[Monoplane, biplane and multiplane transesophageal echocardiography. Indications, contraindications, complications...

Major clinical applications and examination technique of transesophageal echocardiography are described on the basis of personal experience and literature data. Capabilities of monoplane and more recent biplane and multiplane transducers are discussed. Transesophageal examination appears to be complementary to transthoracic technique; it is also utilized in the preoperative and intraoperative monitoring of surgical procedures and during interventional catheterization. The clinical indications for transesophageal echocardiography include aortic dissection, dysfunction of valvar prosthesis, detection of an intracardiac source of embolism, assessment of infective endocarditis, congenital and valvular heart disease, and evaluation of cardiac masses. Another application is the assessment of cardiovascular function of critically ill patients in the coronary, medical, or surgical intensive care unit, due to limited transthoracic echocardiographic acoustic windows. When performing a transesophageal examination, a methodical approach is preferred consisting of a sequence of transducer positions and views. With each successive advance in transducer technology the number of available imaging planes has increased. The monoplane device can optimally image only two primary planes of the heart, i.e. short-axis and frontal planes. The biplane probe adds substantially more diagnostic information over a monoplane transducer because of a second imaging array in the longitudinal orientation. The multiplane device produces a continuum of transverse and longitudinal images by rotation of the electronic array and more readily provides intermediate and off-axis images between the primary planes.