The role of transoesophageal echocardiography in adolescents and adults with congenital heart defects

Abstract

Between April 1985 and December 1989, outpatient transoesophageal echocardiography was performed in 133 adolescent and adult patients (14% of all outpatient transoesophageal studies) (age range 11-78 years; weight 30-95 kg) to determine the value of this technique both in establishing the primary diagnosis (62 patients) and in the post-surgical follow up (71 patients) of congenital heart disease. The results were correlated with the findings of precordial echocardiography, catheterization and surgical inspection. Clear advantages of transoesophageal imaging over precordial imaging include: (1) direct identification of atrial appendage morphology in all patients; (2) delineation of systemic and pulmonary venous connections; (3) atrial baffle function (eight patients); (4) better evaluation of the Fontan-type circulation (five patients); (5) improved morphologic assessment of the atrioventricular junction and valves (29 patients); (6) definition of subaortic obstruction (18 patients); and (7) definition of ascending aortic morphology in Marfan's syndrome and supravalvar aortic stenosis (13 patients). The problems encountered with transoesophageal imaging include: (1) limited imaging planes; (2) poor visualization of specific intracardiac regions (antero-apical trabecular septum, right ventricular outflow tract); (3) flow masking behind implanted intracardiac prosthetic material.

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary

“…TTE supplemented with intraoperative TEE usually provides sufficient data to permit operative intervention without the need to obtain additional preoperative diagnostic structural information in patients with Ebstein's anomaly. [185][186][187] The diagnostic workup may require a TEE to assess the presence of an ASD or to delineate intracardiac anatomy in patients with suboptimal TTE images.…”

ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article

“…Echocardiography is useful in the performance of interventional therapeutic procedures. [165][166][167][168][169][170][171][172][173][174][175][176][177] Class I…”

Diagnosis in adolescents and adults with congenital heart disease. Prospective assessment of individual and combined roles of magnetic resonance imaging and transesophageal echocardiography.

“…Palliated, 2 Unoperated, 3 Double-inlet left ventricle, 9 With pulmonary stenosis, 6 (shunt, 1) With pulmonary hypertension, 2 With large systemic-to-pulmonary shunt (mild PS), 1 Atrial septal defect, 6 Primum, 1 Secundum, 3 Sinus venosus, 2 (superior, 1; inferior, 1) Ventricular septal defect, 6 With pulmonary stenosis, 4 With pulmonary hypertension, 2 Corrected transposition of the great arteries, 5 Repaired, 1 With pulmonary stenosis, 3 With pulmonary hypertension, 1 Double-outlet right ventricle, 4 With pulmonary stenosis, 3 With pulmonary hypertension, 1 Tricuspid atresia, 3 With pulmonary stenosis, 3 Other, 20 Atrioventricular septal defect, 2 Aortic coarctation, 2 Pulmonary atresia with intact ventricular septum, 2 Absent left connection (mitral atresia), 2 Common arterial trunk, 2 Aortic stenosis, 2 Double-outlet left ventricle, 2 Left isomerism, 2 Right isomerism, 1 Pulmonary valve stenosis, 1 LEOPARD syndrome, hypertrophic cardiomyopathy, 1 Constrictive pericarditis after aortic valve surgery, 1 VSD indicates ventricular septal defect; PS, pulmonary stenosis; and PHT, pulmonary hypertension. diagnostic problem, the information available from their medical and surgical notes and previous angiograms was examined, and the patients had a diagnostic work-up that included physical examination, ECG, chest radiograph, and TTE.…”

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] As would be expected, most early studies have been mainly descriptive or concerned with validating the new techniques. Only a few have addressed the adult population specifically,9,20 and none have included both investigations in a prospective comparative design.…”