Identification of a Retained Intravascular Wire by Three-Dimensional Transesophageal Echocardiography

A 78-year-old man with an implantable cardioverter-defibrillator (ICD) for ischemic cardiomyopathy and prior ventricular tachycardia (VT) ablation presented with abdominal pain and was found to have a small bowel obstruction requiring immediate surgery. His postoperative course was complicated by incessant VT leading to multiple ICD shocks. He was referred to our hospital for repeat VT ablation. TEE revealed a wire coiled in the right pulmonary artery. This is the first reported identification of an embolized wire by transesophageal three-dimensional echocardiography.     

Immediate Change in Pulmonary Venous Flow Pattern after Deployment of Occluder Device for Atrial Septal Defect

Transcatheter closure of a secundum defect using a septal occluder is a safe and effective procedure based on long-term follow-up, but no clinical studies have examined immediate hemodynamic changes. We evaluated pulmonary venous flow velocity pattern before and immediately after deployment of the Amplatzer septal occluder for closure of atrial septal defect. From May 2003 to January 2005, 48 patients with secundum atrial septal defect received transcatheter closure with complete occlusion. Patients were divided into two groups according to age: pediatric group, under 16 years (n = 30, age 7.3 ± 3.2 years), and adult group, 16 years or older (n = 18, age 30.1 ± 11.4 years). Pulmonary venous flow pattern was recorded by transesophageal echocardiography before and immediately after occluder deployment. Immediately after deployment in both patient groups, pulmonary vein systolic (S) and diastolic (D) wave velocity decreased, but atrial reversal (AR) wave velocity increased. In the pediatric group, S-wave was 56.1 ± 17.1 versus 35.5 ± 11.3 cm/sec (P < 0.001); D-wave was 57.6 ± 12.5 versus 42.9 ± 11.8 cm/sec (P < 0.001); and AR wave velocity was 12.2 ± 3.8 versus 15.5 ± 4.1 cm/sec (P < 0.001). In the adult group, S-wave was 48.4 ± 13.7 versus 32.7 ± 10.3 cm/sec (P < 0.001); D-wave was 51.9 ± 11.7 versus 38.0 ± 8.5 m/sec (P < 0.001); and AR wave velocity was 12.1 ± 4.1 versus 16.2 ± 4.9 cm/sec (P < 0.001). Comparison of pulmonary venous flow before and immediately after deployment of the Amplatzer septal occluder provides an excellent model to evaluate the influence of an atrial communication on pulmonary venous flow. Pulmonary venous forward flow decreases following atrial septal defect (ASD) closure.     

The Potential Impact of Contemporary Transthoracic Echocardiography on the Management of Patients with Native Valve Endocarditis: A Comparison with Transesophageal Echocardiography

Background: Between 1987 and 1994, several studies demostrated transthoracic echocardiography (TTE) to be less sensitive than transesophageal echocardiography (TEE) in detecting native valve endocarditis. Recent technologic advances, especially the introduction of harmonic imaging and digital processing and storage, have improved TTE image quality. The aim of this study was to determine the diagnostic accuracy of contemporary TTE. Methods: Between 2003 and 2007, 75 patients underwent both TTE and TEE for clinically suspected infective endocarditis. The diagnostic accuracy of TTE was assessed using transesophageal echocardiography as the gold standard for diagnosis of endocarditis. Results: Of the 75 patients in this study, 33 were found to be positive by TEE. The sensitivity for detection of infective endocarditis by TTE was 81.8%. It provided good image quality in 81.5% of cases; in these patients sensitivity was even greater (89.3%). Conclusion: Contemporary TTE has improved the diagnostic accuracy of infective endocarditis by ameliorating image quality; it provides an accurate assessment of endocarditis and may reduce the need for TEE.     

Imaging of Right Coronary Artery Ostial Stents by Transesophageal Echocardiography

A 55-year-old female with a history of rheumatic mitral stenosis and coronary artery disease underwent a transesophageal echocardiographic examination to assess the feasibility of performing balloon mitral valvuloplasty. During the examination, an unusual echodensity was incidentally discovered in the right sinus of Valsalva which represented a coronary artery stent. Transesophageal imaging of ostial stents have rarely been described in the literature. Their characteristic echocardiographic findings are discussed.     

Two-Dimensional Echocardiographic Findings of Pulmonary Valve Cyst Secondary to Pulmonary Valvuloplasty

Real time two-dimensional transthoracic and transesophageal echocardiography demonstrated a mobile echolucent mass attached to the pulmonary valve in a 25-year-old adult, 20 years following balloon pulmonary valvuloplasty. The mass was surgically excised and pathology showed it to be a cyst.     

Evaluation of a Posterior Mitral Valve Leaflet Aneurysm by Real Time Three-Dimensional Transesophageal Echocardiography

Posterior mitral valve (MV) leaflet aneurysms are extremely rare complications of infective endocarditis (IE). When MV aneurysms occur, they usually involve the anterior leaflet. Real time three-dimensional transesophageal echocardiography (RT3D TEE) has been recently developed and provides views of unparalleled quality by optimizing visualization of spatial relationships. We present a rare case of a posterior MV leaflet aneurysm due to IE in a 64-year-old woman, best visualized by RT3D TEE.     

经食管实时三维超声心动图在二尖瓣病变中的应用价值

目的初步探讨经食管实时三维超声心动图（RT3D—TEE）在二尖瓣病变术前诊断、术中监测及术后评价中的临床应用价值。方法应用RT3D—TEE对31例二尖瓣病变患者进行术前、术中及术后检查,并与外科手术结果对比。结果RT3D—TEE清晰显示23例风湿性瓣膜病变患者的二尖瓣病变情况、累及瓣膜情况,并指导手术成功完成;准确显示7例二尖瓣脱垂患者的病变部位并量化病变情况;准确诊断1例二尖瓣人工机械瓣置换术后再狭窄患者的病因。31例患者均获得满意的RT3D—TEE图像。结论RT3D—TEE能在二尖瓣病变术前、术中及术后提供真实准确的评价信息。