bicuspid aortic valve; transesophageal echocardiography, transnasal, monoplane probeBicuspid aortic valve is a common congenital heart disease whose incidence is 0.4-2.25%, 1 often associated with aortic coarctation. Complications of this valve disease are regurgitation since pediatric age, while valvular stenosis, ascending aorta dilatation, 2 and dissection 3 may occur after 40 years. Transthoracic echocardiography (TTE) successfully identifies this valvular anomaly in infant and children, whilst transesophageal echocardiography (TEE) is often required in adults.We report a case of bicuspid aortic valve diagnosed by a transesophageal echocardiography through nasal way (TEENW). A 54-yearold hypertensive man was referred for dyspnea and throbbing. On physical examination heart rate was 66 beats/min, arterial blood pressure was 145/90 mmHg and an apical pandiastolic murmur was present. ECG showed anterior fascicular block. TTE with color-Doppler revealed mild left ventricular hypertrophy (interventricular septum and posterior wall = 13 mm), thickened and reduced excursions of aortic cusps with suspect of bicuspid valve, moderate aortic regurgitation with a mild stenosis (transvalvular peak = 41 mmHg, average gradient = 23 mmHg), and ascending aorta dilatation (46 mm). In order to reach a definitive diagnosis, agreement from the patient was obtained to perform a TEENW, using a 10F, multifrequency (5.5-10 MHz), monoplane probe developed for intracardiac ultrasounds (AcuNav, Somerset, WI; Acuson Corporation, Mountain View, CA, U.S.A.). This probe was previously used for transesophageal examina-
Percutaneous device closure of patent foramen ovale (PFO) has become an effective and safe alternative to medical or surgery treatment. Transesophageal echocardiography (TEE), as commonly used to guide this procedure, has the limitation to require general anesthesia. Recently, intracardiac echocardiography (ICE) with AcuNav probe was used to guide percutaneous PFO closure. We report a 42 year-old man with two previous cryptogenetic strokes in whom both diagnosis and guidance of PFO closure were performed by means of TEE using the AcuNav catheter introduced through nasal way (TEENW). This technique, that does not require general anesthesia, provided adequate and complete view of the Amplatzer procedure. TEENW might offer a feasible and equivalent echocardiographic alternative either to standard TEE or ICE as a guide to percutaneous PFO closure.
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