Transesophageal echocardiography in the evaluation of prosthetic valves

Biplane TEE, with its relatively low risk, has become an invaluable adjunct to comprehensive transthoracic 2-D Doppler and color flow examination. It should be undertaken in all instances in which transthoracic information is not adequate, or if there is suspicion of an abnormality not detected by TEE. One can advocate the use of TEE in the operating room in all instances wherein a patient is scheduled to undergo implantation of a prosthetic valve, because it enables baseline information to be obtained that may be valuable in the management of patients with questionable findings, permitting a comparison. The role of cardiac catheterization is limited. Hemodynamic cardiac catheterization should only be resorted to in instances in which there is discrepancy between echocardiographic findings and clinical presentation. Visualization of coronary arteries may be indicated in some situations in which a limited coronary arteriogram could be obtained. This procedure is less morbid if separated from hemodynamic catheterization of the right and left sides of the heart. Echocardiography represents the state-of-the-art in the evaluation of patients with valvular prostheses. Biplane TEE and multiplane TEE are valuable complementary technologies to TEE, when the situation dictates its use, because these modalities provide useful information that alters management of the patient.