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Other Applications, Including the Critical Care Setting

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Transesophageal Echocardiography for Pediatric and Congenital Heart Disease

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Abstract

While the majority of this textbook addresses the use of transesophageal echocardiography (TEE) for the evaluation of pediatric patients and all patients (pediatric and adult) with congenital heart disease (CHD) primarily in the intraoperative and interventional settings, there are other areas in which TEE can play a significant role in these patients. This chapter focuses on other applications of TEE. We will discuss the most common indications for TEE in this setting, including evaluation for infective endocarditis, cardiac thrombi after CHD surgery, and prosthetic valves.

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Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

CHD:

Congenital heart disease

CHF:

Congestive heart failure

DVI:

Doppler velocity index

EOA:

Effective orifice area

IE:

Infective endocarditis

PPM:

Patient-prosthesis mismatch

SVC:

Superior vena cava

TAVR:

Transcatheter aortic valve replacement

TEE:

Transesophageal echocardiography

THV :

Transcatheter heart valve

TTE:

Transthoracic echocardiography

VTI:

Velocity time integral

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Authors and Affiliations

  1. Pediatric Cardiology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA

    Pei-Ni Jone & Adel Younoszai

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  1. Pei-Ni Jone
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  2. Adel Younoszai
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Correspondence to Pei-Ni Jone .

Editor information

Editors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Pierre C. Wong

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Arthur S. Keats Division of Pediatric Cardiovascular Anesthesiology and Department of Pediatrics, Section of Cardiology, Baylor College of Medicine, Texas Children’s Hospital; Texas Heart Institute, Houston, TX, USA

    Wanda C. Miller-Hance

Electronic Supplementary Materials

Large vegetation on the anterior leaflet of mitral valve, resulting in chordal destruction and severe mitral regurgitation (MP4 2708 kb)

Aortic valve endocarditis, seen from a midesophageal aortic valve long axis view (transducer angle 85°–106°) (MP4 5186 kb)

A patient with Staphylococcus aureus bacteremia who had a transthoracic echocardiogram showing a large mass on the aortic valve with fibrinous strands. A vegetation is seen on the aortic valve from endocarditis in the midesophageal five-chamber view. There is a ventricular septal defect that occurred as a complication of the endocarditis, and color Doppler shows flow across the defect (MP4 466 kb)

Endocarditis in a patient with a prosthetic aortic valve (St. Jude). The midesophageal four-chamber view demonstrates a perivalvar abscess that extends into the noncoronary cusp, causing a fistulous tract communicating with the right atrium. A large vegetation has developed in this area and shunting is seen into the right atrium. There is marked aortic regurgitation seen through an area of valve dehiscence (MP4 27995 kb)

Infected sinus of Valsalva aneurysm from aortic valve endocarditis. The preoperative study, obtained from the midesophageal aortic valve short axis and long axis views, shows a large vegetation of the aortic valve and erosion of the right sinus of Valsalva, with blood filling the aneurysm during diastole. Following aortic valve and aortic root surgery, no residual vegetation is seen and the aortic valve manifests normal function, with no insufficiency (MP4 12622 kb)

Infected pseudoaneurysm off ascending aorta. This TEE was performed to evaluate the aortic valve in a patient with a previous aortic valve surgery and persistent fungemia. A large pseudoaneurysm was discovered using the upper esophageal window, transducer angle about 60°. Note that the superior portion of aorta and innominate vein can be seen well in this patient by TEE (MP4 4562 kb)

Thrombus in the superior vena cava, probably associated with a catheter, as seen from a midesophageal bicaval view, (transducer angle 99°), as well as the midesophageal four-chamber view. LA left atrium, LV left ventricle, RA right atrium, RV right ventricle (MP4 4458 kb)

Modified midesophageal left atrial appendage view (transducer angle 55°) showing a thrombus (arrow) in the left atrial appendage (LAA) of a patient with atrial fibrillation. LA left atrium, LUPV left upper pulmonary vein (MP4 691 kb)

Prosthetic mitral valve (bileaflet tilting disk). Midesophageal mitral commissural view, transducer angle 69°. The transducer angle is rotated until both leaflets are profiled and open symmetrically in diastole. There is the usual color flow Doppler profile across the valve (MP4 2015 kb)

Prosthetic mitral with a frozen leaflet, causing stenosis of the valve (mean inflow gradient 21 mm Hg). Midesophageal four-chamber view, transducer angle 0°–14° (MP4 6688 kb)

Concentric pannus formation (arrows) above the mitral valve prosthesis, causing significant supravalvar narrowing (mean gradient 37 mm Hg), seen during diastole. Note that the valve leaflets actually manifest normal, symmetric motion. Midesophageal mitral commissural view, transducer angle 58° (MP4 7150 kb)

Paravalvar regurgitation in a child who underwent mitral valve replacement with a mechanical bileaflet prosthesis (previous history of atrioventricular septal defect repair). This video was obtained from a midesophageal four-chamber view (transducer angle 0°). The prosthesis was too large for the annulus and required insertion at an angle, which resulted both in a large area of paravalvular regurgitation (seen to the left of the prosthesis) as well as a very small effective inflow orifice (MP4 7531 kb)

Prosthetic aortic valve (bileaflet tilting disk) viewed from a deep transgastric position. At a transducer angle of 25° the valve is seen from the side, and the usual peri-valvar washing jets can be seen by color flow Doppler. The transducer angle is then rotated until both leaflets are profiled and symmetric leaflet motion is noted in diastole and systole (about 96°). This view affords a good edge-on view of leaflet motion and flow across the valve, and also provides an excellent angle for spectral Doppler evaluation. Of note, there is a normal spectral Doppler velocity obtained across the valve (MP4 8785 kb)

2D/3D imaging of a biologic prosthetic valve demonstrating vegetation and thrombus formation on the valve. The patient presented with severe aortic valve stenosis related to infective endocarditis, with associated thrombus formation (MP4 192 kb)

Same patient as Video 19.14. Midesophageal aortic valve long axis view (transducer angle 120°) demonstrates a vegetation on a biologic prosthetic valve (MP4 408 kb)

Same patient as Video 19.14. Midesophageal aortic valve short axis view using a transducer angle of 37° to demonstrate the vegetation and fibrinous strands on the biologic prosthetic valve. Note the shadowing of the prosthetic valve (MP4 447 kb)

Midesophageal four-chamber view using color compare of a mitral valve replacement with a Melody valve in the mitral position. There is unobstructed antegrade flow across the valve in diastole, mean inflow gradient 4 mm Hg. There is shadowing produced by the Melody valve prosthesis (MP4 1339 kb)

Case #1. Vegetation is seen on the aortic valve from endocarditis in the midesophageal five-chamber view. There is a ventricular septal defect that occurred as a complication of the endocarditis, and color Doppler shows flow across the defect (MP4 466 kb)

Case #1. The patient from Video 19.18. Multiple vegetations are seen on the aortic valve in a modified midesophageal right ventricular inflow-outflow view using a transducer angle of 87° (MP4 859 kb)

Case #1. The patient from Video 19.18, again using a modified midesophageal right ventricular inflow-outflow view with a transducer angle of 87°. The vegetation has prolapsed through the aortic valve across the ventricular septal defect (MP4 470 kb)

Case #1. The patient from Video 19.18. Midesophageal four-chamber view. Vegetation on the mitral valve (MP4 851 kb)

Case #1. The patient from Video 19.18. Midesophageal four-chamber view. Vegetation on the tricuspid valve (MP4 852 kb)

Case #1. The patient from Video 19.18. Sinus of Valsalva aneurysm formation from infective endocarditis, as seen from a midesophageal aortic valve long axis view. Note the vegetation adjacent to the aneurysm. Color Doppler shows that there is left to right shunting across a ventricular septal defect (MP4 863 kb)

Case #1. The patient from Video 19.18. Sinus of Valsalva aneurysm formation from infective endocarditis, as seen from a midesophageal aortic valve long axis view (using the color compare function). Note the vegetation adjacent to the aneurysm. Color Doppler shows that there is left to right shunting across a ventricular septal defect (MP4 439 kb)

Case #2. Left ventricular (LV) thrombus (arrow) in a patient with dilated cardiomyopathy, undergoing ventricular assist device placement (MP4 2411 kb)

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Jone, PN., Younoszai, A. (2021). Other Applications, Including the Critical Care Setting. In: Wong, P.C., Miller-Hance, W.C. (eds) Transesophageal Echocardiography for Pediatric and Congenital Heart Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-57193-1_19

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  • DOI: https://doi.org/10.1007/978-3-030-57193-1_19

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  • Online ISBN: 978-3-030-57193-1

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