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The Miniaturized Multiplane Micro-Transesophageal Echocardiographic Probe: A Comparative Evaluation of Its Accuracy
Benjamin J Toole1, Timothy C Slesnick1, Joseph Kreeger1
1Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, Georgia.
Background:
The initial experience with the miniaturized multiplane micro-transesophageal echocardiographic probe (MTEE) reported high-quality diagnostic imaging in small infants. The aim of this study was to compare the diagnostic accuracy and image quality of the intraoperative MTEE with the pediatric multiplane transesophageal echocardiographic probe (PTEE).
Methods:
Infants weighing <5 kg who underwent intraoperative transesophageal echocardiography were identified. Studies using the MTEE were matched 1:1 with those using the PTEE by cardiac diagnosis. The postoperative transesophageal echocardiograms, obtained using either probe, were reviewed for the presence of 11 cardiac abnormalities. Postoperative transesophageal echocardiograms were compared with predischarge transthoracic echocardiograms to assess accuracy. Using receiver operating characteristic curves, the areas under the curve for the MTEE and PTEE were compared. Two pediatric cardiologists scored six image quality metrics on equal numbers of studies obtained with the MTEE and the PTEE. Composite scores from both reviewers were used to compare image quality.
Results:
The study included 110 transesophageal echocardiograms per probe type. The mean weight for the MTEE was lower than for the PTEE (3.15 ± 0.58 vs 3.70 ± 0.52 kg, P < .001). There was no significant difference in the diagnostic accuracy of the MTEE and PTEE using receiver operating characteristic curves. The numbers of residual anatomic lesions missed by the MTEE and PTEE were similar (19 vs 22, respectively). The composite image quality score was worse for the MTEE compared with the PTEE (81% vs 92%, respectively, P < .0001).
Conclusions:
Although the image quality of the MTEE is inferior compared with the PTEE, its diagnostic accuracy in infants weighing <5 kg is comparable.
Insights
The miniaturized micro-transesophageal echocardiographic probe (MTEE) offers comparable diagnostic accuracy to the pediatric probe (PTEE) in infants under 5 kg. However, the MTEE provides lower image quality compared to the PTEE.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Echocardiography
Background:
- Transesophageal echocardiography (TEE) is crucial for diagnosing cardiac conditions in infants.
- The miniaturized multiplane micro-transesophageal echocardiographic probe (MTEE) was developed for high-quality imaging in small infants.
- This study aimed to compare the diagnostic accuracy and image quality of the MTEE versus the pediatric multiplane transesophageal echocardiographic probe (PTEE).
Purpose of the Study:
- To compare the diagnostic accuracy of the intraoperative MTEE with the PTEE in infants weighing less than 5 kg.
- To evaluate and compare the image quality obtained by the MTEE and PTEE during intraoperative echocardiography.
- To determine if the MTEE is a viable alternative to the PTEE for pediatric cardiac diagnostics.
Main Methods:
- A retrospective review of intraoperative transesophageal echocardiograms in infants weighing <5 kg was conducted.
- Studies using MTEE were matched 1:1 with PTEE studies based on cardiac diagnosis.
- Diagnostic accuracy was assessed by comparing echocardiogram findings with predischarge transthoracic echocardiograms, and image quality was scored by two independent pediatric cardiologists.
Main Results:
- No significant difference in diagnostic accuracy was found between the MTEE and PTEE (Area Under Curve comparison).
- The number of missed residual anatomic lesions was similar between the two probes (19 for MTEE vs. 22 for PTEE).
- The MTEE yielded a significantly lower composite image quality score (81%) compared to the PTEE (92%).
Conclusions:
- The MTEE demonstrates comparable diagnostic accuracy to the PTEE in infants weighing less than 5 kg.
- Despite inferior image quality, the MTEE is a diagnostically accurate tool for this patient population.
- The findings suggest the MTEE is a suitable option for intraoperative echocardiography in neonates and small infants.
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