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Functional Evaluation of the Heart by Transesophageal Echocardiography

  • Benjamin W. EidemEmail author
Chapter

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.

Keywords

Transesophageal echocardiography Congenital heart disease Pediatric acquired heart disease Ventricular function Myocardial performance Systolic function Diastolic function 

Supplementary material

Video 5.1a

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)

Video 5.1b

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)

Video 5.1c

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)

Video 5.1d

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)

Video 5.1e

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)

Video 5.2a

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)

Video 5.2b

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)

Video 5.3a

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)

Video 5.3b

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)

Video 5.3c

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)

Video 5.3d

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)

Video 5.3e

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)

Video 5.3f

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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© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Division of Pediatric Cardiology and Cardiovascular Diseases, Departments of Pediatrics and MedicineMayo ClinicRochesterUSA

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