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[Transesophageal and transthoracic echocardiography--their diagnostic contributions]
G Kamenský1, N Plevová, F Slavícek
1Oddelenie funkcného vysetrovania NsP Smidkeho 6, UNZh. m. B., Bratislava.
Insights
Transesophageal echocardiography offers significantly higher sensitivity than transthoracic echocardiography for diagnosing complex cardiac conditions, especially in patients with poor echogenicity. It effectively complements standard echocardiography without replacing it.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Standard echocardiography can be limited in visualizing certain cardiac pathologies.
- Technically inadequate transthoracic examinations occur in patients with low echogenicity.
- Specific conditions like myocardial infarction complications and endocarditis require detailed cardiac assessment.
Purpose of the Study:
- To compare the diagnostic efficacy of transesophageal echocardiography (TEE) versus transthoracic echocardiography (TTE).
- To evaluate the utility of TEE in specific complex cardiac conditions.
- To assess the safety and tolerability of TEE.
Main Methods:
- Retrospective analysis of 77 patients undergoing both TTE and TEE.
- Review of indications including myocardial infarction complications, embolization sources, endocarditis, congenital defects, cardiac masses, aortic disease, and comatose states.
- Comparison of diagnostic yield and accuracy between TEE and TTE.
Main Results:
- TEE demonstrated higher sensitivity (57.1%) compared to TTE (32.4%).
- TTE was inconclusive in 19.5% of cases.
- TEE showed approximately 30% greater sensitivity than TTE, with equal specificity.
Conclusions:
- TEE is the preferred method for diagnosing embolization sources, mitral valve apparatus, thoracic aorta affections, intracardiac formations, and atrial septal defects.
- TEE is highly valuable in critically ill patients and those with poor echogenicity.
- TEE safely supplements TTE, improving diagnostic accuracy and ruling out false positives.
Abstract:
Of 815 patients referred for echocardiographic examination 77 were examined also by the transoesophageal route. The most frequent reason were pathological processes where standard echocardiography provides relatively limited information as well as technically inadequate transthoracic examinations, if the echogenicity of the patient is low. The reasons for examination were complications of myocardial infarctions, a cardiac source of embolization bacterial endocarditis, congenital heart defects, cardiac formations, aortal disease and comatose conditions. Transthoracic echocardiography was positive in 25 cases (32.4%), transoesophageal echocardiography in 44 cases (57.1%). In 15 patients the transthoracic approach was not conclusive from the diagnostic aspect (19.5%). From the results ensues that transesophageal echocardiography has a ca 30% higher sensitivity than transthoracic echocardiography, the specificity being equal. The authors emphasize that the transoesophageal approach is the method of choice in the diagnosis of sources of embolization (auricular appendage), in evaluation of the mitral apparatus, in affections of the thoracic aorta, in the diagnosis of intracardiac formations and defects of the atrial septum. It is very useful in the critically ill, in particular in patients with poor echogenicity. It helps in a significant way to rule out falsely positive transthoracic findings. The examination is safe, relatively well tolerated by out- and in-patients. Transoesophageal echocardiography supplements in an effective way the transthoracic approach but does not replace it.