Transesophageal echocardiography in the evaluation of prosthetic valves

Biplane and multiplane TEE, with its relatively low risk, has become an invaluable complement to a comprehensive transthoracic two-dimensional Doppler and color flow examination. It should be undertaken in all instances when the transthoracic information is not adequate or if there is suspicion of abnormality that is not detected by TTE. One can advocate the use of TEE in the operating room in all instances wherein a patient is going to be implanted with a prosthetic valve because it will permit one to obtain baseline information that may be valuable in the management of patients seen subsequently with questionable findings when comparison is valuable. The role of cardiac catheterization is limited. Hemodynamic cardiac catheterization should only be used in instances in which there is discrepancy between echocardiographic findings and clinical presentation. Visualization of coronary arteries may be indicated in some situations, and a limited coronary arteriogram could be performed, the procedure being less morbid if separated from hemodynamic right and left heart catheterization. Echocardiography represents the state of the art in evaluation of patients with valvular prosthesis. Biplane TEE and multiplane TEE are valuable complementary technology to be used in conjunction with TTE, when the situation dictates its use, because it provides useful information that alters management of the patient.