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.

麻醉医生在TEE培训中授课与模拟训练理想顺序的探索

目的:探讨基于仿真模拟器的TEE(transesophageal echocardiography)培训中,模拟训练后再进行授课的教学效果是否优于授课后再进行模拟训练。方法:选取首都医科大学附属北京朝阳医院麻醉科未接受过任何TEE培训课程的非心脏麻醉医生60名,随机分为两组。对照组(n=30)先授课后进行模拟训练;试验组(n=30)先进行模拟训练后授课。通过笔试及模拟操作成绩来评估教学效果。用SPSS 25.0统计软件进行统计分析,组间比较采用独立样本t检验,计数资料采用χ^(2)检验。结果:最终51名学员的成绩纳入数据分析,两组学员课后即时MCQ测试成绩及技能测试成绩无统计学差异,但1个月后试验组MCQ测试成绩及技能测试成绩均优于对照组。结论:对于无任何TEE相关基础的非心脏麻醉医生,最好先进行基于仿真模拟人的实践技能培训,再进行理论知识授课,此种顺序的安排可使新手学员对TEE切面及心脏结构的记忆时间更长久。

TTE联合TEE诊断主动脉瓣二瓣畸形致二尖瓣前叶瘤1例报告及文献复习

目的:分析二尖瓣瘤(MVA)的临床表现、影像学特征、治疗措施和疗效,提高临床医师对MVA的认识。方法:收集1例主动脉瓣二瓣畸形导致二尖瓣前叶瘤形成患者的临床资料,根据其临床特点和影像学特征明确临床诊断、选择治疗方法并对疗效进行分析,同时进行相关文献复习。结果:患者,女性,68岁,因心慌气短13年,加重1个月入院。患者于13年前无诱因出现心慌气短,在当地医院诊断为“心脏瓣膜病”,1个月前上述症状加重而住院治疗。经胸二维超声心动图(TTE)显示左心室肥大,主动脉瓣呈二瓣,瓣叶增厚,回声增强,主动脉瓣前向血流速度增快,瓣口面积2.0 cm^(2);二尖瓣前叶瓣缘局部略增厚,回声略增强,呈囊性“蜂窝状”结构,与主动脉瓣反流束密切相关,反流束似进入“囊袋”。术前经食管超声心动图(TEE)显示主动脉瓣二瓣畸形,前方瓣叶舒张期脱向左心室流出道;二尖瓣前叶心房面可探及“囊袋状”结构,随心动周期囊壁形态发生改变,该“囊袋”与左心室血流相交通。超声诊断为主动脉瓣二瓣畸形-横裂式、重度关闭不全伴轻度狭窄和二尖瓣前叶瘤。术中主动脉瓣瓣环扩大,瓣叶呈明显关闭不全,将瓣叶切除,主动瓣位置换1枚23号生物瓣;经主动脉瓣口探查二尖瓣,前叶瓣体可探及“囊袋样”结构,未进行特殊处理。术后TEE显示主动瓣位生物瓣回声及活动良好,二尖瓣“囊袋状”结构仍然不变。术后10 d和术后4个月随访显示主动瓣位生物瓣回声及活动良好,二尖瓣囊性病变的性质及大小与术前比较无明显变化。结论:MVA临床罕见,TTE是目前临床诊断MVA最有价值的影像学诊断方式,特别是TTE联合TEE是最佳诊断方法,且可协助治疗及疗效评价。

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.

Study on Three Dimensional Reconstruction of Transesophageal Echocardiographic Images

Using biplane transesophageal echocardiography and the concept of three dimensional transthoracic echocardiography,we performed three dimensional reconstruction of transesophageal images of various clinicopathologic cases,including atrial septal defect,mitral stenosis,mitral valve prolapse and pulmonary stenosis.The hardware equipments and image processing flow chart of three dimensional reconstruction of transesophageal echocardiographic images are described. Our present study indicates that three dimensional reconstruction of transesophageal echocardiographic images could display multi-regional three dimensional structures of heart and great vessels,including superior vena cava,ascending aorta,right ventricular outflow tract, pulmonary artery and left heart,with clear,visual and stereoscopic imaging.The regional structures could be displayed at different levels of stereo-anatomic-sec-tions and in different orientations of rotating stereo-images,which could provide accurate three dimensional anatomical information for cardiac stereo-morphological study and definition of spatial location and size of cardiac abnormalities.

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.

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.

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.

DSA与TEE引导经皮PFO封堵术安全性与有效性比较

目的比较血管造影(DSA)与经食管超声心动图(TEE)引导下行经皮卵圆孔未闭(PFO)封堵术的可行性、安全性和有效性。方法2018年1月—2022年12月,山东第一医科大学第一附属医院住院治疗的不明原因脑卒中和药物治疗无效的PFO相关性偏头痛332例,所有病人均接受经皮PFO封堵术治疗。根据其引导方式分为TEE组101例,DSA组231例;根据病因分为偏头痛组151例和隐匿性脑卒中组181例。回顾性分析病人的临床特征、超声心动图、术中及术后1年随访等临床资料。结果DSA组和TEE组的手术成功率与手术并发症发生率无显著差异,但TEE组的手术时间更长、住院费用更高(t=5.125,Z=8.265,P<0.001)。偏头痛组和隐匿性脑卒中组的手术成功率和并发症发生率与总体结果相一致。随访1年偏头痛亚组DSA和TEE病人的HIT-6评分差异无统计学意义;隐匿性脑卒中亚组DSA病人复发脑卒中3例(2.2%),而TEE病人无脑卒中复发者,但差异无统计学意义。结论TEE和DSA引导下经皮PFO封堵术,在手术成功率、并发症发生及术后1年疗效等方面无明显差异,但在手术时长和住院费用方面DSA病人更具优势。

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.

Effects of sevoflurane on left ventricular function by speckletracking echocardiography in coronary bypass patients: A randomized trial

The present study aimed to dynamically observe the segmental and global myocardial movements of the left ventricle during coronary artery bypass grafting by transesophageal speckle-tracking echocardiography,and to assess the effect of sevoflurane on cardiac function.Sixty-four patients scheduled for the off-pump coronary artery bypass grafting were randomly divided into a sevoflurane-based anesthesia(AS)group and a propofolbased total intravenous anesthesia(AA)group.The AS group demonstrated a higher absolute value of left ventricular global longitudinal strain than that of the AA group at both T1(after harvesting all grafts and before coronary anastomosis)and T_(2)(30 min after completing all coronary anastomoses)(P<0.05).Moreover,strain improvement in the segment with the highest preoperative strain was significantly reduced in the AS group,compared with the AA group at both T1 and T_(2)(P<0.01).The flow of the left internal mammary artery-left anterior descending artery graft was superior,and the postoperative concentration of troponin T decreased rapidly in the AS group,compared with the AA group(P<0.05).Compared with total intravenous anesthesia,sevoflurane resulted in a significantly higher global longitudinal strain,stroke volume,and cardiac output.Sevoflurane also led to an amelioration in the condition of the arterial graft.Furthermore,sevoflurane significantly reduced strain improvement in the segmental myocardium with a high preoperative strain value.The findings need to be replicated in larger studies.

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)

Clinical Application of Three－dimensional Transesophageal Echocardiography in the Diagnosis of Atrial Septal Defect

This paper reports the use of three-dimensional (3-D) transesophageal echocardiography(TEE) in the diagnosis of atrial septal defect. The results displayed that the interatrial septum had integrity in normal persons. The size,shape and position of atrial septal defects could be showed clearly and the type of the defects could be identified. The reconstructed imaging of interatrial septum on 3-D TEE was clear and stereoscopic. The technique is helpful in defining spatial location and extent of atrial septal defects.

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.

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.

Assessment of Right Coronary Artery Fistula by Multiplane Transesophageal Echocardiography

Coronary artery fistula(CAF) is a relatively uncommon cardiovascular disease. It is an abnormal communication between a coronary artery and a cardiac chamber, great vessels, or other vascular structures. Most are congenital. Multiplane transesophageal echocardiography(multiplane TEE. MTEE) can reveal the proximal dilation, the course and the drainage site of CAF. Presented in this paper was a report of right coronary artery-left ventricle fistula , for the first time,right coronary-left ventricle fistula diagnosed by MTEE and confirmed by angiography.

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.

CLINICAL ASSESSMENT OF BIPLANAR TRANSESOPHAGEAL ECHOCARDIOGRAPHY──A REPORT OF 125 CASES

One hundred and twenty-five patients with cardiovascular disease were examined by biplanar transesophageal echocardiography (BTEE), including 67 with rheumatic heart disease (7 monitored during operation), 22 with aortic diseases, 20 with congenital heart diseases. and 16 with other kinds of heart disease. The results showed that BTEE was not influenced by corpulent and pulmonary emphysema and was better than transthoracic echocardiography at imaging the interatrial septum, left atrium and left atrial appendage, thoracic aorta, and mitral artificial valve and at intraoperative monitoring. BTEE was also better than single-plane transesophageal echocardiography,because BTEE could be used to observe the heart and thoracic aorta in transverse and longitudinal planes, thus enlarging the transmission 'window' as well as allowing the entire lesion to be imaged.This study suggests that BTEE will have good prospects in clinical application.