BACKGROUND The present study designed to evaluate feasibility of transesophageal echocardiographic (TEE) imaging of the pulmonary valve (PV) at the transaortic upper esophageal (TAUE) window. We hypothesized that patients with larger aorta would be more likely to have visualization of the PV from this TAUE window. METHODS 2D TEE images of the PV were prospectively acquired by one operator at the TAUE window looking through the aortic arch. Patients were divided into four groups based on image quality of PV (group 1, not visualized; group 2, barely visualized; group 3, sufficient visualization; group 4, excellent visualization). Clinical, echocardiographic, and radiologic parameters were collected. RESULTS A total of 212 consecutive patients (54 ± 14 years, 63.7% male) were enrolled. Group distribution was as follows: group 1, n = 60 (28.3%); group 2 n = 39 (18.4%); group 3, n = 27 (12.7%); group 4, n = 86 (40.6%). There were no differences between groups' baseline clinical characteristics. There was a weak although statistically negative correlation between PV image quality and aortic arch dimension (r = -0.17 P = 0.01). There was a stronger positive correlation between PV thickness (r = 0.38 P < 0.001) and PV image quality. Retrospective subgroup analysis of 76 patients with recent chest CT showed similar, but not significant trends as by TEE. CONCLUSION The use of 2D TEE TAUE results in diagnostic image quality of the PV in the majority of patients and outstanding image quality in a subset of patients. PV image quality is negatively affected by increasing aorta diameter and positively affected by PV thickness.

Feasibility of pulmonary valve imaging using transesophageal echocardiography upper esophageal view.

and post contrast TTE images in apical four, two and three chamber views were evaluated for endocardial definition score (EDS) (1 = good, 2 = sub-optimal, 3 =notvisible), EDS index, LVEF calculation and assessment for LV thrombus/LV morphology. Results: Ten patients on MCS (ECMO=6, VAD=2, IABP= 2) had UE and CE TTE.M= 6, mean age= 45± 13.2 years. Contrast infusion= 6, bolus dosing= 4. 360 myocardial segments were assessed. EDS=1 (UE vs. CE: 69 vs. 166) EDS=2 (40 vs. 12) and EDS=3 (71 vs. 2). Wilcoxon signed rank test (CE improving EDS) p< 0.0001 for combined data.MeanEDSI (UE vs. CE) = 2.0 vs. 1.1 (p= 0.0002). CE imaging excludedLV thrombus in four cases suspected on UE imaging. There were no adverse reactions or alteration in MCS function following contrast administration. Conclusion:Contrast enhanced TTE is feasible and safe in patients onMCS and can also improve endocardial definition and assessment for LV thrombus/morphology. doi:10.1016/j.hlc.2011.05.431

Feasibility of Pulmonary Valve Morphological Assessment Using Simultaneous Biplane and Three-Dimensional Transoesophageal Echocardiography

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Feasibility of Pulmonary Valve Morphological Assessment Using Simultaneous Biplane and Three-Dimensional Transoesophageal Echocardiography