Biplane transesophageal echocardiography utilizing transverse and sagittal imaging planes: technique, echo-anatomic correlations, and display approaches

The recent development of biplane transesophageal probes equipped with both transverse plane and sagittal plane imaging transducers allows a more complete examination of cardiac and aortic anatomy than is possible with conventional single plane transesophageal instruments. While the imaging planes used in transverse plane transesophageal imaging have been standardized, several different approaches have been suggested for the orientation and display of the newer sagittal plane images. An accepted display convention for the transverse and sagittal plane images would ease interpretation of the multiple complex images obtained during the biplane transesophageal examination. In this article, the different transverse plane and sagittal plane echocardiographic images that may be acquired during the biplane transesophageal examination are described and correlated with cardiac anatomy. A method for image display orientation is suggested that is most consistent with that previously used for the single plane transesophageal examination.     

New direction of biplane transesophageal echocardiography with special emphasis on real-time biplane imaging and matrix phased-array biplane transducer

This article reports on the technical aspects of an online real-time biplane transesophageal echocardiographic imaging system and of a single-matrix, phased-array transducer capable of transverse and longitudinal scanning.     

Future technical prospects in biplane transesophageal echocardiography: use of adult and pediatric biplane matrix probes

This study evaluates the feasibility of the combined use of an adult matrix probe with a real-time biplane imaging system, and also describes the performance of a newly developed pediatric matrix probe.     

Transesophageal echocardiographic evaluation of mechanical biventricular assist device

The usefulness of transesophageal echocardiography in the assessment of mechanical biventricular assist devices is described.     

Transesophageal echocardiographic imaging of the pulmonary veins

This report focuses on the technical aspects of the assessment of pulmonary veins using biplane transesophageal echocardiography, taking into account their spatial anatomical orientation and relationship to neighboring structures. This is aimed at increasing the echocardiographer's ability to visualize the proximal segments of all four pulmonary veins.     

Pediatric transesophageal color flow imaging 1990: the long and short of it

Noninvasive cardiac imaging has dramatically altered the practice of cardiology, specifically, the pediatric patient with congenital heart disease over the past decade. Since the introduction of transesophageal echocardiography nearly 15 years ago, addition of high-resolution cross-sectional imaging combined with Doppler color flow mapping has provided a new window to examine the heart. Recently, miniaturization of the transesophageal probe to "pediatric-size" has enabled its use in the smallest of infants to add significantly to the assessment of congenital heart malformations. Most recently, addition of a longitudinal-plane probe to the already-existent, transverse-plane probe has made biplane transesophageal echocardiography a reality with significant additional information being provided by orthogonal images of the cardiac structures. We used these probes in complementary fashion in 30 studies performed in 23 patients ages 1 day to 12 years with a mean of 35 months, weighing 2.6-40 kg (mean 12.4 kg). These studies were performed in the operating room, intensive care unit, cardiac catheterization laboratory, and outpatient department. Limitations of single-plane, transverse transesophageal echocardiography were overcome using the longitudinal-axis pediatric probe: left and right ventricular outflow tracts, distal pulmonary arteries, and all of the interventricular and atrial septa were easily visualized. Its use in the operating room and postoperative cardiac intensive care unit for continuous ventricular monitoring in otherwise-inaccessible patients also provided critical information. Transesophageal echocardiography in infants and small children is a valuable "noninvasive" imaging technique which, with addition of complementary longitudinal-plane views, offers important additional information regarding congenital heart malformations and their repair.     

Transesophageal color Doppler three-dimensional echocardiographic detection of prosthetic aortic valve dehiscence: correlation with surgical findings

Three-dimensional echocardiography is being used with increasing frequency to evaluate cardiac function and structure. We present two cases of prosthetic aortic valve endocarditis where three-dimensional transesophageal echocardiography correlated with the intraoperative surgical findings of prosthetic dehiscence and communication with an abscess cavity. When compared with two-dimensional transesophageal echocardiography, three-dimensional echocardiography was more accurate in defining the exact site of dehiscence and communication with an abscess cavity. The echocardiographic images were oriented as a clockface watch to conform to the surgeon's visualization of the aortic root as viewed from the right side of the patient.     

Transesophageal Echocardiographic Identification of Atrial Septal Aneurysm

This case illustrates the usefulness of biplane transesophageal echocardiography in the diagnosis of an atrial septal aneurysm, which in some views, mimicked a mass lesion in the left atrium. (ECHOCARDIOGRAPHY, Volume 8, July 1991)     

Color Doppler Transesophageal Echocardiography in Detection of Massive Pulmonary Embolism

In this article, the potential value of color Doppler in improving diagnostic accuracy of transesophageal echocardiography (TEE) in patients with incomplete obstruction of large pulmonary vessels is illustrated, We present an unusual case of massive pulmonary embolism that was unequivocally detected by color Doppler TEE both before and after pulmonary angiography, which failed to demonstrate filling defects in the pulmonary artery.     

Atypical Aortic Dissection Diagnosed by Transesophageal Echocardiography

This case report describes a patient in whom a thin dissection of the proximal aorta was diagnosed by transesophageal echocardiography. Dissection was not firmly diagnosed in our patient with computed tomography, angiography, or magnetic resonance imaging. A definitive diagnosis was made prospectively using intraoperative transesophageal echocardiography by demonstrating the presence of a thin immobile dissection flap located very close to the anterior aortic wall. Color Doppler examination showed absence of flow signals in the small false lumen, suggesting that it may be clotted. At surgery the presence of dissection involving the ascending aorta, as well as a clotted false lumen were confirmed. This finding demonstrates the utility of transeophageal echocardiography in the diagnosis of aortic dissection and the ability of this test to differentiate a thin dissection from intimal thickening. (ECHOCARDIOGRAPHY, Volume 11, May 1994)     

Transesophageal two-dimensional echocardiographic identification of hiatal hernia

We report a case of a middle-aged woman in whom a transesophageal echocardiogram showed a mass-like lesion posteriorly near the descending thoracic aorta. We were able to make a definitive diagnosis of this mass as a hiatal hernia because of a thick inner lining measuring 6-9 mm in thickness similar to the stomach mucosa, and the presence of a few microbubbles within the mass. In addition, the microbubbles increased considerably after 10 cc of agitated normal saline flush via a nasogastric tube.     

Transesophageal three-dimensional echocardiographic demonstration of Ebstein's anomaly

We report three-dimensional transesophageal echocardiographic findings in an adult patient with Ebstein's anomaly. Using the anyplane technique and multiple views, especially the short-axis view of tricuspid valve, three-dimensional transesophageal echocardiography clearly demonstrated the intermittent tethering of all three leaflets of tricuspid valve to the right ventricular walls giving a "bubble-like" appearance. On the other hand, two-dimensional transesophageal echocardiography demonstrated well the tethering of the septal tricuspid leaflet, but tethering of the other two leaflets was not well seen. To our knowledge, these findings have not been demonstrated by three-dimensional transesophageal echocardiography before.     

Transesophageal Three-Dimensional Echocardiographic Assessment of Left Main Coronary Artery Fistula

We describe a patient with a left main coronary artery fistula with an opening at the superior vena cava-right atrial junction in whom three-dimensional transesophageal echocardiography permitted more accurate assessment of the shape and size of the communication site than two-dimensional transesophageal echocardiography.     

Multiplane transesophageal echocardiography. Imaging planes, echocardiographic anatomy, and clinical experience with a prototype phased array OmniPlane probe

Multiplane transesophageal echocardiography is a new exciting development in echocardiography. We examined the methodology and echo-anatomic correlations of multiplane transesophageal echocardiography and its clinical applications in 100 patients. We used a 5-MHz phased array multiplane (OmniPlane) transesophageal probe. In this instrument, the transducer array can be steered through 180 degrees from any transducer location. This provides a vast assembly of imaging planes, allowing for detailed visualization of all dimensions of cardiac anatomy. This report presents our observations on the echocardiographic anatomy seen in various image planes and the unique clinical potential of multiplane transesophageal echocardiography in the diagnostic assessment of cardiovascular disorders. This technique appears to provide incremental diagnostic information that enhances the interpretative ability. Less esophageal probe manipulation is required with consequent decrease in patient discomfort. We conclude that multiplane transesophageal echocardiography enhances the versatility of transesophageal examination and offers many new avenues for developments such as three-dimensional echocardiography.     

Assessment of Ebstein's Anomaly and Its Surgical Repair Using Transesophageal Two-Dimensional Echocardiography and Doppler Color Flow Mapping

Transthoracic echocardiography is generally accepted as the procedure of choice for diagnosing Eb-stein's anomaly; however, an optimal evaluation is not always possible due to technical limitations. We have reported the utility of transesophageal echocardiography and Doppler color flow mapping in this condition, particularly for demonstrating structures and flow patterns in the atria and right ventricle. We conclude that in the evaluation of Ebstein's anomaly, these two echocardiography techniques are complementary and together can provide an excellent anatomical and functional assessment. (ECHOCARDIOGRAPHY, Volume 8, May 1991)     

Transesophageal Three-Dimensional Color Doppler Echocardiographic Reconstruction of the Left Vertebral Artery

We present a patient in whom we successfully reconstructed a long segment of the proximal left vertebral artery in three dimensions using color Doppler transesophageal echocardiography (TEE). Three-dimensional (3-D) color Doppler TEE may complement two-dimensional (2-D) TEE by its ability to view cross sections of the left vertebral artery at any desired level from the 3-D data stored in the computer.     

Assessment of Aortic Coarctation and Collateral Circulation By Biplane Transesophageal Echocardiography

Our experience in using biplane transesophageal echocardiography in the assessment of coarctation of the aorta is described.     

Transesophageal Color Doppler Echocardiographic Diagnosis of Cardiac Rupture Following Acute Myocardial Infarction

This report describes a case of cardiac rupture following acute myocardial infarction accurately diagnosed by transesophageal color Doppler echocardiography, which showed a very narrow transmural tract from the left ventricle into the pseudoaneurysm cavity. Such a small, slitlike rupture would most likely have been missed by an otherwise routine transesophageal examination, and we stress the importance of color Doppler interrogation in its accurate diagnosis.