Transnasal Transesophageal Stress Echocardiography

Abstract

Exercise echocardiography is a widely used modality for the noninvasive assessment of coronary artery disease. However, limitations exist inherent to the acquisition of transthoracic echocardiographic images. Although transesophageal echocardiography has been used during pacing or pharmacological stress, its use during exercise stress testing has not been clinically feasible due to the large probe size. Recently, a miniaturized transesophageal probe was developed, and we sought to test the feasibility of using this probe during graded treadmill exercise testing. Normal subjects were studied with transnasal echocardiography during upright treadmill exercise testing. The transnasal probe was passed in 13 of the 15 subjects. Excellent-quality monoplane two-dimensional echocardiographic images were obtained in all patients in the upright position. During exercise treadmill testing, high quality clinically useful echocardiographic images of the left ventricular short axis could be maintained. We conclude that transnasal transesophageal stress echocardiography may offer a new modality for the exercise assessment of ischemic heart disease.

Transesophageal Echocardiography Through Nasal Way as a Guide to Percutaneous Closure of Patent Foramen Ovale

“…Several studies reported the feasibility and accuracy of ICE using a miniaturized 10 Fr, monoplane, probe (AcuNav/Acuson/Siemens) to guide transcatheter PFO closure 13–15 . This miniaturized probe has been used previously during conventional TEE, 7 and the nasal approach by means of both the AcuNav catheter and a prototype TEE probe has also been utilized for the purpose 8–12 . Prompted by the above studies, we felt that the AcuNav transducer inserted via the nose could have been used profitably to guide transcatheter closure of PFO.…”

“…[13][14][15] This miniaturized probe has been used previously during conventional TEE, 7 and the nasal approach by means of both the AcuNav catheter and a prototype TEE probe has also been utilized for the purpose. [8][9][10][11][12] Prompted by the above studies, we felt that the AcuNav transducer inserted via the nose could have been used profitably to guide transcatheter closure of PFO.…”

“…Three days later, the patient underwent percutaneous PFO closure with the Amplatzer septal occluder (AGA Medical, Golden Valley, Minnesota). Prompted by previous reports, 7–11 we decided to perform the procedure under guidance of TEENW, with the purpose to avoid either two vascular accesses or endotracheal intubation with further general anesthesia 12–15 …”

“…Three days later, the patient underwent percutaneous PFO closure with the Amplatzer septal occluder (AGA Medical, Golden Valley, Minnesota). Prompted by previous reports, [7][8][9][10][11] we decided to perform the procedure under guidance of TEENW, with the purpose to avoid either two vascular accesses or endotracheal intubation with further general anesthesia. [12][13][14][15] With the patient in supine position, a miniaturized, 10 Fr, multifrequency (5.5-10 MHz), monoplane probe developed for intracardiac echocardiography (ICE) (AcuNav, Acuson/ Siemens, Mountain View, CA), was inserted into the esophagus, only with a lubricant jelly, through a nostril (Fig.…”

Pacing stress echocardiography

“…High-rate pacing is a valid stress test to be used in conjunction with echocardiography; it is independent of physical exercise and does not require drug administration[ 1 ]. Its evolution in the last 20 years started from an invasive (intravenous) right atrial pacing modality, combined with a ionising imaging technique such as radionuclide ventriculography; it moved to a seminvasive modality combined with 2D echo, using transnasal[ 2 ] or transoral catheter for transesophageal [ 3 - 8 ] left atrial pacing; and finally evolved to a totally noninvasive modality with external programming in patients with permanent pacemaker for right atrial or ventricular pacing [ 1 , 9 - 11 ].…”