Preoperative two- and three-dimensional transesophageal echocardiographic assessment of heart tumors

Two-dimensional transesophageal echocardiography is the most widely used diagnostic approach in the rare entity of heart tumors. The aim of this study was to assess the diagnostic usefulness of three-dimensional echocardiography in comparison with the two-dimensional technique in a rare clinical setting.

Twenty-seven patients (18 women; mean age, 49.7 +/- 14 years) with a histologically proven diagnosis of a cardiac tumor were studied. The primary diagnosis was done by a two-dimensional transthoracic echocardiography (n = 9) and transesophageal echocardiography (n = 18). In addition, we performed three-dimensional transesophageal assessment in 5 patients with left atrial myxomas. The echocardiographic findings were compared with the intraoperative appearance and pathologic diagnosis.

The echocardiographically suspected diagnosis of a heart tumor in 29 cases was histologically correct in 27 patients (myxomas, 20; epicardial lipoma, 1; malignant epicardial mesothelioma, 1; metastatic processes of hypernephromas, 2; and undifferentiated tumors of the pericardium, 3). Only the combination of multiplane transesophageal and three-dimensional echocardiography was able to demonstrate the shape, dimensions, location, origin, surface, three-dimensional movement, and involvement of valves and was most useful in the preoperative diagnosis and planning.

Three-dimensional transesophageal echocardiography yields important additional clinical information and improves the operative planning. Three-dimensional echocardiography may become the best approach to study the anatomy and pathology of the heart as it provides an objective display of cardiac size and shape in heart tumors.