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Value of transesophageal echocardiography during complex or high-risk coronary interventions in the cardiac
G S Pavlides1, A M Hauser, P I Dudlets
1Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073-6769.
Insights
Transesophageal echocardiography (TEE) is feasible and valuable for monitoring left ventricular (LV) function and imaging the left main coronary artery (LMCA) during complex cardiac interventions. TEE provides critical insights beyond standard monitoring, influencing procedural management.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Limitations in hemodynamic and electrocardiographic monitoring during coronary interventions necessitate advanced imaging.
- Transesophageal echocardiography (TEE) is established for intraoperative monitoring but underutilized in cardiac catheterization labs.
Purpose of the Study:
- To assess the feasibility and clinical value of TEE during complex or high-risk coronary interventions.
- To evaluate TEE's utility for left ventricular (LV) monitoring and left main coronary artery (LMCA) imaging in the catheterization setting.
Main Methods:
- TEE probe insertion and utilization in patients undergoing complex or high-risk coronary interventions.
- Assessment of TEE's success rates for LV monitoring and LMCA imaging.
- Comparison of TEE findings with standard monitoring methods and quantitative angiography.
Main Results:
- High success rate for TEE probe insertion (98%) and LV monitoring (98%).
- Significant additional diagnostic information provided by TEE in 58% of LV monitoring cases, including unexpected myocardial function changes and mitral regurgitation.
- TEE findings directly influenced procedural management in 26% of monitored cases.
- Successful LMCA visualization in 93% of cases, with strong correlation between TEE and angiography for lesion diameter measurement (r=0.83 pre-intervention, r=0.80 post-intervention).
Conclusions:
- TEE is a feasible and valuable tool in the cardiac catheterization laboratory for complex coronary interventions.
- TEE enhances patient monitoring by detecting subtle hemodynamic changes and structural abnormalities.
- TEE can guide interventional decisions and accurately assess coronary lesions, particularly in the LMCA.
Abstract:
The increasing complexity of coronary intervention and the limitations of hemodynamic and electrocardiographic monitoring have facilitated the introduction of new imaging techniques in the cardiac catheterization laboratory. Transesophageal echocardiography (TEE) has proved valuable for left ventricular (LV) monitoring during high-risk surgery, but its reported use in the cardiac catheterization laboratory has been limited. Accordingly, we assessed the feasibility and value of TEE during complex or high-risk coronary intervention in the catheterization laboratory. The TEE probe was successfully introduced in 53 of 54 (98%) attempted cases. The primary imaging goals were LV monitoring in 39 (74%), left main coronary artery (LMCA) imaging in 9 (17%) and both in 5 (9%) cases. LV monitoring was successful in 43 of the 44 (98%) attempted cases. In 25 (58%) of these, additional important observations were made by TEE that were not apparent by symptoms, or hemodynamic, electrocardiographic or radiographic monitoring. These included unexpected changes in regional myocardial function (n = 20), alteration in LV size (n = 2), exclusion of considered pericardial tamponade (n = 2) and detection of unsuspected mitral regurgitation (n = 1). Management of the interventional procedure was directly influenced by the findings of TEE in 11 of the 43 (26%) monitored cases. The LMCA was successfully visualized in 13 of the 14 (93%) attempted cases. In 11 of these, measurement of the stenotic lesion diameter by TEE correlated well with quantitative angiography both before (r = 0.83, standard error of the estimate = 0.01, p less than 0.002) and after (r = 0.80, standard error of the estimate = 0.03, p less than 0.005) intervention.(ABSTRACT TRUNCATED AT 250 WORDS)