Transesophageal Three-Dimensional Echocardiographic Assessment of Normal and Stenosed Coronary Arteries.

ABSTRACT

We describe our preliminary experience in assessing normal and stenosed coronary arteries using transesophageal three-dimensional echocardiography (3-D echo) in 27 adult patients. Multiplane transesophageal two-dimensional images of the coronary arteries (20 left, 3 right, 3 both left and right, and 1 posterior descending) were first acquired in the TomTec computer in 3 degrees sequential increments, from 0 degrees to 180 degrees, and then 3-D reconstruction was performed. The entire left main (LMC, measuring 0.5 to 1.7 cm, mean 1.0 cm) as well as variable lengths of proximal or both proximal and middle segments of the left anterior descending (LAD, measuring 0.2 to 2.5 cm, mean 0.8 cm) and circumflex (LCX, measuring 0.2 to 2.8 cm, mean 0.9 cm) coronary arteries together with some of their branches could be visualized in 3-D in 22 of 23 patients. In the remaining patient, the LMC was absent, and both LAD and LCX could be visualized in 3-D as having separate but adjacent origins from the left sinus of Valsalva (proven by angiography). In two patients, long segments of interventricular and great cardiac veins were also visualized accompanying the LAD and LCX, respectively. The right coronary artery (RCA, measuring 0.7 to 3.0 cm, mean 1.9 cm) was also successfully delineated in 3-D in all six patients in whom an attempt was made to visualize it during echo examination. Using the transgastric approach, a long (1.8 cm) segment of the posterior descending branch (PDA) of RCA was imaged in one patient. In addition, nine significantly stenotic lesions (>50% lumen diameter) were identified by 3-D in eight patients involving LMC (1), proximal LAD (1), mid LAD (1), proximal LCX (2), proximal RCA (3), and mid PDA (1). Eight of these 9 lesions were confirmed by coronary angiography. The remaining lesion (mid PDA) could not be confirmed since the patient did not undergo angiography. Our preliminary study demonstrates the usefulness of transesophageal 3-D echo not only in delineating normal coronary arteries but also diagnosing significant atherosclerotic stenosis in these vessels. (ECHOCARDIOGRAPHY, Volume 13, September 1996)