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Potential applications for transesophageal echocardiography in hypertrophic cardiomyopathies
P Widimsky1, F J Ten Cate, W Vletter
1Department of Cardiology and Cardiovascular Surgery, Erasmus University, Rotterdam, The Netherlands.
Insights
Transesophageal echocardiography (TEE) offers precise mitral valve and subaortic assessments for hypertrophic cardiomyopathy, influencing surgical management. Transthoracic echocardiography (TTE) remains sufficient for initial diagnosis and medical treatment.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Hypertrophic cardiomyopathy (HCM) diagnosis and management require detailed cardiac imaging.
- Transthoracic echocardiography (TTE) is the standard initial imaging modality for HCM.
- Transesophageal echocardiography (TEE) may offer complementary diagnostic information in select HCM cases.
Observation:
- Ten patients with suspected or confirmed HCM underwent TEE for specific clinical questions.
- TEE was well-tolerated with no procedural arrhythmias.
- Comparison revealed TTE's strength in left ventricular assessment and myocardial thickness measurement for HCM diagnosis.
Findings:
- TEE provided precise assessment of mitral valve morphology and regurgitant jets.
- TEE enabled detailed evaluation of systolic anterior motion and identified a subaortic membrane missed by TTE.
- In three patients, TEE findings directly influenced clinical management decisions.
Implications:
- TEE enhances diagnostic precision for specific HCM features, particularly related to the mitral valve and subaortic region.
- TEE has the potential to guide surgical interventions in HCM patients.
- TTE remains adequate for the medical management and initial diagnosis of hypertrophic cardiomyopathy.
Abstract:
The purpose of the present study was to evaluate the potential advantages of transesophageal echocardiography (TEE) in comparison with transthoracic echocardiography (TTE) in selected patients with hypertrophic cardiomyopathy. Ten patients with previously established or suspected diagnosis of hypertrophic cardiomyopathy were examined by TEE to solve specific clinical questions. TEE was well tolerated by all patients; no arrhythmias were seen during the procedure. The comparison of TTE and TEE showed the following: Advantages of TTE--better assessment of the left ventricle, myocardial thickness measurements available in all regions and sufficient for the diagnosis of hypertrophic cardiomyopathy in nine out of 10 patients; advantages of TEE--precise assessment of mitral valve morphology and regurgitant jets, detailed evaluation of systolic anterior motion, and subaortic membrane (not seen by TTE) recognized in one patient. Clinically, in three patients TEE influenced the management (mitral leaflet perforation, subaortic membrane, and residual mitral regurgitation after valvuloplasty). Thus TEE enables more precise diagnosis in some patients with hypertrophic cardiomyopathy and has the potential to influence their surgical management. However, for medical treatment of hypertrophic cardiomyopathy, TTE is sufficient.