Additional Applications of Transesophageal Echocardiography

  • Pierre C. WongEmail author


While the majority of this book addresses the use of transesophageal echocardiography (TEE) for the evaluation of patients with congenital heart disease (CHD), there are a number of other conditions in which TEE can play a significant role in pediatric and young adult patients. Some conditions, such as infective endocarditis, can occur in patients with a history of CHD. Other pathologies, such as cardiac tumors, can be seen in the absence of coexisting CHD. This chapter addresses additional applications of TEE in the pediatric and young adult population.


Endocarditis Bacterial Heart valve prosthesis Heart neoplasms Heart-assist devices Heart transplantation Lung transplantation Aneurysm Dissecting Echocardiography Transesophageal 

Supplementary material

Video 16.1

Large vegetation on the anterior leaflet of mitral valve, resulting in chordal destruction and severe mitral regurgitation (MPG 4146 kb)

Video 16.2

Aortic valve endocarditis, seen from a mid esophageal aortic valve long axis view (multiplane angle 85°–116°) (MPG 8328 kb)

Video 16.3

Endocarditis in a patient with a prosthetic aortic valve (St. Jude). The mid esophageal 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 (MPG 48550 kb)

Video 16.4

Infected sinus of Valsalva aneurysm from aortic valve endocarditis. The preoperative study, obtained from the mid esophageal 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 (MPG 23246 kb)

Video 16.5

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 (arrow) was discovered using the upper esophageal window, multiplane angle 60°. Note that the superior portion of aorta and innominate vein can be seen well in this patient by TEE (MPG 7110 kb)

Video 16.6

Thrombus in the left ventricular apex of a patient with Duchenne’s muscular dystrophy and dilated cardiomyopathy. Mid esophageal four chamber view, multiplane angle 0° (MPG 7026 kb)

Video 16.7

Thrombus in the superior vena cava, probably associated with a catheter, as seen from mid esophageal bicaval view, (multiplane angle 99°) (MPG 6592 kb)

Video 16.8

Thrombus in the left atrial appendage, as viewed from a modified mid esophageal aortic valve short axis view with leftward rotation. There are mobile filamentous strands arising from the thrombus. AoV aortic valve, LA left atrium. Video courtesy of Siemens Medical Systems USA, Inc. © 2012–13 Siemens Medical Solutions USA, Inc. All Rights Reserved (MPG 5100 kb)

Video 16.9

Example of spontaneous echo contrast in a patient after repair of D-transposition of the great arteries, with a pseudoaneurysm arising from a previous cannulation site in the aorta. Video obtained from the upper esophageal ascending aorta long axis view. Note the visible swirling of flow due to red cell aggregation. The left pulmonary artery is being compressed by the pseudoaneurysm (MPG 6956 kb)

Video 16.10

Wilm’s tumor (arrow) invading the right atrium by direct extension from the inferior vena cava, as seen from the mid esophageal bicaval view, multiplane angle 113°. The multiplane angle is rotated to 55° and all four chambers are visualized. The tumor obstructs IVC inflow. At the end of the video, the extracted tumor is shown (MPG 10052 kb)

Video 16.11

Multiple rhabdomyomas in a patient with tuberous sclerosis, including one that caused near complete obstruction of the left ventricular outflow tract. Mid esophageal four chamber view, multiplane angle 0° shows a large tumor in the outflow tract. Turbulent color flow Doppler is seen (MPG 22644 kb)

Video 16.12

Fibroma attached to the left ventricular free wall, visualized from mid esophageal aortic valve long axis view, multiplane angle 90°. The fibroma is very large, circumscribed, and has a heterogeneous appearance, studded with echolucent areas most likely representing cystic degeneration or necrosis (MPG 19366 kb)

Video 16.13

Left atrial myxoma, seen from mid esophageal four chamber view, multiplane angle 0°. A large, lobulated myxoma is attached to the left atrial wall, just posterior to the aortic root. Multiple fimbriations of the tumor are freely mobile (MPG 17046 kb)

Video 16.14

Right atrial hemangioma as seen from the mid esophageal four chamber and mid esophageal right ventricular inflow-outflow view. Note the heterogeneous nature of the large mass in the right atrium. As can be seen by the rapid atrial rate, the patient had an atrial arrhythmia, probably chaotic atrial tachycardia, during the study (MPG 21928 kb)

Video 16.15

Prosthetic mitral valve (bileaflet tilting disk). Mid esophageal mitral commissural view, multiplane angle 69°. The multiplane angle is rotated until both leaflets are profiled and open symmetrically in diastole. There is the usual color flow Doppler profile across the valve (MPG 2942 kb)

Video 16.16

Prosthetic mitral with a frozen leaflet (arrow), causing stenosis of the valve. Mid esophageal four chamber view, multiplane angle 0° (MPG 11380 kb)

Video 16.17

Concentric pannus formation (arrows) above the mitral valve prosthesis, causing significant supravalvar narrowing, seen during diastole. Mid esophageal mitral commissural view, multiplane angle 58° (MPG 12516 kb)

Video 16.18

Prosthetic aortic valve (bileaflet tilting disk) viewed from deep transgastric position. At a multiplane 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 multiplane angle is then rotated until both leaflets are profiled and symmetric leaflet motion is noted in diastole and systole (about 95°). 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 (MPG 13948 kb)

Video 16.19

Paravalvar regurgitation in a child who underwent mitral valve replacement with a mechanical bileaflet prosthesis (the patient previously underwent repair of an atrioventricular septal defect). This video was obtained from a mid esophageal four chamber view. 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 orifice (MPG 13054 kb)

Video 16.20

Transcatheter aortic valve replacement/implantation (TAVR/TAVI). This video, obtained from a mid esophageal aortic valve long axis view at 120°–130° first shows the abnormal aortic, which is thickened and has restricted motion. A catheter and then the balloon-mounted valve are seen, with the balloon shown as it is expanded and the valve implanted in the aortic position. During balloon dilation, rapid ventricular pacing is performed to reduce ventricular ejection, thereby stabilizing the valve for placement. Following valve implantation, leaflet motion is seen and there rare two jets of regurgitation seen—one central (transvalvular), one peripheral (paravalvular). LM left main coronary artery (Echocardiographic images were obtained from a Siemens SC 2000 platform and are courtesy of Siemens Medical Systems USA, Inc. © 2012–13 Siemens Medical Solutions USA, Inc. All Rights Reserved) (MPG 39428 kb)

Video 16.21

Berlin Heart placement in a patient with dilated cardiomyopathy. Mid esophageal four chamber view. The cannula in the left ventricular apex withdraws blood returning from the left atrium. When the blood has sufficiently filled the chamber in the device, it is pumped into the ascending aorta, as shown from mid esophageal view, multiplane angle 102° (MPG 36604 kb)

Video 16.22

Following heart transplantation, imaging in the mid esophageal four chamber view, multiplane angle 0°. The anastomosis of the donor left atrium to the cuff of the recipient left atrium creates an area of echogenicity (arrow) that can be mistaken for thrombus (MPG 29690 kb)

Video 16.23

Post-lung transplant, with thrombosis of the right pulmonary veins due to a large lymph node. Mid esophageal view, multiplane angle 0°. There is extensive thrombus in the right pulmonary veins. No flow was seen in the vessel by color flow Doppler. Normal flow is seen in the contralateral left pulmonary veins (MPG 17500 kb)

Video 16.24

Dissection of the ascending and descending aorta (DeBakey Type I) in a patient with Marfan’s syndrome. The patient also had a dilated aortic root and significant aortic valve regurgitation. The intimal flap is clearly seen, as well as the true and false lumens. Upper esophageal aortic arch long axis view, multiplane angle 0°, shows the false lumen to be much larger than the true lumen in the ascending aorta and aortic arch. Retrograde diastolic flow reversal is seen only in the true lumen by color flow mapping. Mid esophageal descending aortic long axis view, multiplane angle 90° (probe rotated leftward) shows the dissection extending into descending aorta (MPG 56434 kb)


  1. 1.
    Karchmer AW. Infective endocarditis. In: Bonow RO, Mann DL, Zipes DP, Libby P, editors. Braunwald’s heart disease: a textbook of cardiovascular medicine. 9th ed. Philadelphia: Elsevier Saunders; 2012. p. 1540–60.Google Scholar
  2. 2.
    McDonald JR. Acute infective endocarditis. Infect Dis Clin North Am. 2009;23:643–64.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Bayer AS, Bolger AF, Taubert KA, et al. Diagnosis and management of infective endocarditis and its complications. Circulation. 1998;98:2936–48.PubMedGoogle Scholar
  4. 4.
    Ferrieri P, Gewitz MH, Gerber MA, et al. Unique features of infective endocarditis in childhood. Circulation. 2002;105:2115–26.PubMedGoogle Scholar
  5. 5.
    Saiman L, Prince A, Gersony WM. Pediatric infective endocarditis in the modern era. J Pediatr. 1993;122:847–53.PubMedGoogle Scholar
  6. 6.
    Morris CD, Reller MD, Menashe VD. Thirty-year incidence of infective endocarditis after surgery for congenital heart defect. JAMA. 1998;279:599–603.PubMedGoogle Scholar
  7. 7.
    Lin YT, Hsieh KS, Chen YS, Huang IF, Cheng MF. Infective endocarditis in children without underlying heart disease. J Microbiol Immunol Infect. 2012;46:121–8.Google Scholar
  8. 8.
    Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994;96:200–9.PubMedGoogle Scholar
  9. 9.
    Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:633–8.PubMedGoogle Scholar
  10. 10.
    Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005;111:e394–434.PubMedGoogle Scholar
  11. 11.
    Bayer AS, Ward JI, Ginzton LE, Shapiro SM. Evaluation of new clinical criteria for the diagnosis of infective endocarditis. Am J Med. 1994;96:211–9.PubMedGoogle Scholar
  12. 12.
    Del Pont JM, De Cicco LT, Vartalitis C, et al. Infective endocarditis in children: clinical analyses and evaluation of two diagnostic criteria. Pediatr Infect Dis J. 1995;14:1079–86.PubMedGoogle Scholar
  13. 13.
    Hoen B, Beguinot I, Rabaud C, et al. The Duke criteria for diagnosing infective endocarditis are specific: analysis of 100 patients with acute fever or fever of unknown origin. Clin Infect Dis. 1996;23:298–302.PubMedGoogle Scholar
  14. 14.
    Stockheim JA, Chadwick EG, Kessler S, et al. Are the Duke criteria superior to the Beth Israel criteria for the diagnosis of infective endocarditis in children? Clin Infect Dis. 1998;27:1451–6.PubMedGoogle Scholar
  15. 15.
    Tissieres P, Gervaix A, Beghetti M, Jaeggi ET. Value and limitations of the von Reyn, Duke, and modified Duke criteria for the diagnosis of infective endocarditis in children. Pediatrics. 2003;112:e467.PubMedGoogle Scholar
  16. 16.
    Prendergast BD. Diagnostic criteria and problems in infective endocarditis. Heart. 2004;90:611–3.PubMedGoogle Scholar
  17. 17.
    Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523–661.PubMedGoogle Scholar
  18. 18.
    Tornos P, Iung B, Permanyer-Miralda G, et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart. 2005;91:571–5.PubMedGoogle Scholar
  19. 19.
    Prendergast BD, Tornos P. Surgery for infective endocarditis: who and when? Circulation. 2010;121:1141–52.PubMedGoogle Scholar
  20. 20.
    Kang D-H, Kim Y-J, Kim S-H, et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med. 2012;366:2466–73.PubMedGoogle Scholar
  21. 21.
    Alexiou C, Langley SM, Monro JL. Surgery for infective valve endocarditis in children. Eur J Cardiothorac Surg. 1999;16:653–9.PubMedGoogle Scholar
  22. 22.
    Karaci AR, Aydemir NA, Harmandar B, et al. Surgical treatment of infective valve endocarditis in children with congenital heart disease. J Card Surg. 2012;27:93–8.PubMedGoogle Scholar
  23. 23.
    Nomura F, Penny DJ, Menahem S, Pawade A, Karl TR. Surgical intervention for infective endocarditis in infancy and childhood. Ann Thorac Surg. 1995;60:90–5.PubMedGoogle Scholar
  24. 24.
    Martin JM, Neches WH, Wald ER. Infective endocarditis: 35 years of experience at a children’s hospital. Clin Infect Dis. 1997;24:669–75.PubMedGoogle Scholar
  25. 25.
    Knirsch W, Nadal D. Infective endocarditis in congenital heart disease. Eur J Pediatr. 2011;170:1111–27.PubMedGoogle Scholar
  26. 26.
    Durack DT, Beeson PB. Experimental bacterial endocarditis. I. Colonization of a sterile vegetation. Br J Exp Pathol. 1972;53:44–9.PubMedCentralPubMedGoogle Scholar
  27. 27.
    Fernicola DJ, Roberts WC. Frequency of ring abscess and cuspal infection in active infective endocarditis involving biologic valves. Am J Cardiol. 1993;72:314–23.PubMedGoogle Scholar
  28. 28.
    Daniel WG, Mugge A, Martin RP, et al. Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography. N Engl J Med. 1991;324:795–800.PubMedGoogle Scholar
  29. 29.
    Shaffer EM, Snider AR, Beekman RH, Behrendt DM, Peschiera AW. Sinus of Valsalva aneurysm complicating bacterial endocarditis in an infant: diagnosis with two-dimensional and Doppler echocardiography. J Am Coll Cardiol. 1987;9:588–91.PubMedGoogle Scholar
  30. 30.
    Anguera I, Miro JM, Vilacosta I, et al. Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality. Eur Heart J. 2005;26:288–97.PubMedGoogle Scholar
  31. 31.
    Kearney RA, Eisen HJ, Wolf JE. Nonvalvular infections of the cardiovascular system. Ann Intern Med. 1994;121:219–30.PubMedGoogle Scholar
  32. 32.
    Sievers H-H, Stierle U, Charitos EI, et al. Major adverse cardiac and cerebrovascular events after the Ross procedure: a report from the German-Dutch Ross Registry. Circulation. 2010;122:S216–23.PubMedGoogle Scholar
  33. 33.
    Mills J, Utley J, Abbott J. Heart failure in infective endocarditis: predisposing factors, course, and treatment. Chest. 1974;66:151–7.PubMedGoogle Scholar
  34. 34.
    Pelletier LLJ, Petersdorf RG. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963–72. Medicine (Baltimore). 1977;56:287–313.Google Scholar
  35. 35.
    Hasbun R, Vikram HR, Barakat LA, Buenconsejo J, Quagliarello VJ. Complicated left-sided native valve endocarditis in adults: risk classification for mortality. JAMA. 2003;289:1933–40.PubMedGoogle Scholar
  36. 36.
    Ryan EW, Bolger AF. Transesophageal echocardiography (TEE) in the evaluation of infective endocarditis. In: Foster E, editor. Cardiology clinics: transesophageal echocardiography. San Francisco; Division of Cardiology, Department of Medicine, University of California; 2000. p. 773–87.Google Scholar
  37. 37.
    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. 1988;9:43–53.PubMedGoogle Scholar
  38. 38.
    Shanewise JS, Martin RP. Assessment of endocarditis and associated complications with transesophageal echocardiography. Crit Care Clin. 1996;12:411–27.PubMedGoogle Scholar
  39. 39.
    Jacob S, Tong AT. Role of echocardiography in the diagnosis and management of infective endocarditis. Curr Opin Cardiol. 2002;17:478–85.PubMedGoogle Scholar
  40. 40.
    Reynolds HR, Jagen MA, Tunick PA, Kronzon I. Sensitivity of transthoracic versus transesophageal echocardiography for the detection of native valve vegetations in the modern era. J Am Soc Echocardiogr. 2003;16:67–70.PubMedGoogle Scholar
  41. 41.
    Daniel WG, Mugge A, Grote J, et al. Comparison of transthoracic and transesophageal echocardiography for detection of abnormalities of prosthetic and biologic valves in the mitral and aortic positions. Am J Cardiol. 1993;71:210–5.PubMedGoogle Scholar
  42. 42.
    Penk JS, Webb CL, Shulman ST, Anderson EJ. Echocardiography in pediatric infective endocarditis. Pediatr Infect Dis J. 2011;30:1109–11.PubMedGoogle Scholar
  43. 43.
    Humpl T, McCrindle BW, Smallhorn JF. The relative roles of transthoracic compared with transesophageal echocardiography in children with suspected infective endocarditis. J Am Coll Cardiol. 2003;41:2068–71.PubMedGoogle Scholar
  44. 44.
    Steckelberg JM, Murphy JG, Ballard D, et al. Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med. 1991;114:635–40.PubMedGoogle Scholar
  45. 45.
    Lopez JA, Ross RS, Fishbein MC, Siegel RJ. Nonbacterial thrombotic endocarditis: a review. Am Heart J. 1987;113:773–84.PubMedGoogle Scholar
  46. 46.
    Asopa S, Patel A, Khan OA, Sharma R, Ohri SK. Non-bacterial thrombotic endocarditis. Eur J Cardiothorac Surg. 2007;32:696–701.PubMedGoogle Scholar
  47. 47.
    González Quintela A, Candela MJ, Vidal C, Román J, Aramburo P. Non-bacterial thrombotic endocarditis in cancer patients. Acta Cardiol. 1991;46:1–9.PubMedGoogle Scholar
  48. 48.
    Beynon RP, Bahl VK, Prendergast BD. Infective endocarditis. BMJ. 2006;333:334–9.PubMedGoogle Scholar
  49. 49.
    Asinger RW, Dyken ML, Fisher M, Hart RG, Sherman DG. Cardiogenic brain embolism. The second report of the Cerebral Embolism Task Force. Arch Neurol. 1989;46:727–43.Google Scholar
  50. 50.
    Agmon Y, Khandheria BK, Gentile F, Seward JB. Echocardiographic assessment of the left atrial appendage. J Am Coll Cardiol. 1999;34:1867–77.PubMedGoogle Scholar
  51. 51.
    de Divitiis M, Omran H, Rabahieh R, et al. Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors. Am J Cardiol. 1999;84:1023–8.PubMedGoogle Scholar
  52. 52.
    Ozer O, Sari I, Davutoglu V. Right atrial appendage: forgotten part of the heart in atrial fibrillation. Clin Appl Thromb Hemost. 2010;16:218–20.PubMedGoogle Scholar
  53. 53.
    Schweizer P, Bardos P, Erbel R, et al. Detection of left atrial thrombi by echocardiography. Br Heart J. 1981;45:148–56.PubMedCentralPubMedGoogle Scholar
  54. 54.
    Aschenberg W, Schluter M, Kremer P, Schroder E, Siglow V, Bleifeld W. Transesophageal two-dimensional echocardiography for the detection of left atrial appendage thrombus. J Am Coll Cardiol. 1986;7:163–6.PubMedGoogle Scholar
  55. 55.
    Manning WJ, Weintraub RM, Waksmonski CA, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern Med. 1995;123:817–22.PubMedGoogle Scholar
  56. 56.
    Veinot JP, Harrity PJ, Gentile F, et al. Anatomy of the normal left atrial appendage: a quantitative study of age-related changes in 500 autopsy hearts: implications for echocardiographic examination. Circulation. 1997;96:3112–5.PubMedGoogle Scholar
  57. 57.
    Karakus G, Kodali V, Inamdar V, Nanda NC, Suwanjutah T, Pothineni KR. Comparative assessment of left atrial appendage by transesophageal and combined two- and three-dimensional transthoracic echocardiography. Echocardiography. 2008;25:918–24.PubMedGoogle Scholar
  58. 58.
    Werner JA, Cheitlin MD, Gross BW, Speck SM, Ivey TD. Echocardiographic appearance of the Chiari network: differentiation from right-heart pathology. Circulation. 1981;63:1104–9.PubMedGoogle Scholar
  59. 59.
    Black IW. Spontaneous echo contrast: where there’s smoke there’s fire. Echocardiography. 2000;17:373–82.PubMedGoogle Scholar
  60. 60.
    Kwaan HC, Sakurai S, Wang J. Rheological abnormalities and thromboembolic complications in heart disease: spontaneous echo contrast and red cell aggregation. Semin Thromb Hemost. 2003;29:529–34.PubMedGoogle Scholar
  61. 61.
    Chan HS, Sonley MJ, Moes CA, Daneman A, Smith CR, Martin DJ. Primary and secondary tumors of childhood involving the heart, pericardium, and great vessels. A report of 75 cases and review of the literature. Cancer. 1985;56:825–36.PubMedGoogle Scholar
  62. 62.
    Roberts WC. Primary and secondary neoplasms of the heart. Am J Cardiol. 1997;80:671–82.PubMedGoogle Scholar
  63. 63.
    Shapiro LM. Cardiac tumours: diagnosis and management. Heart. 2001;85:218–22.PubMedGoogle Scholar
  64. 64.
    Miyake CY, Del Nido PJ, Alexander ME, et al. Cardiac tumors and associated arrhythmias in pediatric patients, with observations on surgical therapy for ventricular tachycardia. J Am Coll Cardiol. 2011;58:1903–9.PubMedGoogle Scholar
  65. 65.
    Luck SR, DeLeon S, Shkolnik A, Morgan E, Labotka R. Intracardiac Wilms’ tumor: diagnosis and management. J Pediatr Surg. 1982;17:551–4.PubMedGoogle Scholar
  66. 66.
    Marx GR, Moran AM. Cardiac tumors. In: Allen HD, Dricoll DJ, Shaddy RE, Feltes TF, editors. Moss and Adams’ heart disease in infants, children, and adolescents: including the fetus and young adult. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 1479–95.Google Scholar
  67. 67.
    Uzun O, Wilson DG, Vujanic GM, Parsons JM, De Giovanni JV. Cardiac tumours in children. Orphanet J Rare Dis. 2007;2:11.PubMedCentralPubMedGoogle Scholar
  68. 68.
    Günther T, Schreiber C, Noebauer C, Eicken A, Lange R. Treatment strategies for pediatric patients with primary cardiac and pericardial tumors: a 30-year review. Pediatr Cardiol. 2008;29:1071–6.PubMedGoogle Scholar
  69. 69.
    Becker AE. Primary heart tumors in the pediatric age group: a review of salient pathologic features relevant for clinicians. Pediatr Cardiol. 2000;21:317–23.PubMedGoogle Scholar
  70. 70.
    Burke AP, Rosado-de-Christenson M, Templeton PA, Virmani R. Cardiac fibroma: clinicopathologic correlates and surgical treatment. J Thorac Cardiovasc Surg. 1994;108:862–70.PubMedGoogle Scholar
  71. 71.
    Reynen K. Cardiac myxomas. N Engl J Med. 1995;333:1610–7.PubMedGoogle Scholar
  72. 72.
    Bulkley BH, Hutchins GM. Atrial myxomas: a fifty year review. Am Heart J. 1979;97:639–43.PubMedGoogle Scholar
  73. 73.
    Hada Y, Wolfe C, Murray GF, Craige E. Right ventricular myxoma. Case report and review of phonocardiographic and auscultatory manifestations. Am Heart J. 1980;100:871–7.PubMedGoogle Scholar
  74. 74.
    Leonhardt ET, Kullenberg KP. Bilateral atrial myxomas with multiple arterial aneurysms—a syndrome mimicking polyarteritis nodosa. Am J Med. 1977;62:792–4.PubMedGoogle Scholar
  75. 75.
    Perez de Isla L, de Castro R, Zamorano JL, et al. Diagnosis and treatment of cardiac myxomas by transesophageal echocardiography. Am J Cardiol. 2002;90:1419–21.PubMedGoogle Scholar
  76. 76.
    Burke A, Johns JP, Virmani R. Hemangiomas of the heart. A clinicopathologic study of ten cases. Am J Cardiovasc Pathol. 1990;3:283–90.PubMedGoogle Scholar
  77. 77.
    Niwa K, Tashima K, Terai M, Okajima Y, Nakajima H. Contrast-enhanced magnetic resonance imaging of cardiac tumors in children. Am Heart J. 1989;118:424–5.PubMedGoogle Scholar
  78. 78.
    Link KM, Lesko NM. MR evaluation of cardiac/juxtacardiac masses. Top Magn Reson Imaging. 1995;7:232–45.PubMedGoogle Scholar
  79. 79.
    Bardo DME. Cardiac magnetic resonance imaging signal characteristics of cardiac tumors in children. J Am Coll Cardiol. 2011;58:1055–6.PubMedGoogle Scholar
  80. 80.
    Obeid AI, Marvasti M, Parker F, Rosenberg J. Comparison of transthoracic and transesophageal echocardiography in diagnosis of left atrial myxoma. Am J Cardiol. 1989;63:1006–8.PubMedGoogle Scholar
  81. 81.
    Geibel A, Kasper W, Keck A, Hofmann T, Konstantinides S, Just H. Diagnosis, localization and evaluation of malignancy of heart and mediastinal tumors by conventional and transesophageal echocardiography. Acta Cardiol. 1996;51:395–408.PubMedGoogle Scholar
  82. 82.
    Engberding R, Daniel WG, Erbel R, et al. Diagnosis of heart tumours by transoesophageal echocardiography: a multicentre study in 154 Patients. European Cooperative Study Group. Eur Heart J. 1993;14:1223–8.PubMedGoogle Scholar
  83. 83.
    Borges AC, Witt C, Bartel T, Muller S, Konertz W, Baumann G. Preoperative two- and three-dimensional transesophageal echocardiographic assessment of heart tumors. Ann Thorac Surg. 1996;61:1163–7.PubMedGoogle Scholar
  84. 84.
    Brown AS, Why H, Monaghan MJ. Value of multiplane transoesophageal echocardiography in recurrent atrial myxoma. Br Heart J. 1994;71:540.PubMedCentralPubMedGoogle Scholar
  85. 85.
    Goldman JH, Foster E. Transesophageal echocardiographic (TEE) evaluation of intracardiac and pericardial masses. Cardiol Clin. 2000;18:849–60.PubMedGoogle Scholar
  86. 86.
    Ross DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet. 1967;2:956–8.PubMedGoogle Scholar
  87. 87.
    Chambers JC, Somerville J, Stone S, Ross DN. Pulmonary autograft procedure for aortic valve disease: long-term results of the pioneer series. Circulation. 1997;96:2206–14.PubMedGoogle Scholar
  88. 88.
    Athanasiou T, Cherian A, Ross D. The Ross II procedure: pulmonary autograft in the mitral position. Ann Thorac Surg. 2004;78:1489–95.PubMedGoogle Scholar
  89. 89.
    Protopapas AD, Athanasiou T. Contegra conduit for reconstruction of the right ventricular outflow tract: a review of published early and mid-time results. J Cardiothorac Surg. 2008;3:62.PubMedCentralPubMedGoogle Scholar
  90. 90.
    Hickey EJ, McCrindle BW, Blackstone EH, et al. Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair. Eur J Cardiothorac Surg. 2008;33:890–8.PubMedGoogle Scholar
  91. 91.
    Christenson JT, Sierra J, Colina Manzano NE, Jolou J, Beghetti M, Kalangos A. Homografts and xenografts for right ventricular outflow tract reconstruction: long-term results. Ann Thorac Surg. 2010;90:1287–93.PubMedGoogle Scholar
  92. 92.
    Dave H, Mueggler O, Comber M, et al. Risk factor analysis of 170 single-institutional contegra implantations in pulmonary position. Ann Thorac Surg. 2011;91:195–302; discussion 202–3.PubMedGoogle Scholar
  93. 93.
    Hopkins RA, editor. Tissue and bio-engineering for congenital cardiac disease. Prog Pediatr Cardiol. 2006;21(2):137–244.Google Scholar
  94. 94.
    Aslam AK, Aslam AF, Vasavada BC, Khan IA. Prosthetic heart valves: types and echocardiographic evaluation. Int J Cardiol. 2007;122:99–110.PubMedGoogle Scholar
  95. 95.
    Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034–48.PubMedGoogle Scholar
  96. 96.
    Oosterhof T, Hazekamp MG, Mulder BJ. Opportunities in pulmonary valve replacement. Expert Rev Cardiovasc Ther. 2009;7:1117–22.PubMedGoogle Scholar
  97. 97.
    Kidane AG, Burriesci G, Cornejo P, et al. Current developments and future prospects for heart valve replacement therapy. J Biomed Mater Res B Appl Biomater. 2009;88:290–303.PubMedGoogle Scholar
  98. 98.
    Waterbolk TW, Hoendermis ES, den Hamer IJ, Ebels T. Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease. Eur J Cardiothorac Surg. 2006;30:28–32.PubMedGoogle Scholar
  99. 99.
    Fleming GA, Hill KD, Green AS, Rhodes JF. Percutaneous pulmonary valve replacement. Prog Pediatr Cardiol. 2012;33:143–50.Google Scholar
  100. 100.
    Momenah TS, El Oakley R, Al Najashi K, Khoshhal S, Al Qethamy H, Bonhoeffer P. Extended application of percutaneous pulmonary valve implantation. J Am Coll Cardiol. 2009;53:1859–63.PubMedGoogle Scholar
  101. 101.
    Hasan BS, McElhinney DB, Brown DW, et al. Short-term performance of the transcatheter Melody valve in high-pressure hemodynamic environments in the pulmonary and systemic circulations. Circ Cardiovasc Interv. 2011;4:615–20.PubMedGoogle Scholar
  102. 102.
    Gurvitch R, Cheung A, Ye J, et al. Transcatheter valve-in-valve implantation for failed surgical biologic valves. J Am Coll Cardiol. 2011;58:2196–209.PubMedGoogle Scholar
  103. 103.
    Gillespie MJ, Dori Y, Harris MA, Sathanandam S, Glatz AC, Rome JJ. Bilateral branch pulmonary artery melody valve implantation for treatment of complex right ventricular outflow tract dysfunction in a high-risk patient. Circ Cardiovasc Interv. 2011;4:e21–3.PubMedGoogle Scholar
  104. 104.
    Billings FT, Kodali SK, Shanewise JS. Transcatheter aortic valve implantation: anesthetic considerations. Anesth Analg. 2009;108:1453–62.PubMedGoogle Scholar
  105. 105.
    Kenny D, Hijazi ZM, Kar S, et al. Percutaneous implantation of the Edwards SAPIEN transcatheter heart valve for conduit failure in the pulmonary position: early phase 1 results from an international multicenter clinical trial. J Am Coll Cardiol. 2011;58:2248–56.PubMedGoogle Scholar
  106. 106.
    Webb JG, Wood DA. Current status of transcatheter aortic valve replacement. J Am Coll Cardiol. 2012;60:483–92.PubMedGoogle Scholar
  107. 107.
    Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014.Google Scholar
  108. 108.
    Rosenhek R, Binder T, Maurer G, Baumgartner H. Normal values for Doppler echocardiographic assessment of heart valve prostheses. J Am Soc Echocardiogr. 2003;16:1116–27.PubMedGoogle Scholar
  109. 109.
    Bach DS. Transesophageal echocardiographic (TEE) evaluation of prosthetic valves. Cardiol Clin. 2000;18:751–71.PubMedGoogle Scholar
  110. 110.
    Morguet AJ, Werner GS, Andreas S, Kreuzer H. Diagnostic value of transesophageal compared with transthoracic echocardiography in suspected prosthetic valve endocarditis. Herz. 1995;20:390–8.PubMedGoogle Scholar
  111. 111.
    Schulz R, Werner GS, Fuchs JB, et al. Clinical outcome and echocardiographic findings of native and prosthetic valve endocarditis in the 1990’s. Eur Heart J. 1996;17:281–8.PubMedGoogle Scholar
  112. 112.
    Lengyel M. The impact of transesophageal echocardiography on the management of prosthetic valve endocarditis: experience of 31 cases and review of the literature. J Heart Valve Dis. 1997;6:204–11.PubMedGoogle Scholar
  113. 113.
    Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.PubMedGoogle Scholar
  114. 114.
    Quiñones M. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22:1–23.PubMedGoogle Scholar
  115. 115.
    Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation. 1978;58:20–4.PubMedGoogle Scholar
  116. 116.
    Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol. 2000;36:1131–41.PubMedGoogle Scholar
  117. 117.
    Mohty D, Mohty-Echahidi D, Malouf JF, et al. Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic position. Circulation. 2006;113:420–6.PubMedGoogle Scholar
  118. 118.
    Walther T, Rastan A, Falk V, et al. Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement. Eur J Cardiothorac Surg. 2006;30:15–9.PubMedGoogle Scholar
  119. 119.
    Rahimtoola SH. Choice of prosthetic heart valve in adults an update. J Am Coll Cardiol. 2010;55:2413–26.PubMedGoogle Scholar
  120. 120.
    Lam B-K, Chan V, Hendry P, et al. The impact of patient-prosthesis mismatch on late outcomes after mitral valve replacement. J Thorac Cardiovasc Surg. 2007;133:1464–73.PubMedGoogle Scholar
  121. 121.
    Blackstone EH, Cosgrove DM, Jamieson WR, et al. Prosthesis size and long-term survival after aortic valve replacement. J Thorac Cardiovasc Surg. 2003;126:783–96.PubMedGoogle Scholar
  122. 122.
    Koch CG, Khandwala F, Estafanous FG, Loop FD, Blackstone EH. Impact of prosthesis-patient size on functional recovery after aortic valve replacement. Circulation. 2005;111:3221–9.PubMedGoogle Scholar
  123. 123.
    Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart. 2006;92:1022–9.PubMedGoogle Scholar
  124. 124.
    Masuda M, Kado H, Tatewaki H, Shiokawa Y, Yasui H. Late results after mitral valve replacement with bileaflet mechanical prosthesis in children: evaluation of prosthesis-patient mismatch. Ann Thorac Surg. 2004;77:913–7.PubMedGoogle Scholar
  125. 125.
    Zamorano JL, Badano LP, Bruce C, et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. J Am Soc Echocardiogr. 2011;24:937–65.PubMedGoogle Scholar
  126. 126.
    Holmes DR, Mack MJ, Kaul S, et al. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol. 2012;59:1200–54.PubMedGoogle Scholar
  127. 127.
    Zaroff J. Echocardiographic evaluation of the potential cardiac donor. J Heart Lung Transplant. 2004;23:S250–2.PubMedGoogle Scholar
  128. 128.
    Stoddard MF, Longaker RA. The role of transesophageal echocardiography in cardiac donor screening. Am Heart J. 1993;125:1676–81.PubMedGoogle Scholar
  129. 129.
    Hetzer R, Potapov EV, Alexi-Meskishvili V, et al. Single-center experience with treatment of cardiogenic shock in children by pediatric ventricular assist devices. J Thorac Cardiovasc Surg. 2011;141:616–23, 623.e1.PubMedGoogle Scholar
  130. 130.
    Cooper DS, Jacobs JP, Moore L, et al. Cardiac extracorporeal life support: state of the art in 2007. Cardiol Young. 2007;17 Suppl 2:104–15.PubMedGoogle Scholar
  131. 131.
    Potapov EV, Stiller B, Hetzer R. Ventricular assist devices in children: current achievements and future perspectives. Pediatr Transplant. 2007;11:241–55.PubMedGoogle Scholar
  132. 132.
    Hetzer R, Potapov EV, Stiller B, et al. Improvement in survival after mechanical circulatory support with pneumatic pulsatile ventricular assist devices in pediatric patients. Ann Thorac Surg. 2006;82:917–24; discussion 924–5.PubMedGoogle Scholar
  133. 133.
    Fraser CD, Jaquiss RDB, Rosenthal DN, et al. Prospective trial of a pediatric ventricular assist device. N Engl J Med. 2012;367:532–41.PubMedGoogle Scholar
  134. 134.
    Chumnanvej S, Wood MJ, MacGillivray TE, Melo MFV. Perioperative echocardiographic examination for ventricular assist device implantation. Anesth Analg. 2007;105:583–601.PubMedGoogle Scholar
  135. 135.
    Davila-Roman VG, Barzilai B. Transesophageal echocardiographic evaluation of patients receiving mechanical assistance from ventricular assist devices. Echocardiography. 1997;14:505–12.PubMedGoogle Scholar
  136. 136.
    Scohy TV, Gommers D, Maat APWM, Dejong PL, Bogers AJJC, Hofland J. Intraoperative transesophageal echocardiography is beneficial for hemodynamic stabilization during left ventricular assist device implantation in children. Paediatr Anaesth. 2009;19:390–5.PubMedGoogle Scholar
  137. 137.
    Sachdeva R, Frazier EA, Jaquiss RDB, Imamura M, Swearingen CJ, Vyas HV. Echocardiographic evaluation of ventricular assist devices in pediatric patients. J Am Soc Echocardiogr. 2013;26:41–9.PubMedGoogle Scholar
  138. 138.
    Baldwin JT, Duncan BW. Ventricular assist devices for children. Prog Pediatr Cardiol. 2006;21:173–84.Google Scholar
  139. 139.
    Miera O, Potapov EV, Redlin M, et al. First experiences with the HeartWare ventricular assist system in children. Ann Thorac Surg. 2011;91:1256–60.PubMedGoogle Scholar
  140. 140.
    Baldwin JT, Borovetz HS, Duncan BW, Gartner MJ, Jarvik RK, Weiss WJ. The national heart, lung, and blood institute pediatric circulatory support program: a summary of the 5-year experience. Circulation. 2011;123:1233–40.PubMedCentralPubMedGoogle Scholar
  141. 141.
    Addonizio LJ. Pediatric ventricular assist devices—first steps for babies. N Engl J Med. 2012;367:567–8.PubMedGoogle Scholar
  142. 142.
    Romano P, Mangion JM. The role of intraoperative transesophageal echocardiography in heart transplantation. Echocardiography. 2002;19:599–604.PubMedGoogle Scholar
  143. 143.
    Ishizuka N, Nakamura K, Fujita Y, et al. Transesophageal echocardiographic findings in patients after heart transplantation. J Cardiol. 1997;29:163–70.PubMedGoogle Scholar
  144. 144.
    del Rio MJ. Transplantation in complex congenital heart disease. Prog Pediatr Cardiol. 2000;11:107–13.PubMedGoogle Scholar
  145. 145.
    Kirklin JK, Naftel DC, Kirklin JW, Blackstone EH, White-Williams C, Bourge RC. Pulmonary vascular resistance and the risk of heart transplantation. J Heart Transplant. 1988;7:331–6.PubMedGoogle Scholar
  146. 146.
    Meyers BF, Lynch J, Trulock EP, Guthrie TJ, Cooper JD, Patterson GA. Lung transplantation: a decade of experience. Ann Surg. 1999;230:362–70; discussion 370–1.PubMedGoogle Scholar
  147. 147.
    Serra E, Feltracco P, Barbieri S, Forti A, Ori C. Transesophageal echocardiography during lung transplantation. Transplant Proc. 2007;39:1981–2.PubMedGoogle Scholar
  148. 148.
    Hausmann D, Daniel WG, Mugge A, et al. Imaging of pulmonary artery and vein anastomoses by transesophageal echocardiography after lung transplantation. Circulation. 1992;86:II251–8.PubMedGoogle Scholar
  149. 149.
    Gonzalez-Fernandez C, Gonzalez-Castro A, Rodriguez-Borregan JC, et al. Pulmonary venous obstruction after lung transplantation. Diagnostic advantages of transesophageal echocardiography. Clin Transplant. 2009;23:975–80.PubMedGoogle Scholar
  150. 150.
    McIlroy DR, Sesto AC, Buckland MR. Pulmonary vein thrombosis, lung transplantation, and intraoperative transesophageal echocardiography. J Cardiothorac Vasc Anesth. 2006;20:712–5.PubMedGoogle Scholar
  151. 151.
    Asfoura JY, Vidt DG. Acute aortic dissection. Chest. 1991;99:724–9.PubMedGoogle Scholar
  152. 152.
    Flachskampf FA, Daniel WG. Aortic dissection. In: Foster E, editor. Cardiology Clinics: Transesophageal Echocardiography. 18(4) ed. Medizinische Klinik II, Universitat Erlangen-Nurnberg, Germany. United States; 2000. p. 807–17.Google Scholar
  153. 153.
    Nienaber CA, Spielmann RP, von Kodolitsch Y, et al. Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography. Circulation. 1992;85:434–47.PubMedGoogle Scholar
  154. 154.
    Matura LA, Ho VB, Rosing DR, Bondy CA. Aortic dilatation and dissection in Turner syndrome. Circulation. 2007;116:1663–70.PubMedGoogle Scholar
  155. 155.
    Erbel R, Bednarczyk I, Pop T, et al. Detection of dissection of the aortic intima and media after angioplasty of coarctation of the aorta. An angiographic, computer tomographic, and echocardiographic comparative study. Circulation. 1990;81:805–14.PubMedGoogle Scholar
  156. 156.
    Kouchoukos NT, Blackstone EH, Hanley FL, Doty DB, Karp RB. Acute aortic dissection. In: Kirklin/Barratt-Boyes cardiac surgery. 3rd ed. Philadelphia: Churchill Livingstone; 2003. p. 1820–49.Google Scholar
  157. 157.
    Miller DC, Mitchell RS, Oyer PE, Stinson EB, Jamieson SW, Shumway NE. Independent determinants of operative mortality for patients with aortic dissections. Circulation. 1984;70:I153–64.PubMedGoogle Scholar
  158. 158.
    DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery. 1982;92:1118–34.PubMedGoogle Scholar
  159. 159.
    Keren A, Kim CB, Hu BS, et al. Accuracy of biplane and multiplane transesophageal echocardiography in diagnosis of typical acute aortic dissection and intramural hematoma. J Am Coll Cardiol. 1996;28:627–36.PubMedGoogle Scholar
  160. 160.
    Penco M, Paparoni S, Dagianti A, et al. Usefulness of transesophageal echocardiography in the assessment of aortic dissection. Am J Cardiol. 2000;86:53G–6.PubMedGoogle Scholar
  161. 161.
    Thrumurthy SG, Karthikesalingam A, Patterson BO, Holt PJE, Thompson MM. The diagnosis and management of aortic dissection. BMJ. 2012;344:d8290.Google Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Division of Cardiology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

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