The Role of Transesophageal Echocardiography for Transcatheter Closure of Atrial Septal Defects with the Amplatzer Septal Occluder

Objective: To evaluate of the role of transesophageal echocardiography (TEE)in percutaneous closure of atrial septal defects (ASD) with the Amplatzer septal occluder. Methods:Sixty- two patients (10 to 55 years of age) were selected for percutaneous closure of ASD bytrans-esophageal echocardiography, which was also used to monitor the procedure, to select theappropriate size of the Amplatzer device, to verify its position, and to access the immediateresults of the procedure. During the follow-up, transthoracic echocardiography (TTE) or TEE was usedto evaluate the presence and magnitude of residual shunt (RS), device position, and right cardiacchamber diameters. Results: The mean ASD diameter by TTE ([19. 1 +- 5. 8] mm) was significantlysmaller (P< 0. 001) than the stretched diameter of the ASD (25. 1 +- 6. 4) mm. There are nosignificant differences between the TEE -measured value (23. 5+_6. 2) mm and the stretched diameterof the ASD (P > 0. 05). Due to proper patient selection all procedures were successful. There wasimmediate and complete closure in 61/62 patients, only one patients had trivial residual shunt.Follow- up was performed using TTE or TEE right after operation, 1 d, 1 month, 3 months, 6 monthsand yearly thereafter. Ail, patients remain asymptomatic without any clinical or technical problems.Conclusion: With the aid of TEE, percutaneous closure of ASD can be performed successfully, safely,and effectively.

Geometric comparison of the mitral and tricuspid valve annulus:Insights from three dimensional transesophageal echocardiography

AIM To apply real time three-dimensional transesophageal echocardiography(RT3D TEE) for quantitative and qualitative assessment of the mitral valve annulus(MVA) and tricuspid valve annulus(TVA) in the same patient.METHODS Our retrospective cohort study examined the MVA and TVA in 49 patients by RT3 D TEE. MVA and TVA shape were examined by TEE. The MVA and TVA volume data set images were acquired in the mid esophageal 4-chamber view. The MVA and TVA were acquired separately, with optimization of each for the highest frame rate and image quality. The 3D shape of the annuli was reconstructed using the Philips~? Q lab, MVQ ver. 6.0 MVA model software. The end-systolic frame was used. The parameters measured and compared were annular area, circumference, high-low distances(height), anterolateralposterolateral(ALPM), and anteroposterior(AP) axes. RESULTS A total of 49 patients(mean age 61 ± 14 years, 45% males) were studied. The ALPM and the AP axes of the MVA and TVA are not significantly different. The ALPM axis of the MVA was 37.9 ± 6.4 mm and 38.0 ± 5.6 mm for the TVA(P = 0.70). The AP axis of the MVA was 34.8 ± 5.7 mm and 34.9 ± 6.2 mm for the TVA(P = 0.90). The MVA and the TVA had similar circumference and area. The circumference of the MVA was 127.9 ± 16.8 mm and 125.92 ± 16.12 mm for the TVA(P = 0.23). The area of the MVA was 1103.7 ± 307.8 mm^2 and 1131.7 ± 302.0 mm^2 for the TVA(P = 0.41). The MVA and TVA are similar oval structures, but with significantly different heights. The ALPM/AP ratio for the MVA was 1.08 ± 0.33 and 1.09 ± 0.28 for the TVA(P < 0.001). The height for the MVA and TVA was 9.23 ± 2.11 mm and 4.37 ± 1.48 mm, respectively(P < 0.0001). CONCLUSION RT3 D TEE plays an unprecedented role in the management of valvular heart disease. The specific and exclusive shape of the MVA and TVA was revealed in our study of patients studied. Moreover, the intricate codependence of the MVA and the TVA depends on their distinctive shapes. This realization seen from our study will allow us to better understand the role valvular disease plays in disease states such as hypertrophic cardiomyopathy and pulmonary hypertension.

Atherosclerotic aortic plaques detected by transesophageal echocardiography

Objective To evaluate the predictive value of atherosclerotic aortic plaques in coronary artery disease (CAD). Methods In 50 patients with suspected coronary artery disease, transesophageal echocardiography was performed to examine their thoracic aortas 2 weeks before or after coronary angiography. In the cases of coronary angiography studied, stenosis of the coronary artery ≥50%was considered to be due to coronary artery disease, whereas the thickness of the intima ≥1.3 mm was taken to be the criteria for the presence of an atherosclerotic aortic plaque on the transesophageal echocardiographic test. Results Among the 50 patients, 37 cases were diagnosed as CAD and 13 cases were considered to be normal. The plaques of the thoracic aorta were observed in 34 cases in the CAD group and 3 cases in the normal group. The sensitivity and specificity of aortic plaques for CAD were 91.9%and 76.9%, respectively. The positive and negative predictive values of the aortic plaques for CAD were 91.9%and 76.9%, respectively. The accuracy was 88.0%. 80 percent of the patients with single-vessel disease had thoracic aortic plaques, 92 percent of the patients with two vessel disease and 100 percent of the patients with three vessel disease had thoracic aortic plaques. There was a significant difference in the thickness of aortic intimas between the normal group and the CAD group. Conclusions Detecting atherosclerotic plaques in the thoracic aorta with transesophageal echocardiography may be of great value in predicting the presence and extent of coronary artery disease.

Evaluate of transesophageal echocardiography during lung transplantation

Objective To investigate the clinical value of transesophageal echocardiography during the lung transplantation. Methods From August 2005 to August 2009, 19 patients with advanced lung diseases received lung transplantation. The average age was (48. 35 ± 13. 04) years. The echocardiographic probe was placed in patient’ s esophagus before surgery. The left and right

Noninvasive Assessment of Cardiac Index with Transesophageal Echocardiography in Patients Undergoing Mitral Valve Replacement: A Comparison between Determinations at the Mitral Valve and the Ascending Aorta

Methods: Sixteen patients with American Society of Anesthesiologists status (ASA) II-III, age ≤ 70 yr, male or female, preoperatively NYHA II-III and EF ≥ 45%, scheduled for mitral valve replacement (MVR) were studied. Complete intravenous general anesthesia was used for induction and anesthesia maintenance. After anesthesia induction we put the TEE probe into the esophagus. The cardiac index was determined at three periods following MVR: T1 30 minutes later following cessation of bypass, T2 60 minutes after cessation of bypass, T3 90 minutes after cessation of bypass. Statistical analysis was made with the Bland and Altman method. Results: Ninety-six measurements were compared. The cardiac index values at the level of prosthesis mitral valve (CIMV) ranged from 1.3 to 5.5 L·min-1·m-2 (mean 2.6 ± 0.9). The Values of cardiac index at aortic valve (CIAA) ranged from 2.7 to8.8 L·min-1·m-2 (mean 4.9 ± 1.7). Bias was -2.3 L·min-1·m-2 and limits of agreement -5.6 to 1.0 L·min-1·m-2. Conclusion: During mitral valve replacement, doubtful correlations were observed between values of cardiac index at the mitral valve and the ascending aorta using TEE.

Research and Application of Transnasal Transesophageal Echocardiography Probe

The intubation of conventional transesophageal echocardiography（TEE） probes into patients causes serious esophagus irritation, and thus the use of TEE probes in pediatric practice is limited. In this study, we aimed at the development of a special probe which could be inserted through the nasopharyngeal cavity into the esophagus to obtain the same high-quality echocardiography images as those obtained by conventional TEE and improve patients＇ experience. During the examination, the patients felt relaxed for a longer time and cooperated with the sonographers in the process of cardiac catheterization conducted in the surgery room or the intensive care unit（ICU）, resulting in improved accuracy of the diagnosis and timely administration of appropriate treatment. Two years ago, Prof. Xin-fang WANG put theories into practice by inserting the probe through the nasal cavity and pharynx into the esophagus of volunteers to successfully detect the heart and great vessels at the retrocardiac space. Later, Prof. Ming-xing XIE performed the transnasal TEE examination in 12 atrial septal defect（ASD） patients and proved the safety and reliability of this method, which could become a new way for clinical diagnosis and treatment.

Catheter ablation of atrial fibrillation facilitated by preprocedural three-dimensional transesophageal echocardiography: Long-term outcome

AIM To evaluate the long-term outcome of catheter ablation of atrial fibrillation(AF) facilitated by preprocedural threedimensional(3-D) transesophageal echocardiography.METHODS In 50 patients, 3D transesophageal echocardiography(3D TEE) was performed immediately prior to an ablation procedure(paroxysmal AF: 30 patients, persistent AF: 20 patients). The images were available throughout the ablation procedure. Two different ablation strategies were used. In most of the patients with paroxysmal AF, the cryoablation technique was used(Arctic Front Balloon, Cryo Cath Technologies/Medtronic; group A2). In the other patients, a circumferential pulmonary vein ablation was performed using the CARTO system [Biosense Webster; group A1(paroxysmal AF), group B(persistent AF)]. Success rates and complication rates were analysed at 4-year follow-up.RESULTS A 3D TEE could be performed successfully in all patients prior to the ablation procedure and all four pulmonaryvein ostia could be evaluated in 84% of patients. The image quality was excellent in the majority of patients and several variations of the pulmonary vein anatomy could be visualized precisely(e.g., common pulmonary vein ostia, accessory pulmonary veins, varying diameter of the left atrial appendage and its distance to the left superior pulmonary vein). All ablation procedures could be performed as planned and almost all pulmonary veins could be isolated successfully. At 48-mo followup, 68.0% of all patients were free from an arrhythmia recurrence(group A1: 72.7%, group A2: 73.7%, group B: 60.0%). There were no major complications.CONCLUSION3 D TEE provides an excellent overview over the left atrial anatomy prior to AF ablation procedures and these procedures are associated with a favourable long-term outcome.

Surgical Resection of Mitral Valve Papillary Fibroelastoma: A Robot-Assisted, Minimally Invasive Approach with Three-Dimensional Transesophageal Echocardiography Imaging

Papillary fibroelastomas (PFEs) are benign tumors of the endocardium that most frequently affect cardiac valves and typically present with embolic symptoms such as stroke or transient ischemic attack (TIA). Surgical excision is usually recommended for left-sided tumors and is associated with excellent long-term outcomes. The use of a robot-assisted, minimally invasive surgical approach for management of mitral valve disease is growing, and has been associated with shorter hospital stays and improved early quality of life. Three-dimensional (3D) transesophageal echocardiography (TEE) offers several advantages in the assessment of mitral valve disease and cardiac tumors, including the ability to precisely locate the site of attachment of the mass and the spatial relationships to surrounding structures. These factors are particularly important when planning a surgical approach. We report two cases of mitral valve PFEs which were successfully removed using a robot-assisted, minimally invasive surgical approach with 3D TEE imaging. This approach to treatment of PFEs is an attractive alternative to the traditional approach involving median sternotomy.

Role of intraoperative transesophageal echocardiography in coronary artery bypass grafting

Transesophapeal echocardiography （TEE） can be used as a diagnostic tool during cardiac surgery to direct the surgical procedure and diagnose unanticipated problems. TEE has also been one of the most important means of monitoring myocardial ischemia dur- ing coronary artery bypas grafting procedures. The cardiac anesthesiologist can apply intraoperative TEE in evaluating coronary artery anatomy and aorta atherosclerosis, assessing diastolic left ventricular function and preload,measuring intracardiac pressure and cardiac output,detecting ischaemic mitral regurgitation,intracardiac air and pericardial effusion.

OMNIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY IMAGING PLANES EXPLORATION

One hundred and twenty-four patients with heart disease were examined by omniplane TEE in order to systematically research every views of omniplane TEE, and further explore anatomy and image feature of each view. The result showed that omniplane TEE transducer can be rotated in probe from 0°to 180°.obtain many views at various angles behind the heart and fully demonstrate the structure and pathology of the heart and great vessels. It was useful for clinical diagnosis because of getting more information about the heart and great vessels. As omniplane TEE probe was little rotated in esophagus, it lessened esophagus stimulation. Meanwhile, it was suitable for three-dimensional reconstruction of left ventriculum.

Upper gastrointestinal bleeding from a Mallory-Weiss tear associated with transesophageal echocardiography during successful cardiopulmonary resuscitation:A case report

BACKGROUND In recent years,it has been recognized that transesophageal echocardiography(TEE)is of great value in resuscitation of cardiac arrest.However,its safety has rarely been reported.CASE SUMMARY We present a 59-year-old male patient scheduled to undergo cardiac surgery for rheumatic heart disease.Upper gastrointestinal bleeding from a Mallory-Weiss tear appeared following cardiopulmonary resuscitation,TEE,and percutaneous cardiopulmonary bypass resuscitation when he suffered from aesthesia-related cardiac arrest.Gastrointestinal injury was diagnosed promptly and treated effectively.However,the exact etiology of gastrointestinal injury was unclear;the interaction of closed-chest cardiac massage and the application of TEE may be involved as a most possible mechanism of injury.CONCLUSION Serious complications should be considered when TEE is used in patients with special pathophysiological conditions.

Assessment of left atrial appendage function by transesophageal echocardiography in patients two weeks after acute coronary syndromes

Background For many years in ischemic heart disease, ventricles rather than atria received attention so not much is known about left atrial function in left ventricular ischemia. Objective Our study aimed to evaluate left atrial appendage (LAA) function by means of biplane transesophageal echocardiography in patients ten days after acute coronary syndromes (ACS). Methods The study was performed on 16 adult patients (65.9±9.9 years old) in whom transesophageal echocardiography was done 10 days after ACS. The following left atrial appendage (LAA) planimetric parameters were analyzed: LAA transversal dimension, LAA longitudinal dimension,LAA maximal area, and LAA minimal area. LAA ejection fraction was calculated and analyzed. The following LAA Doppler parameters were analyzed: the peak LAA emptying and the peak LAA filling velocities. The control group consisted of 14 patients (43±14.6 years old) without cardiovascular diseases. Results Both LAA longitudinal dimension and LAA transversal dimension were significantly higher in patients with ACS than in control patients. The same was observed for LAA maximal area. Also LAA ejection fraction was higher in patients with ACS . LAA minimal area did not differ in the patients in either group. LAA peak emptying flow (LAAE) and LAA peak filling flow (LAAF) were significantly higher in patients of the study group than of the control group. Conclusion Our study shows that two weeks after acute coronary syndrome LAA as a reservoir as well as a pump works at a higher level than it does in the control group. (J Geriatr Cardiol 2005; 2(4):198-201)

Is transesophageal echocardiography needed for evaluating tissue-based transient ischemic attack？

Transient ischemic attack（TIA） is a warning signal for stroke.A comprehensive evaluation of TIA may reduce the risk for subsequent stroke.Data on the findings of cardiac evaluation with transesophageal echocardiography（TEE） in patients with TIA are sparse.Our aims were to determine the frequency of TEE performance and to investigate the findings of TEE in patients with TIA based on the new definition of TIA（i.e.,transient neurological symptoms without evidence of infarction）.During a 4-year period（2011–2014）,1071 patients（mean age,70 ± 13 years;female,49.7%） with TIA were included in a prospective study and evaluated.Of 1071 consecutive patients suffering from TIA,288 patients（27%） underwent TEE.The median time between admission and TEE was 6 days.Patients with TIA who were evaluated by TEE were younger（67 vs.71 years,P 〈 0.001） than those who were not evaluated by TEE.They had a higher rate of sensibility disturbance as a TIA symptom（39% vs.31%,P = 0.012） but a lower rate of previous stroke（15% vs.25%,P = 0.001） and atrial fibrillation（2% vs.21%,P 〈 0.001） than those who did not.Foramen ovale was detected in 71 patients（25.7%）,atrial septal aneurysm in 13 patients（4.6%）,and severe atherosclerotic plaques（grade 4 and 5） in the aortic arch in 25 patients（8.7%）.One patient（0.3%） had a fibroma detected by TEE.In 17 of the 288 patients（6%） who underwent TEE,the indication for anticoagulation therapy was based on the TEE results,and 1 patient with fibroma underwent heart surgery.During hospitalization,7 patients experienced a subsequent stroke,and 27 patients had a recurrent TIA.At 3 months following discharge,the rates of readmission,stroke,recurrent TIA,and death were 19%,2.7%,4.2%,and 1.6%,respectively.The rates of mortality（0.9% vs.1.8%,P = 0.7）,stroke risk（1.9% vs.3.0%,P = 0.8）,and recurrent TIA（5.0% vs.3.9%,P = 0.8） were similar in patients who underwent TEE and in those who did not.Performing TEE in patients with tissue-based TIA is helpful in detecting cardiac sources for embolism and may indicate for anticoagulation.

Feasibility of percutaneous closure of left atrial appendage under the guidance of transesophageal echocardiography without fluoroscopy

Background In an effort to avoid x-ray and contrast agents for patients of atrial fibrillation(AF)with chronic kidney disease,we developed a method for transcatheter closure of left atrial appendage(LAA)under the guidance of transesophageal echocardiography(TEE)without fluoroscopy.

CLINICAL COMPLICATIONS AND SAFETY OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY:A REPORT OF 1552 EXAMINATIONS

Method Fifteen hundred and fifty two patients with heart disease were examined with monoplane, biplane and omniplane TEE probe(including male 727, female 825;9～76 years old) During the same period, 113 307 precordial echocardiographic examinations were performed in our laboratory The ratio between TEE and transthoracic Echo examines was 1:73 Result All different kinds of complication were occurred during TEE examination, including vomiting, minor mucus bleeding, laryngospasm, mandibular dislocation, angina pectoris, arrhythmia, even ventricular fibrillation and death The article suggested that there were five steps must be improved during TEE examination including instrument and patients preparation, local anesthesia, manipulation technique and TEE probes pattern Conclusion Although TEE is a semiinvasive technique and can cause some kinds of complication, it is a safe technique if the five steps are improved

CLINICAL APPLICATION OF OMNIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

One hundred and twenty-four patients with heart disease(75 cases of rheumatic heart disease,26 cases of congenital heart disease,13 cases of aortic disease and 10 cases of other disease)were examined by Omniplane transesophageal echocardiography(TEE).The result showed that Omniplane TEE transducer can be rotated from 0°to 180°in probe and had the advantages of broader scope,obtaining more information,less stimulation to esophagus and easy to manipulate.It suggests that Omniplane TEE is a efficient technique in clinical diagnosis and can be extensively used in the future.

Natural orifice transesophageal thoracoscopic surgery:A review of the current state

Since the concept of Natural Orifice Translumenal Endoscopic Surgery(NOTES) was introduced,it has continued to gain significantly in popularity and enthusiasm for its potential clinical applications.The ability to perform conventional laparoscopic and thoracoscopic procedures without the creation of scars and perhaps faster and less painful recovery has prompted a worldwide devotion to further this field.While intraabdominal NOTES has rapidly transitioned from animal models to human trials,applying the NOTES concept to perform thoracic procedures has been slower to gain momentum.The goal of this review is to summarize the current state of transesophageal NOTES thoracoscopy by looking at its potential for diagnostic and therapeutic interventions as well as the challenges in transitioning to human trials.

Pump models assessed by transesophageal echocardiography during cardiopulmonary resuscitation

OBJECTIVE: Transesophageal echocardiography was performed during closed-chest cardiopulmonary resuscitation (CPR) in in-hospital cardiac arrest to further explore the hemodynamic mechanism of CPR. METHODS: CPR attempts were performed according to advanced cardiovascular life support guidelines in 6 cases of in-hospital cardiac arrest. Multi-plane transesophageal echocardiography was carried out within 15 min of initiation of CPR. Throughout CPR, the motion of the mitral, tricuspid and aortic valves, the changes in the left ventricular cavity size and the thoracic aortic diameter were observed. Trans-mitral and trans-aortic Doppler files of blood flow were also documented. RESULTS: A closure of the mitral and tricuspid valves with simultaneous opening of the aortic valve occurred exclusively during chest compression, resulting in forward blood flow in the pulmonary and systemic circulation. Peak forward aortic flow at a velocity of 58.8 +/- 11.6 cm/s was recorded during the compression phase. Whereas, a closure of the aortic valve and rapid opening of the atrioventricular valves associated with ventricular filling during relaxation of chest compression was noted in all 6 patients. Peak forward mitral flow at a velocity of 60.6 +/- 20.0 cm/s was recorded during the release phase. Mitral regurgitation during the chest compression period was detected in 5 patients, reflecting a positive ventricular-to-atrial pressure gradient. A reduction in the left ventricular chamber and an increase in the thoracic aortic diameter during the compression phase was found in all patients, indicating that direct cardiac compression contributed to forward blood flow. CONCLUSION: These observations favor the cardiac pump theory as the predominant hemodynamic mechanism of forward blood flow during CPR in human beings.

Application of transesophageal echocardiography to aortic embolic stroke

OBJECTIVES: To determine the relative value of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in exploring the potential embolic source (PES) in heart and aortic arch and to study the clinical significance of aortic arch atherosclerosis (AAA). METHODS: Forty-nine patients with cerebral embolism were included in this study. TEE and TTE were used to evaluate the potential source of emboli in aortic arch, heart and duplex in the carotid artery. An atherosclerotic lesion of the aortic arch was defined as normal, mild plaque, moderate plaque, and protruding plaque or mobile plaque. RESULTS: Of the 49 patients, 31 (63%) patients showed evidence of AAA: 7 (14.1%) patients were mild, 9 (18.4%) were moderate and 15 (30.6%) were severe. In those 15 patients, 11 had neither severe ICAA nor heart disease. Thirty-three patients had internal carotid arterial atherosclerosis (ICAA). The potential sources of embolization of heart and aortic arch is 48.98% by TEE, but only 18.4% by TTE; 9 patients had heart disease. Age and ICAA were significantly correlated with AAA. CONCLUSION: At present, TEE is a better method for exploring atherosclerotic lesions in the thoracic aorta. AAA is an important potential source of cerebral embolic stroke.

Application of transesophageal echocardiography to aortic embolic stroke

s To determine the relative value of transesophageal echocardiography (TEE) and tr ansthoracic echocardiography (TTE) in exploring the potential embolic source (PE S) in heart and aortic arch and to study the clinical significance of aortic arc h athersclerosis (AAA) Methods Forty nine patients with cerebral embolism were included in this study TEE an d TTE were used to evaluate the potential source of emboli in aortic arch, heart and duplex in the carotid artery An atherosclerotic lesion of the aortic arch was defined as normal, mild plaque, moderate plaque, and protruding plaque or m obile plaque Results Of the 49 patients, 31(63%) patients showed evidence of AAA: 7 (14 1%) patients were mild, 9 (18 4%) were moderate and 15 (30 6%) were severe In those 15 p atients, 11 had neither severe ICAA nor heart disease Thirty three patients h ad internal carotid arterial atherosclerosis (ICAA) The potential sources of e mbolization of heart and aortic arch is 48 98% by TEE, but only 18 4% by TTE; 9 patients had heart disease Age and ICAA were significantly correlated with A AA Conclusion At present, TEE is a better method for exploring atherosclerotic lesions in the thoracic aorta AAA is an important potential source of cerebral embolic stroke