J Korean Soc Echocardiogr.  1995 Jul;3(1):49-57. 10.4250/jkse.1995.3.1.49.

The Clinical Application and Usefulness of transesophageal Echocardiography

• Kim KS
• Hur SH
• Kim YN
• Kim YK
• Kim KB

• KMID: 2410433
• DOI: http://doi.org/10.4250/jkse.1995.3.1.49

Abstract

BACKGROUND
During the past few years, transesophageal echocardiography(TEE) became one of most impartant method to detect various cardiac disease. But it was performed less than 10% of transthoracic echocardiography(TTE) in most of echocardiographic laboratoties because of major and minor complicatios associated with this procedure. The purposes of this study are to evaluate the clinical applications and the usefulness of transesophageal echocardiography in various cardiac disorders. METHOD: From 1990 to 1995, 942 cases were included in this study. All subjects were taken TTE and TEE simultaneously The causes of request, related side effect, cause of failed cases, and the benefit of TEE compared to TTE were analysed. The benefit of TEE were classified into major and minor benefit. Major benefit was defined as to diagnose the disease or to change the therapeautic method by TEE. Minor benefit was defined as to have additional findings by TEE whic could not be enrolled in major benefit.
RESULTS
1) The success rate of TEE was 95.5%(900/942). In 42 failed cases(4.5%), 19 were interrupted procedure earlier, 16 were failed to insert the TEE probe, 4 cases showed arrhythmia, and 3 cases had esophageal stricture or varices. 2) The causes of request were to assess the prosthetic valve function(35.5%), cardiac source of embolism(23.7%), valvular heart disease(22.7%), congenital heart disease(10.2), aortic disease(2.7%), endocarditis(2.3%), cardiac mass(1%), and coronary artery disease(1%), in orders. 3) The benefit of TEE was 77%, congenital heart disease was revealed greatest benefit(97%), but major benefit was highest for the evaluation of cardiac source of emboli(100%).
CONCLUSION
TEE was very useful method for the detection of intra-cardiac and aortic abnormalities. TEE is a relatively safe procedure but it is a semi-invasive method and has few complications. So it is wise to apply TEE as adjuvant method of TTE.

Keyword

Transesopageal echocardiography

MeSH Terms

Arrhythmias, Cardiac
Coronary Vessels
Echocardiography
Echocardiography, Transesophageal*
Esophageal Stenosis
Heart
Heart Defects, Congenital
Heart Diseases
Methods
Varicose Veins

Figure

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  Fig. 1. Indication of transesophageal echocardiography in keimyung university hospital(n = 942). PV: prosthetic valve function, NE: neurologic patient, V: valvular heart disease. CHD: congenital heart disease, AO: aortic disease, BE: bacterial endocarditis M: cardiac mass. IHD: ischemic heart disease. O: others

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  Fig. 2. Benefit of transesophageal echocardiography.

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  Fig. 3. Spontaneous echo contrast in left atrium in paitent with mitral stenosis.

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  Fig. 4. Protruding aortic atheroma (arrow) at aortic arch level in patient with cerebral infarction.

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  Fig. 5. Ruptured chordae(arrow) in mitral valve prolapse.

Reference

References

1). 이태회 • 조용원 • 박영춘 · 김권배 · 김기식 · 심인 성 뇌전색중의 진단읍 위한 경식도 심초읍파도의 유용성, 대한신경과학회지. 12:10. 1994.

2). 이근호 · 김주동 · 윤병우 · 이상적 영호진 · 박성 호 • 나덕열 · 손대원 · 김철호. 심인성 전색의 진단 에 있어서의 Transesoph og; a l Echocardiograph;’의 유 용성. 대한신경과학회지. 9:387. 2992.

3). 오병회 · 박숭우 · 최영진 · 구상회 • 김철호 • 손대 원· 이명 묵·박영배 ·최윤식·서정돈·이영우· 박정수 · 이한보. 허혈성 뇌혈판질환 환자에서 경 식도조영 심초옴파도로 명가한 난원 공개방중의 빈 도에 관한 연구 순환기. 23:227. 1993.

4). 구상회 • 성지동 · 박찬우 • 박숭우 • 김도수 • 손대 원·김철호·오병회·이영묵·박영배·최윤식. 서정돈·이영우;인공판악부전 환자에서 경식도 심초음파도의 임상적 의의. 순환기. 23:928. 1993.

5). 김한수 · 정냥식 • 박시훈 • 심원홈 · 조숭연 • 김성 순. 조직숭모판막 기농부전의 명가에서 경식도 초 음파도 검사 및 Color Doppler의 유용성. 한국심초 음파학회지. 1:122. 2993.

6). 김한수 • 융정환 • 정냥식 ’ 박시훈 • 김병욱 • 섬원 홈·조숭연·김성순·이웅구;대동맥박리 진단에 서 경식도 초음파 검사의 유용성. 순환기. 22:105. 1992.

7). 최경혈 • 허숭호 · 송영성 · 김기식 • 김윤년 • 김권 배. 경식도 싱초음파로 진단왼 박리성 대동맥류 4 례. 순환기. 22:863. 2992.

8). Daniel WG, Erbel R, Kasper W, et al. Safety of transesophageal echocardiograhy: A multicenter survey of 10,419 examinations. Circulation. 87:1426. 1993.

9). Chan KL, Cohen GI, Sochowski RA, Baird MG. Complications of transesophageal echocardiography in ambulatory adult patients: analysis of 1500 consecutive examinations. J Am Soc Echocardiogr. 4:577. 1991.

10). Frazin L, Talano JV, Stephanides L, Loeb HS, Kopel L, Gunnar RM. Esophageal echocardiography. Circulation. 54:102. 1976.

11). Hisanaga K, Hdsanaga A, Nagata K, Yoshida S. A new transesophageal real-time two-dimensional echocardiographic system using a flexible tube and its clinical applications. Proc Jpn J Med Ultrason. 32:43. 1977.

12). Matsuzaki M, Shimizu M, Nomoto R, et al. Assessment of left ventricular anterior wall motion: a new application of esophageal echocardiography. J Cardiogr. 8:113–24. 1978.

13). Hisanaga K, Hisanaga A, Hibi N, Nishimura K, Kambe T. High speed rotating scanner for transesophageal cross-sectional echocardiography. Am J Cardil. 46:837. 1980.

14). Omoto R, Kyo S, Masumura M, Shah PM, Adachi H, Matsunaka T. Biplane color Doppler transesophageal echocardiography: its impact on cardiovascular surgery and further technological progress in the probe, a matrix phased-array biplane probe. Echocardiography. 6:423. 1989.

15). Seward JB, Khandheria BK, Edwards WD, Oh JK, Freeman WK, Tajik AJ. Biplanar transesophageal echocardiography: anatomic correlation, image, orientation, and clinical applications. Mayo Clin Proc. 65:1193. 1990.

16). Flachskampf FA, Hoffmann R, Verlande M, Schneider W, Ameling W, Hanrath P. Initial experience with a multiplane transesophageal echo-transducer: assessment of diagnostic potential. Eur Heart J. 13:201. 1992.

17). Nanda NC, Pinheiro L, Sanyal R, Rosenthal S, Kirklin JK. Multiplane transesophageal echocardiograpic imaging and three-dimensional reconstruction: a perliminary study. Echocardiography. 9:667. 1992.

18). Pandian NG, Hsu T-L, Schwartz SL, et al. Multiplane transesophageal echocardiography: image planes, echocardiographic anatomy, and clinical experience with a prototype phased array omniplane probe. Echocardiography. 9:649. 1992.

19). Roelandt JR, Thomson IR, Vletter WB, Brommersma P, Bom N, Linker DT. Multiplane transesophageal echocardiography: latest evolution in an imaging revolution. J Am Soc Echocardiogr. 5:361. 1992.

20). Perlman AS, Gardin JM, Martin RP, et al. Transesophageal echocardiography: technique anatomic correlations, implementation, and clinical applications. Mayo Clin Proc. 63:649. 1988.

21). Mugge A, Daniel WG, Haverich A, Lichtlen PR. Diagnosis of noninfective cardiac mass lesions by two-dimensional echocardiography: companion of the transthoracic and transesophageal approaches. Circulation. 83:70. 1991.

22). Mugge A, Kuhn H, Daniel WG. The role of transesophageal echocardiography in the detection of left atrial thrombi. Echocardiography. 10:405. 1993.

23). Daniel WG, Nellessen U, Schroder E, et al. Left atrial spotaneous echocontrast in mitral valve disease: an indicator for an increased thromboembolic risk. J Am Coll Cardiol. 11:1204. 1988.

24). Black IW, Hopkins AP, Lee LCL, Walsh WF. Left atrial spontaneous echocontrast: a clinical and echocardiographic analysis. J Am Coll Cardiol. 18:398. 1991.

25). Castello R, Pearson AC, Labovitz AJ. Prevalence and clinical implications of atrial spontaneous contrast in patients undergoing transesphageal echocardiography. Am J Cardiol. 65:1149. 1990.

26). Siostrzonek P, Zangench M, Gossinger H, et al. Comparison of transesophageal and transthoracic contrast echocardiography for detection of a patent foramen ovale. Am J Cardiol. 68:1247. 1991.

27). Hausmann D, Mugge A, Becht I, Daniel WG. Diagnosis of patent foramen ovale by transesophageal echocardiography and association with cerebral and peripheral embolic events. Am J Cardiol. 70:668. 1992.

28). Chenzbraun A, Pinto FJ, Schnittger I. Biplane transesophageal echocardiography in the diagnosis of patent foramen ovale. J Am Soc Echocardiogr. 6:417. 1993.

29). Schneider B, Hanrath P, Vogel P, Meinertz T. Improved morphologic characterization of atrial septal aneurysm by transesophageal echocardiography: relation to cerebrovascular events. J Am Coll Cordiol. 16:1000. 1990.

30). Tunick PA, Peerez JL, Kromzon I. Protruding atheromas in the thoracic aorta and systemic embolization. Ann Intern Med. 115:423. 1991.

31). Karalis DG, Chandrasekaran K, Victor MF, Ross JJ Jr, Mintz GS. Recognition and embolic potential of intraaortic atherosclerotic debris. J Am Coll Cardiol. 17:73. 1991.

32). Bergeron GA, Shah PM. Echocardiography unwarranted in patients with cerebral ischemic events. N Engl J Med. 304:489. 1981.

33). Greenland P, Knopman DS, Giuliani ER, Nasser FN. Two-dimensional echocardiography in patients with focal cerebral ischemia. Ann Intern Med 1981:. 95:1. 1981.

34). Zenker G, Erbel R, Kramer G, et al. Transesophageal two-dimensional echocardiography in young patients with cerebral ischemic events. Stroke. 19:345. 1988.

35). Pop G, Sutherland GR, Koudstaal Pj, Sit TW, De Jong G, Roelandt JRTC. Transesophageal echocardiography in the detection of intracardiac embolic sources in patients with transient ischemic attacks. Stroke. 21:560. 1990.

36). Lee RJ, Bartzokis T, Yeoh TK, Grogin HR, Choi D, Schnittger I. Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography. Stroke. 22:743. 1991.

37). Khandheria BK, Oh J. Transesophageal echocardiography: state-of-the art and future directions. Am J Cardiol. 69:6111. 1992.

38). Silvis S. Nevel O, Rogers G, et al. Endoscopic complications: Results of the 1974 American Society for GI endoscopy Survey. JAMA. 235:928. 1976.

39). Mugge A, Daniel WG, Frank G, Lichtlen PR. Echocardiography in infective endocarditis: reassessment of the prognostic implications of vegetation size determined by ther transthoracic and transesophageal approach. J Am Coll Cardiol. 14:631. 1989.

40). Erbel R, Rohmann S, Drexler M, et al. Improved diagnostic value of echocardiography in patients with infective endocarditis by transoesophageal approach: a prospective study: Eur Heart J. 9:43. 1988.

41). Birmingham GD, Rahko PS, Ballantyne F III. Improved detection of infective endocarditis with transesophageal echocardiography. Am Heart J. 123:774. 1992.

42). Pedersen WR, Walker M, Olson JD. Value of transesophageal echocardiograpy as an adjunct to transthoracic echocardiography in evaluation of native and prosthetic valve endocarditis. Chest. 100:351. 1991.

43). Daniel WG, Mugge A, Martin Rp, et al. Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography. N Engl J Med. 324:795. 1991.

44). Erbel R, Engberding R, Daniel W, Roelandt J, Visser C, Rennollet H. Echocardiography in diagnosis fo aortic dissection. Lancet. 1:457. 1989.