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Impact of transesophageal color flow Doppler echocardiography in current cardiology practice
K Chandrasekaran1, R C Bansal, G S Mintz
1Likoff Cardiovascular Institute of Hahnemann University Hospital, Philadelphia, PA 19102.
Insights
Transesophageal echocardiography is a valuable tool when transthoracic echocardiography is insufficient, especially for aortic and mitral valve disorders. It significantly aids patient management in complex cardiac cases.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Transthoracic echocardiography (TTE) is the primary non-invasive imaging modality for cardiac evaluation.
- In certain clinical scenarios, TTE may be technically limited or provide insufficient diagnostic information.
Purpose of the Study:
- To evaluate the utility and impact of transesophageal echocardiography (TEE) in a large cohort of patients.
- To determine specific conditions where TEE offers significant diagnostic and management advantages over TTE.
Main Methods:
- Retrospective analysis of 3,480 patients referred for cardiac ultrasound.
- Identification of 230 patients (6.6%) who subsequently underwent TEE due to limitations with TTE.
- Review of patient demographics, diagnoses, and the role of TEE in management decisions.
Main Results:
- TEE was performed in 230 patients, with the majority (79%) having aortic or mitral disorders.
- TEE significantly impacted patient management in 72% of cases.
- TEE proved most useful for aortic diseases, mitral prostheses, endocarditis complications, left atrial appendage thrombi, and mitral insufficiency etiology.
Conclusions:
- TEE is a crucial alternative when TTE is inadequate for optimal patient management.
- TEE provides essential diagnostic information for complex aortic and mitral valve diseases, endocarditis, and thrombus evaluation.
- TEE is particularly beneficial in critically ill patients and those with severe lung disease.
Abstract:
Of 3,480 patients who were referred for cardiac ultrasound evaluation, 230 patients (6.6%) underwent transesophageal echocardiography because the transthoracic study was not feasible, technically inadequate, or provided insufficient diagnostic information for optimal patient management. There were 149 inpatients and 81 outpatients. The majority (182 patients, 79%) had aortic or mitral disorders. In 166 patients (72%), transesophageal echocardiography played a significant role in patient management. Transesophageal echocardiography was most useful in evaluating diseases of the aorta (dissection, root abscess, or aneurysm), mitral prosthesis, complications of endocarditis, left atrial appendage thrombi, and in determining the cause of mitral insufficiency. Transesophageal echocardiography was useful in the evaluation of critically ill patients and those with severe lung disease.