Transesophageal Echocardiography

Peterson, Gail; Brickner, M. Elizabeth; Reimold, Sharon C.

doi:10.1161/01.cir.0000071540.97144.89

Cited by 78 publications

(5 citation statements)

References 20 publications

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“…TEE is considered safe with a 0.025 complication rate [66] but cases of paradoxical air emboli have been published [67] and the risks of hypotension during the procedure should not be underestimated in acute stroke patients [39]. …”

Section: Cardiac Imagingmentioning

confidence: 99%

Cardiac Workup of Ischemic Stroke

Ustrell

Pellisé²

2010

CCR

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Stroke is the leading cause of disability in developed countries and the third cause of mortality. Up to 15-30% of ischemic strokes are caused by cardiac sources of emboli being associated with poor prognosis and high index of fatal recurrence. In order to establish an adequate preventive strategy it is crucial to identify the cause of the embolism. After a complete diagnostic workup up to 30% of strokes remain with an undetermined cause, and most of them are attributed to an embolic mechanism suggesting a cardiac origin.There is no consensus in the extent and optimal approach of cardiac workup of ischemic stroke. Clinical features along with brain imaging and the study of the cerebral vessels with ultrasonography or MRI/CT based angiography can identify other causes or lead to think about a possible cardioembolic origin.Atrial fibrillation is the most common cause of cardioembolic stroke. Identification of occult atrial fibrillation is essential. Baseline ECG, serial ECG(’s), cardiac monitoring during the first 48 hours, and Holter monitoring have detection rates varying from 4 to 8% each separately. Extended cardiac monitoring with event loop recorders has shown higher rates of detection of paroxysmal atrial fibrillation.Cardiac imaging with echocardiography is necessary to identify structural sources of emboli. There is insufficient data to determine which is the optimal approach. Transthoracic echocardiography has an acceptable diagnostic yield in patients with heart disease but transesophageal echocardiography has a higher diagnostic yield and is necessary if no cardiac sources have been identified in patients with cryptogenic stroke with embolic mechanism.

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Section: Cardiac Imagingmentioning

confidence: 99%

Cardiac Workup of Ischemic Stroke

Ustrell

Pellisé²

2010

CCR

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“…The esophageal duct is located just behind the posterior wall of the LA allowing a favorable acoustic window of the region of the heart. This access path has been used extensively for echocardiographic imaging (Ward and Lang 2003) with little or no pain under intravenous sedation (Peterson et al 2003).…”

Section: Introductionmentioning

confidence: 99%

Circumferential lesion formation around the pulmonary veins in the left atrium with focused ultrasound using a 2D-array endoesophageal device: a numerical study

Pichardo

Hynynen

2007

Phys. Med. Biol.

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Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia affecting humans. The electrical isolation by ablation of the pulmonary veins (PVs) in the left atrium (LA) of the heart has been proven as an effective cure of AF. The ablation consists mainly in the formation of a localized circumferential thermal coagulation of the cardiac tissue surrounding the PVs. In the present numerical study, the feasibility of producing the required circumferential lesion with an endoesophageal ultrasound probe is investigated. The probe operates at 1 MHz and consists of a 2D array with enough elements (114 x 20) to steer the acoustic field electronically in a volume comparable to the LA. Realistic anatomical conditions of the thorax were considered from the segmentation of histological images of the thorax. The cardiac muscle and the blood-filled cavities in the heart were identified and considered in the sound propagation and thermal models. The influence of different conditions of the thermal sinking in the LA chamber was also studied. The circumferential ablation of the PVs was achieved by the sum of individual lesions induced with the proposed device. Different scenarios of lesion formation were considered where ultrasound exposures (1, 2, 5 and 10 s) were combined with maximal peak temperatures (60, 70 and 80 degrees C). The results of this numerical study allowed identifying the limits and best conditions for controlled lesion formation in the LA using the proposed device. A controlled situation for the lesion formation surrounding the PVs was obtained when the targets were located within a distance from the device in the range of 26 +/- 7 mm. When combined with a maximal temperature of 70 degrees C and an exposure time between 5 and 10 s, this distance ensured preservation of the esophageal structures, controlled lesion formation and delivery of an acoustic intensity at the transducer surface that is compatible with existing materials. With a peak temperature of 70 degrees C, the device and setup presented here induced highly localized lesions with a lesion volume varying from 10 +/- 4 to 18 +/- 7 mm(3) for an ultrasound exposure between 5 and 10 s, respectively, while the intensity varied from 26 +/- 7 to 20 +/- 6 W cm(-2).

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“…TEE specifically has seen major growth in terms of technology, use, and indications since its introduction to the medical community nearly half a decade ago. 33 These advancements include the increase in TEE use from 29% in 2009 to 45% in 2011, and upgrades in technology such as the 3-D TEE systems. 34 3-D TEE imaging has been shown to improve detecting infective endocarditis in a study by Chahine et al 35 Additional advancements include continuous TEE monitoring, strain imaging, and diastolic function assessment.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Anesthesia Intraoperative Interpretation Accuracy of Transesophageal Echocardiograms: A Review of the Current Literature and Meta-Analysis

Kawana¹,

Vachirakorntong²,

Zhitny³

et al. 2023

VHRM

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Background In the United States, echocardiography is an essential component of the care of many cardiac patients. Recently, increased attention has been given to the accuracy of interpretation of cardiac-based procedures in different specialties, amongst them the field of cardiac anesthesiology and primary echocardiographers for transesophageal echocardiogram (TEE). The purpose of this study was to assess the TEE skills of cardiac anesthesiologists in comparison to primary echocardiographers, either radiologists or cardiologists. In this systematic review, we evaluated available current literature to identify if cardiac anesthesiologists interpret TEE procedures at an identical level to that of primary echocardiographers. Methods A PRISMA systematic review was utilized from PubMed from the years 1952–2022. A broad keyword search of “Cardiology Anesthesiology Echocardiogram” and “Echocardiography Anesthesiology” to identify the literature was used. From reviewing 1798 articles, there were a total of 9 studies included in our systematic review, 3 of which yielded quantitative data and 6 of which yielded qualitative data. The mean accuracy from each of these three qualitative studies was calculated and used to represent the overall accuracy of cardiac anesthesiologists. Results Through identified studies, a total of 8197 TEEs were interpreted by cardiac anesthesiologists with a concordance rate of 84% to the interpretations of primary echocardiographers. Cardiac anesthesiologists had a concordance rate of 83% when compared to radiologists. On the other hand, cardiac anesthesiologists and cardiologists had a concordance rate of 87% in one study and 79% in another study. Conclusion Based on these studies, cardiac anesthesiologists are shown to interpret TEEs similarly to that of primary echocardiographers. At this time, there is no gold standard to evaluate the accuracy of TEE readings. One way to address this is to individually assess the TEE interpretation of anesthesiologists and primary echocardiographers with a double-blind study.

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Transesophageal Echocardiography

Cited by 78 publications

References 20 publications

Cardiac Workup of Ischemic Stroke

Cardiac Workup of Ischemic Stroke

Circumferential lesion formation around the pulmonary veins in the left atrium with focused ultrasound using a 2D-array endoesophageal device: a numerical study

Cardiac Anesthesia Intraoperative Interpretation Accuracy of Transesophageal Echocardiograms: A Review of the Current Literature and Meta-Analysis

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