The impact of transesophageal echocardiography on daily clinical practice

The development of transesophageal echocardiography (TEE) almost 20 years ago has tremendously widened the diagnostic potential of cardiac ultrasound and has, without doubt, strongly improved our pathophysiological understanding of many cardiovascular diseases such as aortic dissection, mitral valve disease or ischemic stroke. Especially the introduction of multiplane transducers that allow imaging of the cardiac structures from various scan plane orientations has yielded a level of diagnostic accuracy that is seldom attained by other imaging modalities. The outstanding image quality as well as the high temporal and spatial resolution provided by TEE renders the method especially suited to visualize small and rapidly moving structures, such as left atrial thrombus formation and valvular vegetations. In addition, TEE is exceptional in its capability to scan the heart from perspectives that cannot be easily attained by any other modality, thus enhancing its diagnostic yield. In the last few years the clinical application of TEE has been extended from a pure diagnostic tool to an indispensable monitoring adjunct for percutaneous interventional procedures as well as for the intra- and peri-operative monitoring in the operating theatre and on the intensive care unit. In the surroundings of emerging sophisticated technologies to image the heart and the great vessels within the thorax such as multi-slice computed tomography and cardiovascular magnetic resonance imaging TEE asserts a firm place in the diagnostic armamentarium for the cardiologist. This review will focus the impact of TEE in daily clinical practice and on possible future applications of the technique.