Transesophageal three-dimensional color Doppler echocardiographic reconstruction of the left vertebral artery.

We present a patient in whom we successfully reconstructed a long segment of the proximal left vertebral artery in three dimensions using color Doppler transesophageal echocardiography (TEE). Three-dimensional (3-D) color Doppler TEE may complement two-dimensional (2-D) TEE by its ability to view cross sections of the left vertebral artery at any desired level from the 3-D data stored in the computer.

Transesophageal echocardiography in patients with ischemic stroke accurately detects significant coronary artery stenosis and often changes management.

OBJECTIVES: TEE is performed in many patients with ischemic stroke, and it is possible to examine the proximal coronaries by TEE in these patients. Our purpose was to (1) determine the accuracy of transesophageal echocardiography (TEE) in the diagnosis of proximal coronary stenosis in patients with ischemic stroke and (2) show that TEE detection of proximal coronary stenosis changed management in a substantial number of patients. METHODS: Thirty-two patients with ischemic stroke undergoing TEE, in whom the proximal coronaries were examined and who had angiographic results available, were studied. RESULTS: Proximal coronaries were visualized as follows: left main (LM) in 31 (97%), left anterior descending (LAD) in 32 (100%), left circumflex (LCx) in 30 (94%) and right coronary artery (RCA) in 21 (66%). The sensitivity and specificity of TEE in diagnosing significant coronary stenosis in visualized vessels were as follows: LM 100% and 100%, LAD 100% and 95%, LCx 100% and 96%, and RCA 100% and 100%, respectively. When visualized and nonvisualized segments were considered, TEE detected significant stenosis as follows: 4 of 5 in the LM (80%), 13 of 13 in the LAD (100%), 2 of 3 in the LCx (66%), and 2 of 8 in the RCA (25%). Of the 32 patients, TEE results changed management in 17 patients (53%). Angiographic findings resulted in 10 of the 17 patients (59%) undergoing revascularization. CONCLUSIONS: TEE was very accurate in diagnosing significant coexisting coronary artery disease in patients with ischemic stroke. TEE diagnosis of these lesions prompted coronary angiography and subsequent revascularization in a substantial number of patients.

Two- and three-dimensional transesophageal echocardiographic localization of a right atrial lipoma: importance of orienting echocardiographic images to the surgeon's view.

We present a patient in whom the exact location of a right atrial lipoma identified with two- and three-dimensional transesophageal echocardiography (2-D and 3-D TEE) was correlated with the surgical findings. By orienting the 3-D TEE images to conform to the view of the surgeon from the right side of the patient and referencing the site of attachment of the tumor to the surrounding structures, this lipoma was correctly localized to a 7 o'clock position in the right atrium.

Transesophageal color Doppler three-dimensional echocardiographic detection of prosthetic aortic valve dehiscence: correlation with surgical findings.

Three-dimensional echocardiography is being used with increasing frequency to evaluate cardiac function and structure. We present two cases of prosthetic aortic valve endocarditis where three-dimensional transesophageal echocardiography correlated with the intraoperative surgical findings of prosthetic dehiscence and communication with an abscess cavity. When compared with two-dimensional transesophageal echocardiography, three-dimensional echocardiography was more accurate in defining the exact site of dehiscence and communication with an abscess cavity. The echocardiographic images were oriented as a clockface watch to conform to the surgeon's visualization of the aortic root as viewed from the right side of the patient.

Transesophageal echocardiographic evaluation of coronary arteries for stenosis in the elderly patient.

This article documents the ability of transesophageal echocardiography to provide adequate images and clinically relevant information about the coronary anatomy of the elderly patient. Transesophageal echocardiography is commonly used to assess elderly patients who suffer cerebral vascular accidents. It is important to evaluate not only for the usually suspected causes of a cardiac source of emboli but also for direct and indirect evidence of coronary artery disease--the leading cause of death in the elderly stroke patient. Because atherosclerotic cardiovascular diseases identified in one vascular bed are prone to universally involve the other vascular territories to some degree, it is not surprising that the coronary arteries are often stenotic. As a sudden event with catastrophic symptoms, a stroke is commonly the first vascular event the elderly patient experiences. Depending on the degree of recovery, physical limitations may contribute to the lack of symptoms from coexistent peripheral or coronary artery disease. Transesophageal echocardiography may be the first, or only, coronary evaluation for high-risk elderly patients.

Transesophageal three-dimensional echocardiographic assessment of left main coronary artery fistula.

We describe a patient with a left main coronary artery fistula with an opening at the superior vena cava-right atrial junction in whom three-dimensional transesophageal echocardiography permitted more accurate assessment of the shape and size of the communication site than two-dimensional transesophageal echocardiography.

Two- and three-dimensional TEE differentiation of lymphoma involving the atrial septum from lipomatous hypertrophy.

In this case report we present two-dimensional (2-D) and three-dimensional (3-D) transesophageal echocardiographic (TEE) findings of a patient with lipomatous atrial septal hypertrophy and a patient with Hodgkin's lymphoma with atrial septal involvement. The echocardiographic characteristics that differentiate these two lesions are discussed.

Transesophageal echocardiographic diagnosis of traumatic rupture of the noncoronary cusp of the aortic valve.

We report a patient with traumatic aortic valve injury in whom a large defect in the noncoronary cusp of the aortic valve was clearly visualized by multiplane TEE and confirmed at surgery.

Transesophageal echocardiographic findings of an intracavitary cardiac metastasis from a neuroendocrine thymic carcinoma.

This case report presents the unusual characteristics of a neuroendocrine thymic carcinoma that probably has metastasized to the left side of the interatrial septum from a primary thymic site.

Transesophageal echocardiographic assessment of coronary stenosis: a decade of experience.

Coronary artery imaging is routinely obtained invasively at cardiac catheterization through coronary angiography. This remains the gold standard, but with advances in ultrasound technology, electron beam computed tomography, and magnetic resonance imaging, newer noninvasive methodologies are achieving greater success at imaging the coronary anatomy. This review is meant to highlight the important accomplishments from transesophageal echocardiographic (TEE) investigations that have studied the coronary arteries. The specific technique for optimally imaging the coronaries with high frequency transducers, color and conventional Doppler, in addition to contrast-enhanced methods, will be analyzed. Importantly, this article serves as a reminder to echocardiographers and cardiologists that excellent, clinically relevant information of the coronary arteries can be obtained routinely during TEE. This technique is part of the trend noted by the other authors in this special edition; that is, echocardiography is becoming the gold standard of the new millennium for many diagnostic areas, even coronary angiography.

Subendocardial steal effect seen with real-time perfusion imaging at low emission power during adenosine stress: replenishment M-mode processing allows visualization of vertical steal.

We present a patient in whom power pulse inversion imaging clearly demonstrated a subendocardial myocardial perfusion defect during contrast vasodilator stress using adenosine. The defect was best appreciated with M-mode postprocessing of power pulse inversion imaging data.

Transpharyngeal echocardiographic imaging of the right and left carotid arteries.

We present a technique for transpharyngeal imaging of the bilateral carotid arteries completed towards the end of a transesophageal echocardiogram. To our knowledge, this is the first report that demonstrates the bifurcation of the right common carotid artery into the right internal and external carotid arteries with a transesophageal echocardiographic probe.

Fibrotic aortic stenosis in a patient with dwarfism.

In this report, we present an adult patient with dwarfism who had severe aortic stenosis with markedly thickened fibrotic valve leaflets without calcification. These findings were well demonstrated by both two- and three-dimensional transesophageal echocardiography and confirmed at surgery and by pathological examination.

Aortic dissection with intimal intussusception: diagnosis and management.

A man presented with acute chest and back pain with loss of consciousness. CT scan showed a mass in the arch that extended into the descending aorta. A diagnosis of type I aortic dissection was ultimately made by echocardiography. At surgery there was a circumferential intimal tear in the aortic root, and an intussuscepted dissection flap was retrieved from the arch and descending aorta.