Abstract
Purpose
The purpose of this review is to introduce the uninitiated to transoesophageal echocardiography (TEE): how it works, and what it can do. Sufficient detail is provided to serve as a reference guide to anaesthetists already using TEE in clinical practice.
Source
A Medline search of English language literature up to and including August 1995 was conducted using the key words echocardiography and TEE. Reference echocardiography textbooks were also utilized in the preparation of this review.
Principle findings
All information available from TEE is derived from either cardiac imaging or analysis of blood flow velocity using various Doppler modes. To understand the diagnostic capabilities of TEE we review clinically useful views of the heart as well as modes of cardiac imaging. Sufficient basic physics is presented to allow proper use of adjustment features on the echocardiography machine so that cardiac imaging can be optimized. Available Doppler modes are explained along with an overview of their clinical applications. Figures illustrating clinically useful views obtainable with omniplane TEE are included along with colour prints demonstrating clinical applications of colour flow Doppler.
Conclusion
TEE is becoming increasingly important in the management of cardiac patients for cardiac and non-cardiac surgery. An understanding of the capabilities of the technology as well as the underlying physics allows the anaesthetist to glean the most information from this valuable technique, both quantitatively and qualitatively.
Résumé
Objectif
L’objectif de cette revue est d’initier le lecteur à l’échocardiographie transoesophagienne (ETO), son fonctionnement et ses possibilités. Les informations incluses sont suffisantes pour servir de texte de référence aux utilisateurs actuels de l’ETO.
Source
Une recherche des publications de langue anglaise s’étendant jusqu’à août 1995 sous les mots clés Echocardiographie et TEE a été effectuée dans Medline. Certains manuels de référence sur l’échocardiographie ont aussi été utilisés dans la préparation de ce texte.
Constatations principales
Toute l’information disponible sur ETO est dérivée de l’imagerie cardiaque ou de l’analyse de la vélocité du flux sanguin avec différents modes Doppler. Pour comprendre les capacités diagnostiques de l’ETO, les vues de base ainsi que les méthodes d’imagerie sont revues. Un rappel de la physique de base, suffisant pour permettre l’exploitation optimale des réglages de l’appareil, est inclus dans le texte. Les divers modes Doppler sont expliqués ainsi qu ’un survol de leurs applications. Des figures illustrant les vues de base utiles qu’on peut obtenir avec l’ETO omniplan sont montrées ainsi que des clichés en couleur démontrant les applications du Doppler couleur.
Conclusion
L’ETO joue un rôle essentiel dans l’évaluation et le traitement du patient cardiaque exposé à une chirurgie cardiaque ou autre. Comprendre les limites de cette technologie et la physique sur laquelle elle se base permet à l’anesthésiste d’utiliser au maximum les capacités de cette remarquable technique et de qualifier et quantifier l’information obtenue.
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References
Gentles TL, Rosenfeld HM, Sanders SP, Laussen PC, Burke RP, van der Welde ME. Pediatric biplane transesophageal echocardiography: preliminary experience. Am Heart J 1994; 128: 1225–33.
Lam J, Neirotti RA, Lubbers WJ, et al. Usefulness of biplane transesophageal echocardiography in neonates, infants and children with congenital heart disease. Am J Cardiol 1993; 72: 699–706.
Tardif J-C, Schwartz SL, Vannan MA, Cao Q-L, Pandian NG. Clinical usefulness of multiplane transesophageal echocardiography: comparison to biplanar imaging. Am Heart J 1994; 128: 156–66.
Weyman AE. Principles and Practice of Echocardiography, 2nd ed. Philadelphia: Lea & Febiger, 1994: 3–28.
Feigenbaum H. Echocardiography, 5th ed. Philadelphia: Lea & Febiger, 1994: 1–67.
Obeid AI. Echocardiography in Clinical Practice. Philadelphia: J.B. Lippincott Co., 1992: 2–117.
Kisslo J, von Ramm OT, Thurstone FL. Cardiac imaging using a phased array ultrasound system. II. Clinical technique and application. Circulation 1976; 53: 262–7.
Wells PNT. Biomedical Ultrasonics. New York: Academic Press, 1977.
Pandian N, Hsu T-L, Schwartz SL, et al. Multiplane transesophageal echocardiography. Echocardiography 1992; 9: 649–66.
Fisher EA, Stahl JA, Budd JH, Goldman ME. Transesophageal echocardiography: procedures and clinical application. J Am Coll Cardiol 1991; 18: 1333–48.
Clements FM, de Bruijn NP. Perioperative evaluation of regional wall motion by transesophageal two-dimensional echocardiography. Anesth Analg 1987; 66: 249–61.
Abel MD, Nishimura RA, Callahan MJ, Rehder K, Ilstrup DM, Tajik AJ. Evaluation of intraoperative transesophageal two-dimensional echocardiography. Anesthesiology 1987; 66: 64–8.
Voci P, Bilotta F, Agati L. Apical transgastric echocardiography: new imaging projections. Eur Heart J 1993; 14: 1669–74.
Amarenco P, Cohen A, Tzourio C, et al. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 1994; 331: 1474–9.
Tunick PA, Rosenzweig BP, Katz ES, Freedberg RS, Perez JL, Kronzon I. High risk for vascular events in patients with protruding aortic atheromas: a prospective study. J Am Coll Cardiol 1994; 23: 1085–90.
Demopoulos LA, Tunick PA, Bernstein NE, Perez JL Kronzon I. Protruding atheromas of the aortic arch in symptomatic patients with carotid artery disease. Am Heart J 1995; 129: 40–4.
Katz ES, Tunick PA, Rusinek H, Ribakove G, Spencer FC, Kronzon I. Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography. J Am Coll Cardiol 1992; 20: 70–7.
Ribakove GH, Katz ES, Galloway AC, et al. Surgical implications of transesophageal echocardiography to grade the atheromatous aortic arch. Ann Thorac Surg 1992; 53: 758–63.
Grossi EA, Kanchuger MS, Schwartz DS, et al. Effect of cannula length on aortic arch flow: protection of the atheromatous aortic arch. Ann Thorac Surg 1995; 59: 710–2.
Wiet SP, Pearce WH, McCarthy WJ, Joob AW, Yao JST, McPherson DD. Utility of transesophageal echocardiography in the diagnosis of disease of the thoracic aorta. J Vasc Surg 1994; 20: 613–20.
Konstadt SN, Reich DL, Quintana C, Levy M. The ascending aorta: how much does transesophageal echocardiography see? Anesth Analg 1994; 78: 240–4.
Nishino M, Masugata H, Yamada Y Abe H, Hori M, Kamada T. Evaluation of thoracic aortic atherosclerosis by transesophageal echocardiography. Am Heart J 1994; 127: 336–44.
Konstadt S, Reich D, Kahn R, Viggiani RF. Transesophageal echocardiography can be used to screen for ascending aortic atherosclerosis Anesth Analg 1995; 81: 225–8.
Guzzetta NA, Lee E, Sadel SM, Shanewise JS, Jones EL. Does the degree of atheromatous disease in the descending thoracic aorta correlate with atheromatous disease in the ascending aorta? Anesth Analg1995; 80: SCA 95.
Thys DM, Hillel Z. How it works: basic concepts in echocardiography,In: de Bruijn NP, Clements FM (Eds). Intraoperative Use of Echocardiography. Philadelphia: JB Lippincott Company, 1991: 13–44.
Muhiudeen IA, Kuecherer HF, Lee E, Cahalan MK, Schiller NB. Intraoperative estimation of cardiac output by transesophageal pulsed Doppler echocardiography. Anesthesiology 1991; 74: 9–14.
Stoddard MF, Prince CR, Ammash N, Goad JL, Vogel RL. Pulsed Doppler transesophageal echocardiographic determination of cardiac output in human beings: comparison with thermodilution technique. Am Heart J 1993; 126: 956–62.
Savino JS, Troianos CA, Aukburg S, Weiss R, Reichek N. Measurement of pulmonary blood flow with transesophageal two-dimensional and Doppler echocardiography. Anesthesiology 1991; 75: 445–51.
Izzat MB, Regragui IA, Wilde P, Angelini GD, Bryan AJ. Transesophageal echocardiographic measurements of cardiac output in cardiac surgical patients. Ann Thorac Surg 1994; 58: 1486–9.
Hartman GS, Yao FS, Ritter SB. Pitfalls of real-time transesophageal echocardiographic analysis of mitral regurgitation performed immediately following cardiopulmonary bypass. Anesthesiology 1993; 79: A68.
Nakatani S, Masuyama T, Kodama K, Kitabatake A, Fujii K, Kamada T. Value and limitations of Doppler echocardiography in the quantification of stenotic mitral valve area: comparison of the pressure half-time and the continuity equation methods. Circulation 1988; 77: 78–85.
Panidis IP, Mintz GS, Ross J. Value and limitations of Doppler ultrasound in the evaluation of aortic stenosis: a statistical analysis of 70 consecutive patients. Am Heart J 1986: 112: 150–8.
Rahimtoola SH Perspective on valvular heart disease: an update. J Am Coll Cardiol 1989; 14: 1–23.
Hatle L. Doppler echocardiographic evaluation of mitral stenosis. Cardiol Clin 1990; 8: 233–47.
Zhang Y, Ihlen H, Myhre E, Levorstad K, Nitter-Hauge S. Measurement of mitral regurgitation by Doppler echocardiography. Br Heart J 1985; 54: 384–91.
Rokey R, Sterling LL, Zoghbi WA, et al. Determination of regurgitant fraction in isolated mitral or aortic regurgitation by pulsed Doppler two-dimensional echocardiography. J Am Coll Cardiol 1986; 1273–8.
Kitabatake A, Ito H, Inoue M et al. A new approach to noninvasive evaluation of aortic regurgitant fraction by two-dimensional Doppler echocardiography. Circulation 1985; 72: 523–9.
Nishimura RA, Rihal CS, Tajik AJ, Holmes DR Jr. Accurate measurement of the transmitral gradient in patients with mitral stenosis: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol 1994; 24: 152–8.
Hatle L, Brubakk A, Tromsdal A, Angelsen B. Noninvasive assessment of pressure drop in mitral stenosis by Doppler ultrasound. Br Heart J 1978; 40: 131–40.
Holen J, Aaslid R, Landmark K, Simonsen S. Determination of pressure gradient in mitral stenosis with a noninvasive ultrasound Doppler technique. Acta Medica Scandinavica 1976; 199: 455–60.
Currie PJ, Seward JB, Reeder GS, et al. Continuous-wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: a simultaneous Doppler-catheter correlative study in 100 adult patients. Circulation 1985; 71: 1162–9.
Otto CM, Pearlman AS, Comess KA, Reamer RP, Janko CL, Huntsman LL. Determination of the stenotic aortic valve area in adults using Doppler echocardiography. J Am Coll Cardiol 1986; 7: 509–17.
Oh JK, Taliercio CP, Holmes DR Jr, et al. Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: prospective Doppler-catheterization correlation in 100 patients. J Am Coll Cardiol 1988: 11: 1227–34.
Hatle L, Angelsen B, Tromsdal A. Noninvasive assessment of atrioventricular pressure half-time by Doppler ultrasound. Circulation 1979; 60: 1096–104.
Smith MD, Handshoe R, Handshoe S, Kwan OL, DeMaria AN. Comparative accuracy of two-dimensional echocardiography and Doppler pressure half-time methods in assessing severity of mitral stenosis in patients with and without prior commissurotomy. Circulation 1986; 73: 100–7.
Teague SM, Heinsimer JA, Anderson JL, et al. Quantification of aortic regurgitation utilizing continuous wave Doppler ultrasound. J Am Coll Cardiol 1986; 8: 592–9.
Mark JB, Ahmed SU, Kluger R, Robinson SM. Influence of jet direction on pulmonary vein flow patterns in severe mitral regurgitation. Anesth Analg 1995; 80: 486–91.
Klein AL, Obarski TP, Stewart WJ, et al. Transesophageal Doppler echocardiography of pulmonary venous flow: a new marker of mitral regurgitation severity. J Am Coll Cardiol 1991; 18: 518–26.
Sutton DC, Kluger R, Ahmed SU, Reimold SC, Mark JB. Flow reversal in the descending aorta: a guide to intraoperative assessment of aortic regurgitation with transesophageal echocardiography. J Thorac Cardiovasc Surg 1994; 108: 576–82.
Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 1984; 70: 657–62.
Berger M, Haimowitz A, Van Tosh A, Berdoff RL, Goldberg E. Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol 1985; 6: 359–65.
Labovitz AJ, Pearson AC. Evaluation of left ventricular diastolic function: clinical relevance and recent Doppler echocardiographic insights. Am Heart J 1987; 114: 836–51.
Pagel PS, Grossman W, Haering JM, Warltier DC. Left ventricular diastolic function in the normal and diseased heart. Anesthesiology 1993; 79: 836–54.
Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988; 12: 426–40.
Gorcsan J III, Diana P, Lee J, Katz WE, Hauler BG. Reversible diastolic dysfunction after successful coronary artery bypass surgery. Assessment by transesophageal Doppler echocardiography. Chest 1994; 106: 1364–9.
Akamatsu S, Terazawa E, Kagawa K, Arakawa M, Dohi S. Transesophageal Doppler echocardiographic assessment of pulmonary venous flow pattern in subjects without cardiovascular disease. Int J Card Imaging 1993; 9: 195–200.
Bryg RJ, Williams GA, Labovitz AJ. Effect of aging on left ventricular diastolic filling in normal subjects. Am J Cardiol 1987; 59: 971–4.
Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography. Effect of different loading conditions. Circulation 1990; 81: 1488–97.
Basnight MA, Gonzalez MS, Kershenovich SC, Appleton CP. Pulmonary venous flow velocity: relation to hemodynamics, mitral flow velocity and left atrial volume, and ejection fraction. J Am Soc Echocardiogr 1991; 4: 547–58.
Sheikh KH, de Bruijn NP, Rankin JS, et al. The utility of transesophageal echocardiography and Doppler color flow imaging in patients undergoing cardiac valve surgery. J Am Coll Cardiol 1990; 15: 363–72.
Sommer RJ, Ritter SB. The physiology of congenital heart disease: assessment by Doppler colorflow mapping. Echocardiography 1991; 8: 565.
Lai L-P, Shyu K-G, Chen J-J, et al. Usefulness of pulmonary venous flow pattern and maximal mosaic jet area detected by transesophageal echocardiography in assessing the severity of mitral regurgitation. Am J Cardiol 1993; 72: 1310–3.
Helmcke F, Nanda NC, Hsiung MC, et al. Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 1987; 75: 175–83.
Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocardiography and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol 1989; 14: 1266–74.
Chen C, Thomas JD, Anconina J, et al. Impact of impinging wall jet on color Doppler quantification of mitral regurgitation. Circulation 1991; 84: 712–20.
Reynolds T, Abate J, Tenney A, Warner MG. The JH/LVOH method in the quantification of aortic regurgitation: how the cardiac sonographer may avoid an important potential pitfall. J Am Soc Echo 1991; 4: 105–8.
Perry GJ, Helmcke F, Nanda NC, Byard C, Soto B. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol 1987; 9: 952–9.
Tribouilloy C, Shen WF, Peltier M, Mirode A, Rey JL, Lesbre J-P. Quantitation of aortic valve area in aortic stenosis with multiplane transesophageal echocardiography: comparison with monoplane transesophageal approach. Am Heart J 1994; 128: 526–32.
Stoddard MF, Prince CR, Ammash NM, Goad JL. Twodimensional transesophageal echocardiographic determination of mitral valve area in adults with mitral stenosis. Am Heart J 1994; 127: 1348–53.
Fehske W, Grayburn PA, Omran H, et al. Morphology of the mitral valve as displayed by multiplane transesophageal echocardiography. J Am Soc Echocardiogr 1994; 7: 472–9.
Rodriguez L, Thomas JD, Monterroso V, et al. Validation of the proximal flow convergence method. Circulation, 1993; 88: 1157–65.
Bargiggia GS, Tronconi L, Sahn DJ, et al. A new method for quantitation of mitral regurgitation based on color flow Doppler imaging of flow convergence proximal to regurgitant orifice. Circulation 1991; 84: 1481–9.
Rivera JM, Vandervoort PM, Mele D, et al. Quantification of tricuspid regurgitation by means of the proximal flow convergence method: a clinical study. Am Heart J 1994; 127: 1354–62.
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Béïque, F., Joffe, D. & Kleiman, S. An introduction to transoesophageal echocardiography: I. Basic principles. Can J Anaesth 43, 252–277 (1996). https://doi.org/10.1007/BF03011744
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DOI: https://doi.org/10.1007/BF03011744