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The role of transesophageal echocardiography in cardiac donor screening
1Division of Cardiology, University of Louisville, KY 40202.
Insights
Transesophageal echocardiography (TEE) improves cardiac donor screening, especially in ventilated patients where transthoracic echocardiography (TTE) is suboptimal. TEE identified abnormalities missed by TTE, aiding donor selection.
Area of Science:
- Cardiology
- Transplant Surgery
- Medical Imaging
Background:
- Transthoracic echocardiography (TTE) is standard for cardiac donor screening.
- TTE can be technically limited in ventilated patients.
- The utility of transesophageal echocardiography (TEE) in this setting is not well-established.
Purpose of the Study:
- To compare the diagnostic yield of TEE combined with TTE for cardiac donor screening.
- To assess the feasibility and findings of TEE in brain-dead potential organ donors.
Main Methods:
- 24 brain-dead patients considered for cardiac donation underwent both TTE and TEE.
- TTE was performed immediately before or after TEE.
- Abnormalities detected by either modality were recorded.
Main Results:
- TTE was technically difficult in 29% of patients.
- TEE revealed abnormalities in 5 of 7 patients with suboptimal TTE, including ventricular wall motion abnormalities and hypertrophy.
- TEE identified a bicuspid aortic valve missed by TTE in one patient.
- Seven patients were excluded as donors based on echocardiographic findings.
Conclusions:
- TEE is a valuable adjunct to TTE for cardiac donor screening, particularly when TTE is suboptimal.
- TEE can detect significant cardiac abnormalities missed by TTE, improving donor suitability assessment.
- Combined TEE and TTE enhance the identification of suitable cardiac allografts.
Abstract:
Transthoracic echocardiography has played a useful role in the screening of cardiac transplant donors. However, transthoracic echocardiograms may be suboptimal in many patients on ventilators. The role of transesophageal echocardiography in cardiac donor screening is unknown. Therefore we compared the potential benefit of transesophageal echocardiography combined with transthoracic echocardiography in 24 (16 men and 8 women) consecutive brain-dead patients with a mean age of 29 +/- 9 years (range 16 to 44 years), who were being considered as cardiac transplant donors. Transthoracic echocardiography was performed immediately before or after transesophageal echocardiography. Transthoracic echocardiography was technically difficult in 7 of 24 (29%) patients. Results of transesophageal echocardiography were abnormal in five of the seven patients and demonstrated left (n = 4) and right (n = 3) ventricular wall motion abnormalities and concentric left ventricular hypertrophy (n = 2). The four patients with wall motion abnormalities were eliminated as potential donors. In 16 of 17 patients with technically adequate transthoracic echocardiograms, transesophageal and transthoracic echocardiographic findings agreed and demonstrated normal hearts in 13 patients, left (n = 2) and right (n = 1) ventricular wall motion abnormalities in two patients, and isolated concentric left ventricular hypertrophy in one patient. In 1 of the 17 patients with a technically adequate transthoracic echocardiographic study, a bicuspid aortic valve was demonstrated by transesophageal echocardiography but not diagnosed by transthoracic echocardiography. Overall seven patients were eliminated as cardiac donors on the basis of transesophageal echocardiograms (n = 7), transthoracic echocardiograms (n = 2), or both.(ABSTRACT TRUNCATED AT 250 WORDS)