infarction. Transesophageal echocardiography (TEE) was used to diagnose a ruptured chordae tendinae as the etiology of tricuspid insufficiency.