TEE has become one of the most powerful tools for evaluating patients with unexplained stroke, TIA, and peripheral and pulmonary embolization. This is especially encouraging in view of the previously disappointing results of TTE in these patients. In addition to the dramatic results in terms of clot visualization and the other intracardiac sources of embolization described previously, a new extracardiac source has been identified, namely protruding atheromas in the thoracic aorta. These atheromas have been seen for the first time because of the new diagnostic window that has been opened by the development of TEE. Their recognition and follow-up may lead to information that will change the approach to a significant number of patients with embolic ischemic episodes.

Aortic Diseases↗

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Transesophageal echocardiographic diagnosis of right atrial thrombi associated with the antiphospholipid syndrome.

Thromboembolic disorders are a hallmark of the antiphospholipid antibody syndrome. We describe a patient with IgM antiphospholipid antibodies associated with pulmonary emboli and in situ thrombosis within an otherwise normal right atrium. Echocardiography, particularly the transesophageal study, proved invaluable in providing a diagnosis and guiding our patient's evaluation and treatment.

Adult↗

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Systolic aortic regurgitation: a hemodynamic challenge for the clinician.

Aortic regurgitation is considered a diastolic phenomenon. We describe a case in which premature beats resulted in a left ventricular systolic pressure that was lower than the aortic pressure, and thus aortic regurgitation continued throughout the systole of the premature beat. This sequence of events was clearly demonstrated by Doppler echocardiography.

Aged↗

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Echocardiographic evaluation of the coronary sinus.

The purpose of this study was to compare transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in the evaluation of the coronary sinus and its blood flow. Forty patients were studied by TTE and TEE. The distal coronary sinus and its right atrial communication could be identified in 21 of 40 by TTE, and in all patients by TEE. Coronary sinus diameter measurement at the right atrial communication was possible by TTE in 16 of 40, and in all patients by TEE (maximal diameter 6 to 14 mm, mean 9 +/- 2). Flow velocity measurement by pulsed Doppler was possible in 25 of 40 patients (63%) by TEE, and in none by TTE. The flow velocity pattern was similar to central vein flow velocity, with systolic and diastolic antegrade waves, and a small retrograde end diastolic wave. The coronary sinus cross-sectional area was measured in 5 patients by intravascular ultrasound. It varied in size and shape during the cardiac cycle, reaching a maximum (0.3 to 1.5 cm2) at end diastole, and decreasing by 40% to 70% at end systole. TEE is superior to TTE in the evaluation of the coronary sinus and its blood flow velocity. However, because of the variability in cross-sectional area size and shape, measurement of coronary sinus blood flow may be inaccurate.

Aged↗

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Absent right and persistent left superior vena cava without other congenital anomaly: a rare combination diagnosed by transesophageal echocardiography.

A 70-year old man with a history of anorexia, weight loss, and progressive shortness of breath was studied by transesophageal echocardiography. In addition to a mass occupying the right ventricular outflow tract, a rare congenital heart anomaly was discovered serendipitously: persistent left superior vena cava, absent right superior vena cava, and no other congenital abnormality. The echocardiographic findings were confirmed by computed tomographic scanning and later during heart surgery performed to resect the malignant tumor.

Aged↗

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Right atrial and right ventricular obstruction by recurrent stromomyoma.

A 30-year-old woman had a history of a uterine fibroid 6 years before admission. She had resection of a right atrial mass diagnosed as a leiomyoma 2 years ago and a second cardiac procedure for recurrent tumor 1 year ago. Pathologic examination at that time indicated that the tumor was a low-grade endometrial stromal sarcoma (stromatosis) with features of benign leiomyoma (intravenous leiomyomatosis). This time she was admitted with facial and lower extremity swelling as well as ascites. Transthoracic and transesophageal echocardiography revealed a large tumor entering the heart from the inferior vena cava and filling the right atrium and ventricle. Lower extremity ischemia from bilateral compartment syndrome due to severe edema developed, and she underwent successful surgical resection of the tumor that filled the right side of the heart, inferior vena cava, and mesenteric and renal veins.

Adult↗

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Transesophageal echocardiography in the diagnosis of ostial left coronary artery stenosis.

The diagnosis of ostial stenosis of the left main coronary artery is usually made by use of coronary angiography. However, positioning of the catheter across the obstruction may obscure this diagnosis during contrast injection. Although a damping of arterial pressure when the catheter enters the left coronary artery may suggest ostial stenosis, it may not be possible to make this diagnosis with certainty during cardiac catheterization. We report a series of four patients in whom the left coronary ostium and proximal left coronary arteries were visualized by means of transesophageal echocardiography. Both ostial narrowing by plaque and abnormally fast flow velocities were seen. In each case the echocardiographic findings contributed to the subsequent management of the patients.

Aged↗

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Fingerlike mass in the left atrium.

Explore the source record for details and available documents.

Adult↗

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Transesophageal echocardiographic diagnosis of the superior vena cava syndrome resulting from aortic dissection: a multiplane study.

The case of an 82-year-old patient with signs and symptoms of superior vena cava syndrome is described. A multiplane transesophageal echocardiogram demonstrated anatomic and Doppler flow evidence of superior vena caval obstruction due to compression by a dissected, aneurysmal ascending aorta. Multiplane transesophageal echocardiography is particularly useful in the diagnosis of superior vena cava syndrome when it is a sequela of thoracic aortic disease.

Aged↗

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Left ventricle-to-ascending aorta communication complicating composite graft repair undetected by aortography: diagnosis by transesophageal echocardiography.

A 57-year-old man underwent composite ascending aortic conduit and prosthetic aortic valve repair of a sinus of Valsalva aneurysm. The patient's course was complicated by recurrent aneurysm formation caused by a communication between the left ventricular outflow tract and the ascending aorta outside the conduit. Transesophageal echocardiography documented the anatomic and functional characteristics of this complication, whereas aortography failed to demonstrate them. Findings at surgery confirmed the transesophageal echocardiogram results of a left ventricular outflow tract to aorta communication, a normal prosthetic aortic valve, and an intact distal anastomosis of the conduit with the aorta. Transesophageal echocardiography is a useful modality for the evaluation of composite graft repairs of the aortic valve and ascending aorta.

Aorta↗

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Diagnosis of tumor embolus to the pulmonary artery by transesophageal echocardiography.

This article describes a patient with renal cell carcinoma and massive tumor extension into the inferior vena cava who experienced sudden tachypnea and subsequent cardiopulmonary arrest. Transesophageal echocardiography was used to diagnose a massive tumor embolus to the pulmonary artery that was subsequently confirmed at autopsy. Transesophageal echocardiography provided a rapid bedside diagnosis of this unusual entity in an acutely ill patient. This technique may prove more widely applicable in the evaluation of patients with suspected pulmonary embolus, whether neoplastic or thromboembolic.

Adult↗

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Echocardiographic and hemodynamic characteristics of atrial septal defects created by percutaneous valvuloplasty.

Twenty-nine patients were studied by pulsed, continuous wave, and color Doppler before and after percutaneous transseptal valvuloplasty. New atrial septal defects were detected in 14 patients, and the patients were monitored for up to 320 days after the procedure. The diameter of the defect, best evaluated by the transesophageal approach, was 3 to 15 mm. A narrow, high velocity (1.4 to 3.1 meters per second) left-to-right shunt jet was detected in 13 of 14 patients. The shunt jet was continuous in nine of 14 patients, late systolic-holodiastolic in four patients, and bidirectional in one patient. Cardiac catheterization in nine patients confirmed the Doppler findings and demonstrated a peak pressure gradient of 10 to 32 mm Hg between the left and right atria. Oximetry revealed a calculated pulmonary to systemic flow ratio ranging from 2.3:1 in the patient with the largest atrial septal defect by echocardiography to 1:1 (no oxygen saturation step-up) in the patient with the smallest atrial septal defect. In the three patients who underwent cardiac surgery, the operative findings confirmed those of echocardiography. We concluded that atrial septal defects are common after transseptal valvuloplasty. Usually, their relatively small size and the underlying valvular disease that produces high left atrial pressure are responsible for the high pressure gradient between the left and right atria. This results in the high velocity and continuous shunt jet detected by Doppler echocardiography.

Adult↗

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Exercise Doppler echocardiography as an aid to clinical decision making in mitral valve disease.

The timing of valve replacement in patients with mitral valve disease, severe resting pulmonary hypertension, and severe symptoms is usually straightforward. However, this may not be true for patients with mild to moderate resting pulmonary pressures and symptoms that are difficult to evaluate. The measurement of hemodynamic parameters with exercise has been useful during cardiac catheterization. The purpose of this study was to evaluate the hemodynamic significance of dyspnea provoked by exercise in patients with mitral valve disease using exercise Doppler echocardiography. Nineteen tests were done in 17 patients (two patients had repeat studies 1 year after the first test). Dyspnea developed in patients during exercise in 11 tests, and the others were limited by fatigue (and angina in one patient). There was a significantly greater increment in pulmonary artery systolic pressure during exercise in the patients who developed dyspnea (24 mm Hg) than in those who did not (15 mm Hg, p = 0.04). The two groups exercised to approximately the same heart rate and blood pressure, but the dyspneic patients had a significantly shorter exercise capacity (p = 0.04). Furthermore, clinical decision making was affected by the test results in 84% (only three tests did not affect patient management) and included a decision to proceed to invasive testing and surgery in seven patients, and a decision to treat the patient medically in nine. In conclusion, exercise Doppler echocardiography is a useful adjunct in the diagnosis and treatment of patients with mitral valve disease and an aid to clinical decision making.

Adult↗