[Echocardiography from the gastric fundus. Description of new projections]

Two new transgastric echocardiographic views obtained using the transesophageal probe are described. The first one (RVOT-MPA view) presents RVOT, pulmonic valve and proximal MPA. The second one (LVOT--Ao view) shows ascending aorta, aortic valve, LVOT, perimembranous area and anterior part of the trabecular septum, mitral valve with its attachment to the anterior papillary muscle and LA. The latter view corresponds to the standard subcostal view. Repeatability and applicability of these two scans were investigated on 25 pts: 10 with valvular heart disease (including 2 after valve replacement and 1 intraoperative study), 3-VSD, 2-TF, 2-ASD II, 5 with aortic aneurysm (including 1 after surgery), 3 after MI. RVOT-MPA view was obtainable in 76% pts, whereas LVOT-Ao view in 84% pts. This latter scan appeared to be very helpful in detecting VSD--either isolated perimembranous or malalignment in TF. In one pt with TF the detailed anatomy of RVOT, MPA and pulmonic arteries could be clearly imaged in fashion resembling standard echocardiographic subcostal short axis view. Left ventricular--right atrial communication was also readily appreciated in one of the pts. This view confirmed also some other informations, previously achieved by means of TEE planes (eg thrombus in LAA, aortic intimal flap protruding into LVOT). RVOT-MPA projection did not reveal more anatomical data than standard TEE planes in the investigated group. However, it should be useful in diagnosing subpulmonic VSD because of its similarity to the corresponding view available with newer TEE probes which provide longitudinal scans of the heart. The results presented proved usefulness of the new echocardiographic views, particularly in detecting VSD and more complex heart defects.