Utility of biplane transesophageal echocardiography in left ventricular wall motion analysis

The biplane transesophageal echocardiography (BTEE) probe increases capabilities for scanning cardiac structures in cross-sectional and longitudinal planes. The present study was undertaken to determine if BTEE would enhance diagnosis of perioperative ischemia by identification of new segmental wall motion abnormalities (SWMAs), and the initial experience in 94 patients (37 intraoperative and 57 intensive care unit) is presented. The left ventricular wall motion at the midpapillary level was observed and recorded on 0.5-in videotape by both transverse and longitudinal scanning transducers. Using a cinememory loop, biplane images were replayed side by side, within minutes of their acquisition, and were compared and recorded for later off-line analysis by two independent observers. Intraoperatively, the images were obtained at various predetermined intervals, and in the intensive care unit one set of observations was made. In 20 patients, new SWMAs were observed: in 4 patients (20%), the SWMAs were observed only in the cross-sectional scanning, whereas in 7 patients (35%) they were observed only in the longitudinal scanning. In the remaining 9 patients (45%) the SWMAs were detected in both planes. Persistent diagnostic electrocardiographic changes of myocardial infarction and elevation of CK enzymes were observed in 6 of the 20 patients within 3 postoperative days. In conclusion, biplane imaging appears to be superior to the traditional single-plane imaging for evaluation of left ventricular function and myocardial ischemia.