The authors encountered a 4-month-old, female Shiba dog weighing 4.0 kg, who had been exhibiting abdominal distension and increasing ascites for 2 months. She was brought for further examination and treatment with the chief complaints of ascites and dyspnoea during sleep. The dog was diagnosed with ascites caused by cor triatriatum dexter based on the physical and imaging findings. Under general anaesthesia, she was treated with hybrid balloon dilation under transoesophageal echocardiography guidance. Her postoperative recovery was quite rapid and uneventful. This method appears to be a useful, new, and less-invasive treatment option for cor triatriatum dexter.
Animals ; Ascites ; Cor Triatriatum ; Dogs ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Defects, Congenital ; Humans ; Infant ; Methods

BACKGROUNDThe left atrial appendage (LAA) is an important source of thrombus formation. We investigated the feasibility of the recently developed real-time three-dimensional transesophageal echocardiography (RT3D-TEE) method in assessment of the morphology and function of the LAA.

METHODSNinety-six consecutive patients (58 males with a mean age of (43.4 ± 12.5) years) who were referred for 2-dimensional (2D) transesophageal echocardiography (TEE) underwent additional RT3D-TEE. LAA morphology was visualized in multiple views. Orifice size, depth, volumes and ejection fraction (EF) of the LAA, were measured.

RESULTSAll the patients underwent RT3D-TEE examination without complications. Ninety-two patients (95.8%) had adequate images for visualization and quantitative analysis of the LAA. The LAA exhibited great variability with respect to relative dimensions and morphology. LAA orifice area was (3.8 ± 1.2) cm(2) with a diameter of (2.4 ± 0.9) cm × (1.4 ± 0.6) cm. The mean depth of the LAA was (2.9 ± 0.7) cm. End-diastolic volume (EDV-LAA), end-systolic volume (ESV-LAA) and EF of the LAA were (6.2 ± 3.7) ml, (4.1 ± 2.8) ml, and 0.35 ± 0.16, respectively. EDV-LAA, ESV-LAA and the orifice area of the LAA in patients with atrial fibrillation (AF) were larger than those without AF, whereas the EF was smaller in the AF patients.

CONCLUSIONSDefining LAA morphology and quantitative analysis of the size and function of the LAA with superior quality and resolution of images using RT3D-TEE is feasible. This technique may be an ideal tool for guidance of the LAA occlusion procedure. Determination of LAA volumes and volume-derived EF by RT3D-TEE provides new insights into the analysis of LAA function.

Adult ; Atrial Appendage ; diagnostic imaging ; Echocardiography, Three-Dimensional ; methods ; Echocardiography, Transesophageal ; methods ; Female ; Humans ; Male ; Middle Aged

Child, Preschool ; Echocardiography, Transesophageal ; methods ; Heart Septal Defects, Ventricular ; diagnostic imaging ; therapy ; Humans ; Male

OBJECTIVETo compare the accuracy of live three-dimensional (Live-3D-TEE) and two-dimensional transesophageal echocardiography (2D-TEE) in the evaluation of functional anatomy of mitral regurgitation. METHDOS: Thirty-eight consecutive patients with severe mitral regurgitation were enrolled prospectively. The accuracy of Live-3D-TEE and 2D-TEE for functional assessment of mitral regurgitation was evaluated against surgical findings.

RESULTSThe accuracy in etiological assessment of mitral regurgitation was 94.7% with Live-3D-TEE and 89.5% with 2D-TEE (P=0.09). For assessment of lesions of the mitral valve, Live-3D-TEE showed an overall accuracy of 93.2%, significantly higher than that of 2D-TEE (88.6%, P=0.001). Live-3D-TEE also showed a significantly higher accuracy than 2D-TEE in localization of mitral valve lesions (93.3% vs 86.7%, P=0.000).

CONCLUSIONBoth Live-3D-TEE and 2D-TEE allow accurate assessment of the etiology of mitral regurgitation, but Live-3D-TEE can be more accurate in the evaluation of the lesions of the mitral valve and their localization.

Adult ; Aged ; Echocardiography ; methods ; Echocardiography, Three-Dimensional ; methods ; Echocardiography, Transesophageal ; methods ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency ; diagnostic imaging ; pathology ; physiopathology ; Young Adult

BACKGROUND: During the past few years, transesophageal echocardiography(TEE) became one of most impartant method to detect various cardiac disease. But it was performed less than 10% of transthoracic echocardiography(TTE) in most of echocardiographic laboratoties because of major and minor complicatios associated with this procedure. The purposes of this study are to evaluate the clinical applications and the usefulness of transesophageal echocardiography in various cardiac disorders. METHOD: From 1990 to 1995, 942 cases were included in this study. All subjects were taken TTE and TEE simultaneously The causes of request, related side effect, cause of failed cases, and the benefit of TEE compared to TTE were analysed. The benefit of TEE were classified into major and minor benefit. Major benefit was defined as to diagnose the disease or to change the therapeautic method by TEE. Minor benefit was defined as to have additional findings by TEE whic could not be enrolled in major benefit. RESULTS: 1) The success rate of TEE was 95.5%(900/942). In 42 failed cases(4.5%), 19 were interrupted procedure earlier, 16 were failed to insert the TEE probe, 4 cases showed arrhythmia, and 3 cases had esophageal stricture or varices. 2) The causes of request were to assess the prosthetic valve function(35.5%), cardiac source of embolism(23.7%), valvular heart disease(22.7%), congenital heart disease(10.2), aortic disease(2.7%), endocarditis(2.3%), cardiac mass(1%), and coronary artery disease(1%), in orders. 3) The benefit of TEE was 77%, congenital heart disease was revealed greatest benefit(97%), but major benefit was highest for the evaluation of cardiac source of emboli(100%). CONCLUSION: TEE was very useful method for the detection of intra-cardiac and aortic abnormalities. TEE is a relatively safe procedure but it is a semi-invasive method and has few complications. So it is wise to apply TEE as adjuvant method of TTE.
Arrhythmias, Cardiac ; Coronary Vessels ; Echocardiography ; Echocardiography, Transesophageal ; Esophageal Stenosis ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Methods ; Varicose Veins

Adolescent ; Cardiac Catheterization ; methods ; Child, Preschool ; Echocardiography, Transesophageal ; methods ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Humans ; Treatment Outcome

Adult ; Aged ; Aged, 80 and over ; Echocardiography, Transesophageal ; methods ; Female ; Foramen Ovale, Patent ; diagnosis ; Humans ; Male ; Middle Aged

BACKGROUNDMinimally invasive cardiac surgery and closed chest cardiopulmonary bypass (CPB) techniques continue to evolve. Previous reports have demonstrated the benefits of fluoroscopy guided cannulation for endovascular CPB during port access cardiac surgery. However, few data are available on the role of transesophageal echocardiography (TEE) guided cannulation for peripheral CPB during robotic cardiac surgery. The purpose of this study was to evaluate TEE guided cannulation for peripheral CPB during robotic cardiac surgery.

METHODSWe performed a retrospective analysis of intraoperative data of 129 consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB from September 2007 to August 2011, which was established using femoral arterial inflow and kinetic venous drainage by way of the femoral vein and right internal jugular vein and a transthoracic aortic cross clamp. TEE was used to guide cannulation of the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). The success rate and the complication rate of TEE guided cannulation for peripheral CPB were evaluated and compared with the results of fluoroscopy guided cannulation in a historical control group.

RESULTSOne hundred and twenty-nine consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB. There were 67 female (51.9%) and 62 male (48.1%) patients, ranging in age from 13 to 70 years (mean (43.94 ± 13.82) years) and body surface area 1.32 to 2.39 m(2) (mean (1.71 ± 0.20) m(2)). Some 61 (47.3%) patients underwent mitral valve repair, 27 (20.9%) mitral valve replacement, 27 (20.9%) left atrial myxoma removal, and 14 (10.9%) ventricular septal defect repair. Of the 129 patients, TEE guided cannulation of the IVC or SVC was successful in all patients (100%), and no puncture related complications occurred in all patients. Of the 129 patients, successful cannulation of the AAO was achieved in all patients (100%), and aortic perforation occurred in 1 patient (0.78%) under TEE guidance. Of the 42 patients in the historical control group, successful cannulation occurred in 39 patients (92.86%), and major complications occurred in 3 patients (7.14%) under fluoroscopy guidance. TEE guided cannulation of the AAO significantly improved success rate (100% vs. 92.86%, P = 0.014) and decreased complication rate (0.78% vs. 7.14%, P = 0.046).

CONCLUSIONTEE may be useful in guiding successful placement of the cannulae in the IVC, SVC, and AAO in the establishment of peripheral CPB during robotic cardiac surgery.

Adolescent ; Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Cardiopulmonary Bypass ; methods ; Echocardiography, Transesophageal ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Robotics ; methods ; Young Adult

BACKGROUND: It has been reported that about one-sixth of all cerebral infarcts are due to cerebral embolism of cardic origin. But transthoracic echocardiographic examination(TTE) of patients with embolic strokes has made low yield for identifying the cause of cardiac or extracardiac source of embolism. Recently, transesophageal echocardiography(TEE) has been proved to be more sensitive than TTE for that purpose. We have studied to detect the potential sources of embolism and to asess the diagnostic yield of TEE in the patient with ischemic strokes. METHOD: Thirty-nine patients with recent cerebral ischemic events(19 men, 20 women, mean age 61), and thirty-eight control patients with other cardiac disease(14 men, 24 women, mean age 52) were examined by both TTE and biplane TEE. For detection of patent foramen ovale, transesophageal contrast echocardiography using 10 ml of agitated saline was performed in all patients. Thoracic aorta, arch of aorta, and ascending aorta were examined during pull back of esophageal probe. RESULTS: 1) TEE is superior to TTE for detection of potential sources pf embolism in the ischemic stroke patients(82 vs 21%, p < 0.001). 2) The potential sources of embolism diagnosed by TEE in the ischemic stroke patients were as follows : 18 aortic atherosclerotic plaque or clot, 11 left atrial(LA) spontaneous echo contrast, 8 LA appendage thrombus, 6 LA thrombus, 6 atrial septal aneurysm, 6 mitral stenosis, 3 patent foramen ovale and 1 prosthetic valve. 3) TEE is the unique procedure to diagnose aortic lesions, LA spontaneous echo contrast, atrial septal aneurysm and patent foramen ovale. 4) The incidence of the aortic lesions by TEE is significantly higher in the patients with ischemic stroke than in the controls(46 vs 11%, p < 0.01). CONCLUSION: Transesophageal echocardiography is useful for detection of potential cardiac and extracardiac sources of embolism compared with TTE and is a unique method for diagnosing aortic atherosclerotic lesion, left atrial spontaneous echo contrast, atrial septal aneutysm, patent foramen ovale and small left atrial appendage thrombus.
Aneurysm ; Aorta ; Aorta, Thoracic ; Atrial Appendage ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Female ; Foramen Ovale, Patent ; Humans ; Incidence ; Intracranial Embolism ; Male ; Methods ; Mitral Valve Stenosis ; Plaque, Atherosclerotic ; Stroke ; Thrombosis

OBJECTIVES: In mitral stenosis, there is an alteration of normal left atrial hemodynamics because the narrowed mitral valve prolongs the decay in diastolic pressure, and atrial function may be impaired secondary to atrial fibrillation. In this study, we purposed to evaluation of the pulmonary venous flow patterns in the patients with mitral stenosis using transesophageal echocardiography. METHODS: The study was performed on 35 patients(13 men and 22 women, mean age 51±13.1 years) with mitral stenosis. We measured the left ventricular end-diastolic and end-systolic dimension, left atrial dimension, mitral valve area by planimetry method and the mean pressure gradient by transthoracic echocardiography. Systolic and diastolic peak velocities, atrial reversal and diastolic pressure half time of pulmonary venous flow by transesophageal echocardiography were evaluated. RESULTS: 1) The pulmonary venous peak systolic and diastolic flow velocities were 27.5±7.0cm/sec, 28.2±9.3cm/sec in patients with sinus rhythm, and 23.9±7.6cm/sec, 27.1±8.3cm/sec in patients with artial fibrillation. But there was no difference between patients with sinus rhythm and with atrial fibrillation. 2) The lesser mitral valve area, the more decreased peak systolic velocity and systolic to diastolic flow ratio. Especially, the systolic to diastolic flow ratio was significantly decreased(1.16±0.26, 0.95±0.23, 0.68±0.20, p < 0.05). But there was no difference at the peak diastolic velocity. 3) The thrombus or spontaneous echo contrast in the left atrium was not influence on the pulmonary venous flow pattern. CONCLUSION: In mitral stenosis, systolic flow and systolic to diastolic flow ratio decrease with the decrease of mitral valve area and diastolic flow becomes predominant, which may be useful in assessing the hemodynamics of mitral stenosis.
Atrial Fibrillation ; Atrial Function ; Blood Pressure ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Atria ; Hemodynamics ; Humans ; Male ; Methods ; Mitral Valve ; Mitral Valve Stenosis ; Thrombosis