Transesophageal Echocardiography

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Transesophageal Echocardiography BIJOY K. KHANDHERIA, M.D., JAMES B. SEWARD, M.D., A. JAMIL TAJIK, M.D. Mayo Clinic Proceedings Volume 69, Issue 9, Pages 856-863 (September 1994) DOI: 10.1016/S0025-6196(12)61788-1 Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 A, Anatomic specimen of heart and related structures, sectioned in basal short-axis plane. Note proximity of esophagus (E) to left atrium (LA), left atrial appendage (LAA), pulmonary veins, and descending thoracic aorta (Ao), posteriorly. B, Multiplane transesophageal echocardiogram (45° rotation) from a patient, showing basal structures similar to those in A. AS = atrial septum; B = bronchus; LUPV = left upper pulmonary vein; PV = pulmonary valve; RA = right atrium; R, L, and N = right, left, and noncoronary cusps of aortic valve; RVO = right ventricular outflow tract. Mayo Clinic Proceedings 1994 69, 856-863DOI: (10.1016/S0025-6196(12)61788-1) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Graph showing utilization trends for transesophageal echocardiography (TEE) as a percentage of transthoracic echocardiography (TTE) at the Mayo Clinic. Note that percentage ranged from 5 to 6% during 1990 through 1993. TEE technology was introduced into our practice in 1988. Mayo Clinic Proceedings 1994 69, 856-863DOI: (10.1016/S0025-6196(12)61788-1) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Top Panel, Evolution of transesophageal ultrasound transducer technology. A, Monoplane device is a single-plane transducer typically perpendicular to shaft of scope. B, In stacked biplane device, distal transverse plane is complemented by separate proximal longitudinal plane parallel to long axis of shaft of scope. C, In matrix biplane device, transverse and longitudinal plane arrays are interdigitated into single footprint. D, Multiplane device (OmniPlane, Hewlett-Packard Co.) uses single array that can be rotated 180°; thus, a continuum of orientations relative to shaft of scope can be produced. (From Seward and associates.3) Bottom Panel, Photograph of array of commercially available transducers. Tips of transducers range from 7 to 12 mm, whereas shafts range from 5 to 9 mm. Typically, transducers are 60 to 110 cm long. Mayo Clinic Proceedings 1994 69, 856-863DOI: (10.1016/S0025-6196(12)61788-1) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 4 Distribution of indications for 7,134 transesophageal echocardiographic examinations performed at the Mayo Clinic from 1988 through 1993. CHD = congenital heart disease; dis = disease; IHD = ischemic heart disease; Mise = miscellaneous cardiac conditions; path = pathologic conditions. Mayo Clinic Proceedings 1994 69, 856-863DOI: (10.1016/S0025-6196(12)61788-1) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 5 Major and minor complications, depicted as percentages of total number of transesophageal echocardiographic procedures (7,134) performed at the Mayo Clinic from 1988 through 1993. CHF = congestive heart failure; Misc = miscellaneous; SVT = supraventricular tachycardia; VT and V tach = ventricular tachycardia. Mayo Clinic Proceedings 1994 69, 856-863DOI: (10.1016/S0025-6196(12)61788-1) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions