Improved detection of wall motion by transesophageal stress echocardiography using a biplane transducer

Transesophageal stress echocardiography using simultaneous transesophageal atrial pacing or pharmacological agents, eg, dobutamine, is a valuable addendum to conventional stress echocardiography. Initial experiences with combined transesophageal echocardiography (TEE) and atrial pacing or during pharmacological infusion are reported with monoplane techniques. Potential advantages of biplane application can be expected in detection or exclusion wall motion abnormalities (WMA). Twenty-one consecutive patients underwent transesophageal stress echocardiography with a biplane transducer. WMA were observed in 19 patients. In 9 of 19 patients (47%) the transverse plane was the only diagnostic section for WMA; the longitudinal plane was the only diagnostic section in 3 of 19 patients (additional yield: 16%). In 7 patients (37%), both planes were diagnostic. Thus, advantages include a higher diagnostic yield compared with monoplane TEE because of better visualization of basal and apical segments. An important limitation of the biplane probe during transesophageal atrial pacing is its restricted mobility. Using pharmacological agents, the ventricle can be monitored from the transgastric as well as from the transesophageal position. Transesophageal stress echocardiography using a biplane transducer is feasible, and allows more successful imaging of the regional basal and apical segments compared with the monoplane technique and increases its diagnostic yield. In conjunction with transesophageal atrial pacing, the biplane technique is limited to one single position only because of restricted mobility during the entire stress procedure.