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Transesophageal Echocardiography in Adults with Congenital Heart Disease

  • Jamil A. AboulhosnEmail author
  • John S. Child
Chapter

Abstract

Significant medical and surgical advances over the past several decades have dramatically altered the care of patients with congenital heart disease (CHD). In the current era, most affected children survive into adulthood. This has resulted in a growing population of adults or “grown-up” patients with CHD, while this patient group continues to increase further. Transesophageal echocardiography (TEE) represents an important diagnostic tool in the management of adults with CHD. In addition, this modality plays an important role during catheter-based and surgical interventions in this patient group. With continuous evolution of and further refinements in technologies applicable to the cardiovascular system, TEE is likely to remain a key imaging modality in the adult patient with CHD.

Keywords

Adult congenital heart disease Grown-up congenital heart disease Transesophageal echocardiography Imaging in the adult with structural heart disease 

Supplementary material

125052_1_En_18_MOESM1_ESM.mov (1023 kb)
Video 18.1 Transesophageal echocardiogram at mid esophageal level, multiplane angle 0°, demonstrating a secundum atrial septal defect. The communication in the interatrial septum is centrally located. Septal rims are seen above and below the defect (MOV 1023 kb)
125052_1_En_18_MOESM2_ESM.mov (164 kb)
Video 18.2 Color flow mapping demonstrating left to right atrial level shunting across a secundum atrial septal defect (MOV 164 kb)
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Video 18.3 Balloon sizing of secundum atrial septal defect during transcatheter device placement in a modified mid esophageal bicaval view (MOV 1278 kb)
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Video 18.4 Mid esophageal bicaval view (multiplane angle 57°) showing a small amount of left to right shunting between the discs of an Amplatzer atrial septal defect occluder device immediately after deployment. This is not an unusual finding (MOV 437 kb)
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Video 18.5 Color Doppler flow imaging in the mid esophageal long-axis view demonstrating a membranous ventricular septal defect with left to right shunting (MOV 746 kb)
Video 18.6

Pre (left panel) and postoperative (right panel) two-dimensional imaging and color Doppler flow mapping in an adult with double-chambered right ventricle as visualized from the mid esophageal right ventricle inflow-outflow view. The preoperative examination demonstrates severe narrowing at the level of the infundibular os (opening), functionally dividing the right ventricle into proximal and distal portions. Aliased flow across this region confirms the level and severity of the obstruction. The post-repair examination demonstrates no residual anatomic obstruction, confirmed by color flow interrogation (MOV 8656 kb)

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Video 18.7 Transgastric basal short-axis view of the left ventricle showing a cleft in the anterior mitral leaflet in a patient with an ostium primum atrial septal defect (MOV 713 kb)
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Video 18.8 Mid esophageal aortic valve long-axis view demonstrating chordal attachments from the anterior mitral leaflet to the outflow septum causing subaortic stenosis in the setting of an atrioventricular canal defect (MOV 838 kb)
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Video 18.9 Color flow mapping at a mid esophageal position demonstrating the right ventricular outflow tract and severe pulmonary regurgitation in a patient with a history of tetralogy of Fallot previously repaired using a transannular patch (MOV 386 kb)
125052_1_En_18_MOESM10_ESM.mov (114 kb)
Video 18.10 Mid esophageal aortic valve short-axis view of bicuspid aortic valve in a patient with a vegetation and clinical evidence of endocarditis. Fusion of the left-right intercoronary commissure is seen (MOV 114 kb)
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Video 18.11 Transgastric long-axis view of the left ventricular during transcatheter aortic balloon valvuloplasty of a stenotic bicuspid aortic valve (MOV 958 kb)
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Video 18.12 Color flow Doppler interrogation post-balloon dilation of bicuspid aortic valve shown in Video 18.11 demonstrates a jet of aortic regurgitation that courses along the edges of the left ventricular outflow. There is reduced systolic excursion of the aortic valve leaflets consistent with residual obstruction (MOV 559 kb)
Video 18.13

Mid esophageal aortic valve long-axis view demonstrating a membrane immediately underneath the aortic valve consistent with subaortic stenosis (MOV 884 kb)

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Video 18.14 Mid esophageal four chamber view displaying the elongated, redundant, ‘sail-like’ anterior leaflet in Ebstein malformation of the tricuspid valve. The apical displacement of the septal leaflet is also seen. Right atrium (RA), left atrium (LA), left ventricle (LV) (MOV 903 kb)
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Video 18.15 Mid esophageal four chamber view in a patient with congenitally corrected transposition of the great arteries. The left panel displays the characteristic appearance of atrioventricular discordance. The right panel demonstrates apical displacement (Ebsteinoid appearance) of the left sided systemic tricuspid valve, valvar dysplasia and associated severe regurgitation (MOV 1053 kb)
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Video 18.16 This image obtained in the mid esophageal long-axis view (multiplane angle 86°) in a patient with congenitally corrected transposition of the great arteries. The abnormal atrioventricular connection is shown as the left atrium (LA) empties into the right ventricle (RV), and the abnormal ventriculoarterial connection is demonstrated as the RV connects and ejects into the aorta (Ao). A significant degree of tricuspid valve regurgitation (TR) is observed (arrow) (MOV 969 kb)
125052_1_En_18_MOESM17_ESM.mov (719 kb)
Video 18.17 Mid esophageal long-axis view in a patient status post Senning atrial baffle procedure for d-transposition of the great arteries. Two pacemaker leads traverse the systemic portion of the atrial baffle (MOV 719 kb)
Video 18.18

Color flow Doppler imaging in orthogonal mid esophageal planes obtained in a patient with d-transposition of the great arteries several years post Senning procedure demonstrating a communication (baffle leak) between the systemic and pulmonary venous baffles resulting in left to right (pulmonary baffle to systemic baffle) shunting (MOV 4281 kb)

Video 18.19

Contrast injection into a central venous catheter in the patient shown in Video 18.18 results in initial opacification of the systemic venous limb of the baffle and subsequent egress of blood into the pulmonary venous aspect confirming the presence of the baffle leak (MOV 7758 kb)

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Video 18.20 Large thrombus in the inferior portion of the dilated right atrium in a patient with an atriopulmonary Fontan connection and history of intra-atrial reentrant tachycardia as seen from a mid esophageal 120° view (MOV 772 kb)
Video 18.21

Mid esophageal view at 44° in a patient with tricuspid atresia and a Bjork Fontan procedure (right atrial to right ventricular outflow tract connection). Spontaneous echo contrast is seen in the dilated right atrium (MOV 2563 kb)

125052_1_En_18_MOESM22_ESM.mov (256 kb)
Video 18.22 Right to left atrial level shunting in same patient with Bjork Fontan connection as shown in Video 18.21 as shown by color Doppler. Pulsed-wave Doppler echocardiography and hemodynamic data obtained at cardiac catheterization confirmed a pressure gradient between the atria (MOV 255 kb)
125052_1_En_18_MOESM23_ESM.mov (560 kb)
Video 18.23 Mid esophageal image demonstrating a large thrombus during long-axis interrogation of a tunnel Fontan connection (MOV 560 kb)
125052_1_En_18_MOESM24_ESM.mov (264 kb)
Video 18.24 Color flow Doppler with a low Nyquist limit (set at 28 cm/s) in the same patient as shown in Video 18.23 demonstrates a small amount of flow around the thrombus without disturbance in this region (MOV 263 kb)
Video 18.25

Gigantic right coronary artery aneurysm in a patient with congenital coronary artery ectasia as shown during transesophageal imaging at mid esophageal level, multiplane angle 60° (MOV 1481 kb)

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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Departments of Medicine and PediatricsDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA

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