Comparison of left atrial dimensions by transesophageal and transthoracic echocardiography

Transesophageal echocardiography (TEE) is an established cardiovascular diagnostic technique. Left atrial (LA) size, as measured by transthoracic echocardiography (TTE), is associated with cardiovascular disease and is a risk factor for atrial fibrillation, stroke, death, and the success of cardioversion. Assessment of LA size has not been as well validated on TEE as on TTE. We determined LA size measurements in four standard views in 122 patients undergoing TEE and TTE at the same setting. In this study, we found that measurement of LA dimensions by TEE suffers from significant limitations in all views except the basal long-axis view (mid-esophageal level) with transducer plane at 120-150 degrees. This view had the best correlation with transthoracic LA measurements: r = 0.79 for TEE long axis (CI 0.71-0.85), P <.0001.     

经胸与经食管超声心动图对心脏人工瓣膜的对比研究

４７例心脏人工机械瓣膜置换术后的病人，经胸超声心动图（ＴＴＥ）和经食管超声心动图（ＴＥＥ）对比研究显示，低估二尖瓣置换后人工瓣膜返流程度的分级和返流的发生率；主动脉瓣和二尖瓣置换的病人，ＴＴＥ探查人工二尖瓣返流的效果硬差。ＴＥＥ能较容易地探查人工二尖瓣瓣周漏。揭示对人工二尖瓣的评价，ＴＥＥ比ＴＴＥ能提供更多更可靠的信息，毫无疑问这是由于ＴＴＥ检查时人工瓣膜材料的声衰减和血流掩盖的影响，但我们的经验揭示，在评价主动脉瓣置换人工瓣膜时，ＴＥＥ并不优于ＴＴＥ。     

Diagnosis of noninfective cardiac mass lesions by two-dimensional echocardiography. Comparison of the transthoracic and transesophageal approaches

This study was conducted in 46 patients with cardiac thrombi, 15 patients with atrial myxomas, and 32 patients with other cardiac or paracardiac tumors. Diagnoses were subsequently proven by surgery, autopsy, computed tomography, magnetic resonance imaging, or angiography in all patients. All patients underwent precordial and transesophageal two-dimensional echocardiography to assess the various mass detection rates. Atrial myxomas and predominantly left-sided cardiac tumors were identified by both echocardiographic techniques with comparable detection rates. Left ventricular apical thrombi were detected more frequently by precordial echocardiography. In contrast, transesophageal echocardiography was superior in visualizing left atrial appendage thrombi, small and flat thrombi in the left atrial cavity, thrombi and tumors in the superior vena cava, and masses attached to the right heart and the descending thoracic aorta. These data indicate that transesophageal echocardiography leads to a clinically relevant improvement of the diagnostic potential in patients in whom cardiac masses are suspected or have to be excluded in order to ensure the safety of clinical procedures.     

Comparison of transthoracic and transesophageal echocardiography in evaluation of 47 Starr-Edwards prosthetic valves.

OBJECTIVES. Our objectives were to characterize by transesophageal echocardiography the normal appearance of the Starr-Edwards prosthetic heart valve and to compare the utility of transesophageal and transthoracic echocardiography in detection of valve abnormality. BACKGROUND. The Starr-Edwards prosthetic heart valve, the first mechanical valve to be used, has demonstrated excellent durability. METHODS. Fifty transthoracic and transesophageal echocardiographic studies on 37 patients with 47 Starr-Edwards prosthetic valves were analyzed retrospectively. Six cases of surgically confirmed infective endocarditis were studied. RESULTS. Vegetation or abscess formation, or both, was identified by transesophageal echocardiography in all six cases of infective endocarditis but was found in only one of these cases by transthoracic echocardiography. Thrombus was detected by transesophageal echocardiography in 9 of 11 patients with transient ischemic attacks or stroke and in 2 patients by transthoracic echocardiography with 3 confirmed at surgery. In 26 of the 30 patients with a mitral Starr-Edwards valve, the valve demonstrated a trivial or mild "closing volume" early systolic or holosystolic leak on transesophageal echocardiography alone. Transthoracic evaluation identified significant mitral regurgitation in six of the eight patients who had this finding on transesophageal echocardiography. Serial studies were performed to assess response to treatment or need for surgical intervention in eight patients. Seventeen valves have been implanted for 12 years; six of these had significant leakage without apparent cause, a finding not observed more recently implanted valves. CONCLUSIONS. These observations demonstrated the unique utility of transesophageal echocardiography in patients with Starr-Edwards prosthetic valve dysfunction, endocarditis or thrombus formation, and of the clear superiority of transesophageal echocardiography over transthoracic echocardiography in these situations.     

Comparison of transthoracic and transesophageal echocardiography for assessment of left-sided valvular regurgitation

To compare transthoracic and transesophageal echocardiography in the clinical assessment of left-sided valvular regurgitation, 118 patients who underwent both transesophageal and transthoracic echocardiographic studies within a 24-hour period were included in this study. Presence or absence of aortic regurgitation was identified concordantly by both techniques in 93 patients (79%). Complete agreement between both techniques was found in 88 patients (75%). Presence or absence of mitral regurgitation was identified concordantly by both techniques in 89 patients (75%). Complete agreement in grade was found in only 74 patients (63%). Twentynine patients (25%) had mitral regurgitation detected by transesophageal echocardiography, but not by transthoracic echocardiography. Four of these patients (14%) had significant (2 to 3+) mitral regurgitation. Differences between transesophageal and transthoracic echocardiography do not appear to be clinically important in patients with aortic regurgitation. In mitral regurgitation, significant differences exist between these 2 techniques, with transesophageal echocardiography being much more sensitive.     

Dynamic intracavitary echoes studied by transthoracic and transesophageal echocardiography]

One hundred consecutive echocardiograms performed on adults using transthoracic and transesophageal (TEE) transducers were analyzed in order to determine the prevalence of spontaneous contrast (SC) and the factors associated with it. Indications for study included complex congenital cardiopathy, evaluation of valve lesions or prosthetic valves, dissecting aortic aneurysm, cardiac masses and evaluation of ventricular function. SC was observed only with TEE and appeared in 25% of cases, most frequently in left atrium. Factors associated with contrast included mitral valve disease and replacement, ventricular dysfunction, left atrial dilatation and atrial fibrillation. An important relationship existed between SC and presence of thrombi. Atrioventricular valvular regurgitation was not associated with SC. Results are compared with those of previous series.     

经胸与经食管超声心动图对先天性二叶式主动脉瓣诊断的比较

目的　比较经胸超声心动图 (TTE)与经食管超声心动图 (TEE)对先天性二叶式主动脉瓣畸形诊断的准确率。方法　应用TTE及TEE检查明确诊断先天性二叶式主动脉瓣畸形及其他主动脉瓣病变。结果　 10 7例患者主动脉瓣听诊区可闻及Ⅱ～Ⅲ级收缩期及舒张期杂音 ,经TTE检查 ,仅有 5 1例患者可明确诊断 ,而用TEE检查均可明确诊断。结论　TEE可进一步明确诊断患者主动脉瓣病变为先天性与获得性 ,有利于临床诊断及治疗。     

Comparison between transesophageal echocardiography and transthoracic echocardiography with harmonic tissue imaging for left atrial appendage assessment

BACKGROUND: Transesophageal echocardiography (TEE) is the method of choice for evaluating both anatomy and function of left atrial appendage (LAA). In contrast, conventional transthoracic echocardiography (TTE) does not result in images of sufficient quality to explore LAA. HYPOTHESIS: The aim of this study was to evaluate the potential role of TTE with harmonic frequency imaging (HFI) for assessing LAA normal anatomy and function. METHODS: The study group comprised 25 patients, (9 men, 16 women, mean age 51 years, range 20-82). The TTE as sessment of LAA both in fundamental frequency imaging (FFI) and HFI was performed using the apical two-chamber view, the longitudinal two-chamber view was used for TEE assessment of LAA. According to image quality, images were categorized into three classes: A: good quality, B: sufficient quality, C: poor quality. RESULTS: Transthoracic echocardiography conventional imaging allowed sufficient LAA visualization (class B) in only 5 of 25 patients (20%); the HFI resulted in adequate LAA visualization in 23 of 25 patients (92%). Images were of good quality (class A) in 18 of 23 patients and of sufficient quality (class B) in 5 of 23 patients. Transesophageal echocardiography achieved good quality images in 24 of 25 patients (96%). Average LAA maximum area determined by HFI and TEE was 3.46 +/-1.17 and 3.59 +/- 1.16 cm2, respectively; LAA minimum area was 1.81 +/- 0.98 and 1.77 +/- 0.97 cm2, respectively. Percent LAA area change was 51 +/- 16.5 and 50.9 +/- 16% with HFI and TEE, respectively. Statistical analysis showed no difference between the data obtained with the two methods. CONCLUSIONS: The results suggest that HFI TNE may be a useful tool for the exploration of LAA.     

Imaging of multiple coronary artery fistulas to right ventricle by transthoracic and transesophageal echocardiography.

A 20-year-old woman presented with extremely rare multiple coronary artery fistulas with left circumflex and right coronary arteries as the feeding vessels and two distinct sites of drainage into the posterior wall of the right ventricle near the apex in close proximity. The large left fistula was well depicted by transthoracic echocardiography, whereas the transesophageal approach better delineated part of the smaller right fistula.     

Comparison of the diagnostic power of transthoracic and transesophageal echocardiography to detect ruptured chordae tendineae

Preoperative information concerning the severity and etiology of MR is very important for selecting the most appropriate surgical strategy. Ruptured chordae tendineae (RCT) are one of the most important preoperative findings. We compared the diagnostic power of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) to detect RCT in patients with MR. We studied 61 patients with MR (30 men, 31 women; mean age, 61 ± 12 years) who underwent mitral valve repair or replacement. Both TTE and TEE were performed before the operations, and the sensitivity and specificity of TTE and TEE to detect RCT were determined. In addition, other factors that influenced the detection of RCT by these two methods were investigated. At the time of an operation, RCT was confirmed in 39 of 61 cases. Transesophageal echocardiography had a higher sensitivity than TTE (74% versus 44%; P = 0.006) to detect RCT, although the specificity was not significantly different. In patients with a body mass index (BMI) > 22 (P = 0.023) or MR grade 4 (P = 0.026), TEE had a significantly higher diagnostic sensitivity than TTE, although there was no significant difference in patients with BMI < 22 or MR grade ≤ 3. In the lateral and medial segments of the mitral valve, TEE had a significantly higher diagnostic sensitivity to detect RCT than TTE (P = 0.0012), although there was no significant difference in the middle segments. There was no significant difference between TTE and TEE with respect to the sensitivity to detect RCT in myxomatous mitral valves. Although the sensitivity of TEE was higher than that of TTE to detect RCT, it was affected by BMI, MR grade, the RCT-presenting segments, and the etiology of MR.     

Comparative prognostic significance of transesophageal versus transthoracic stress echocardiography

Patients with a negative transthoracic stress echocardiographic study (TTE-SE) are at low risk for adverse cardiac events. Because of a higher sensitivity for detection of coronary artery disease, transesophageal dobutamine stress echocardiography (TEE-DSE) might permit identification of an even lower risk population. We compared the relative prognostic values of TTE-SE and TEE-DSE in 236 patients with negative stress echocardiograms. Baseline and follow-up information on 236 consecutive subjects who had a negative stress echocardiographic study during the period of October 1996 to December 1997 was obtained. Baseline cardiac risk factors and major cardiac events (nonfatal myocardial infarct or cardiac death) were identified. Follow-up was obtained in 233 subjects for a mean duration of 25 months. At baseline, the TEE-DSE group had more hypertensives (85% vs 67%, P = 0.02) and more baseline wall-motion abnormalities (41% vs 26%, P = 0.03). At 34 months of follow-up, there was no significant difference in the occurrence of major cardiac events between the two groups (8% vs 8.6%, P = NS). In the TEE-DSE group, there were more than twice as many events in the second year of follow-up as compared with the first year, indicating that a negative TEE-DSE has lessened prognostic value 1 year after the test. Standard TTE-SE provides prognostic data in patients at high risk for major cardiac ischemic events that is equivalent to that obtained by TEE-DSE. While advances in ultrasound techniques may improve our ability to detect coronary artery disease, it remains to be seen whether this will have an impact on prognostication.     

Primary cardiac non-Hodgkin's lymphoma diagnosed by transthoracic echocardiography

Primary cardiac lymphomas are extremely rare and can be diagnosed by echocardiography. We present the case of a 79-year-old man with an intracardiac mass, shown to be an aggressive large B-cell lymphoma by mediastinal aspiration, who had rapid regression of the tumor following one cycle of chemotherapy.     

Diagnosis of suspected cardiac echinococcosis with negative serologies: role of transthoracic, transesophageal, and contrast echocardiography.

The early recognition and treatment of hydatid disease of the heart is important as it can result in potentially lethal complications. We present the clinical and echocardiographic features of a 71 year old Afghanistani man who presented with left-sided chest pain. Transthoracic (TTE), transesophageal (TEE), and contrast echo demonstrated a calcified cystic structure within the distal anterior septum consistent with an echinococcal cyst, despite negative serologies. Treatment strategies for this patient are discussed.