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Functional Evaluation of the Heart by Transesophageal Echocardiography

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Transesophageal Echocardiography for Congenital Heart Disease

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Abstract

The noninvasive echocardiographic evaluation of ventricular performance is an essential tool in the clinician’s assessment and management of children and adults with congenital heart disease (CHD). However the unique anatomic and physiologic features in these patients, which include nonstandard ventricular geometries as well as variable loading conditions, can make the quantitative assessment of ventricular function challenging, particularly by transesophageal echocardiography (TEE). Newer echocardiographic methods are enabling more accurate and quantitative evaluation of ventricular performance, both by the transthoracic as well as the transesophageal approach. This chapter discusses the current applications of TEE in the evaluation of ventricular function in patients with CHD.

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Authors and Affiliations

  1. Division of Pediatric Cardiology and Cardiovascular Diseases, Departments of Pediatrics and Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Benjamin W. Eidem MD, FACC, FAAP, FASE

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  1. Benjamin W. Eidem MD, FACC, FAAP, FASE
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Correspondence to Benjamin W. Eidem MD, FACC, FAAP, FASE .

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Editors and Affiliations

  1. Childrens Hospital Los Angeles Department of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA

    Pierre C. Wong

  2. Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital, Houston, USA

    Wanda C. Miller-Hance

Electronic Supplementary Material

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An 11 year old referred for surgical closure of moderate sized secundum atrial septal defect. (a) Preoperative mid esophageal four chamber view demonstrates mild right ventricular dilation with qualitatively normal systolic function. Normal left ventricular size and systolic function are also present. In this view the interatrial communication is not displayed (MOV 3304 kb)

An 11 year old referred for surgical closure of moderate sized secundum atrial septal defect. Transgastric image demonstrating a short axis view of the left and right ventricles. Note the mild right ventricular dilatation with normal qualitative systolic function. Normal left ventricular size and systolic function are demonstrated as well (MOV 3241 kb)

An 11 year old referred for surgical closure of moderate sized secundum atrial septal defect. Postoperative mid esophageal four chamber view demonstrates a smaller right ventricular size after atrial septal defect closure as compared to the preoperative examination (Video 5.1a) with qualitatively normal systolic function. A rhythm disturbance is noted (MOV 3625 kb)

An 11 year old referred for surgical closure of moderate sized secundum atrial septal defect. Transgastric image demonstrating a short axis view of the left and right ventricles. Note the normalized right ventricular size and normal biventricular systolic function (MOV 2057 kb)

An 11 year old referred for surgical closure of moderate sized secundum atrial septal defect. Postoperative imaging from a transgastric window demonstrating a short axis view of the left ventricle that may allow for quantitative M-mode assessment (MOV 1905 kb)

Same patient as Video 5.1. Postoperative mid esophageal four chamber view demonstrates normal right and left ventricular size and systolic function (MOV 4441 kb)

Same patient as Video 5.1. Video from transgastric orientation demonstrating a short axis view of the left and right ventricles. Note the normal right ventricular size and normal biventricular systolic function (MOV 3206 kb)

A 20 year old with history of tetralogy of Fallot and long-standing severe pulmonary regurgitation. (a) Preoperative mid esophageal four chamber demonstrates moderate right ventricular dilatation with qualitatively low normal right ventricular systolic function (MOV 4396 kb)

A 20 year old with history of tetralogy of Fallot and long-standing severe pulmonary regurgitation. Deep transgastric sagittal view demonstrating the ventricles. Note the moderate right ventricular dilation with qualitatively low normal systolic function. Normal left ventricular size and systolic function are noted (MOV 4474 kb)

A 20 year old with history of tetralogy of Fallot and long-standing severe pulmonary regurgitation. Deep transgastric imaging in the sagittal plane demonstrating the right ventricular outflow tract (RVOT). Note the severe pulmonary regurgitation (red flow) into the dilated right ventricle as detected by color flow Doppler. No RVOT obstruction is present (laminar blue flow) (MOV 3568 kb)

A 20 year old with history of tetralogy of Fallot and long-standing severe pulmonary regurgitation. Multiplane pre-operative imaging (42°) from the transgastric position demonstrating a short axis view of ventricles. Note the orientation of the left ventricle suitable for M-mode assessment (MOV 4323 kb)

A 20 year old with history of tetralogy of Fallot and long-standing severe pulmonary regurgitation. Postoperative mid esophageal four chamber view following pulmonary valve replacement demonstrates a lesser degree of right ventricular dilatation as compared to the preoperative examination (5.3a) with qualitatively mildly decreased systolic function (MOV 3556 kb)

A 20 year old with history of tetralogy of Fallot and long-standing severe pulmonary regurgitation. Postoperative deep transgastric view in a sagittal plane confirms a lesser degree of right ventricular dilatation as compared to the preoperative examination (5.3c) and qualitatively mild-moderately decreased systolic function (MOV 2454 kb)

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Eidem, B.W. (2014). Functional Evaluation of the Heart by Transesophageal Echocardiography. In: Wong, P., Miller-Hance, W. (eds) Transesophageal Echocardiography for Congenital Heart Disease. Springer, London. https://doi.org/10.1007/978-1-84800-064-3_5

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  • DOI: https://doi.org/10.1007/978-1-84800-064-3_5

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