Transoesophageal echocardiography for definitive diagnosis of haemodynamically significant pulmonary embolism

Transoesophageal echocardiographic evaluation of right and leftpulmonary arteries, up to the origin of their lobar branches,was prospectively performed with a single plane probe in 32consecutive patients (18M, 14F, aged 55.5 ± 14.6, from32 to 80 years) with clinical or echocardiographic suspicionof pulmonary embolism, who met transthoracic echocardiographiccriteria of right ventricular overload Transoesophageal echocardiographyshowed unequivocal (20 patients) or suspected (three patients)intraluminar thrombi in 88.5% of 26 patients with haemodynamicallysignificant acute or chronic pulmonary embolism, confirmed withreference methods. The sensitivity of the unequivocal transoesophagealechocardiographic diagnosis was 80% for acute and 73% for chronichaemodynamically significant pulmonary embolism. No false-positiveresults were found (specificity 100%). Additionally, in three cases, transoesophageal echocardiographydisclosed the cause of the right ventricular overload revealinga previously undiagnosed atrial septal defect or Ebstein anomaly. Direct visualization of proximal pulmonary arterial thrombiby transoesophageal echocardiography emerges as a useful newmethod of prompt and definite diagnosis of haemodynamicallyimportant pulmonary embolism.