Related Experiment Videos
[Clinical usefulness of transesophageal Doppler echocardiography]
S Hashimoto1, T Kumada, G Osakada
1Department of Clinical Sciences and Laboratory Medicine, Kyoto University.
Insights
Transesophageal Doppler echocardiography (TEE) offers superior imaging for dissecting aortic aneurysms and valvular diseases compared to conventional methods. TEE also enables crucial hemodynamic monitoring during and after cardiac surgery.
Area of Science:
- Cardiovascular Imaging
- Echocardiography
- Surgical Echocardiography
Background:
- Transesophageal Doppler echocardiography (TEE) is a valuable tool in cardiovascular diagnostics.
- Conventional echocardiography may have limitations in visualizing certain cardiac structures and conditions.
Purpose of the Study:
- To assess the utility of TEE in patients with various cardiovascular diseases.
- To compare TEE's diagnostic capabilities with conventional Doppler echocardiography.
Main Methods:
- TEE was performed on patients with dissecting aortic aneurysm, thoracic aneurysm, ischemic heart disease, and acquired valvular diseases.
- TEE findings were compared with conventional Doppler echocardiography and surgical confirmations.
Main Results:
- TEE clearly visualized intimal flaps in dissecting aortic aneurysms, including the aortic arch and descending aorta.
- TEE accurately detected aneurysm entry sites (73%) and differentiated true aneurysms from dissecting aortic aneurysms.
- TEE facilitated detailed observation of all four heart valves, identified mitral leaflet aneurysms, and detected left atrial appendage thrombi in mitral stenosis cases.
- TEE provided essential hemodynamic monitoring for patients undergoing cardiac surgery, especially those with left ventricular assist devices.
Conclusions:
- TEE is highly effective for morphological assessment of complex cardiovascular conditions like dissecting aortic aneurysms and valvular diseases.
- TEE offers significant advantages over conventional methods for visualizing aortic pathology and intracardiac structures.
- TEE is indispensable for intraoperative and postoperative hemodynamic monitoring in cardiac surgery.
Abstract:
The usefulness of transesophageal Doppler echocardiography (TEE) was assessed in patients with various cardiovascular diseases including 15 patients with dissecting aortic aneurysm (DAA), two with thoracic aneurysm, 16 with ischemic heart disease and 14 with acquired valvular diseases. In dissecting aortic aneurysms, TEE provided clear images of the intimal flaps even in the aortic arch and descending aorta in which clear images could not be obtained by conventional external Doppler echocardiography. The entry site was detected in 11 of the 15 (73%) cases using TEE, but in only three of the 15 cases using conventional Doppler technique. In two cases of true aortic aneurysms, TEE provided clear images of the aneurysm in the descending thoracic aorta, which was discriminated precisely from DAA. In valvular disease, all four valves (aortic, pulmonary and atrio-ventricular valves) were easily observed without disturbance by any other tissues using a transesophageal approach. In addition, valve aneurysms in the posterior mitral leaflets were detected using TEE in two cases. In two cases of mitral stenosis, a thrombus was observed in the left atrial appendage. These findings were confirmed during surgery, but could not be obtained by the conventional external studies. In 16 cases, TEE was performed during aorto-coronary bypass surgery under general anesthesia. In two of these cases, left ventricular assist devices were applied after surgery. In these cases, where conventional Doppler echocardiography was not applicable, cardiac function could be monitored by TEE. Thus, TEE is useful not only in evaluating morphological function in the cardiovascular system but also in monitoring cardiac hemodynamics during and after heart surgery.