Abstract
During recent years, transesophageal echocardiography (TEE) has evolved as a major adjunct to conventional transthoracic echocardiography. Although TEE is a semi-invasive procedure, carries some discomfort for the patient and has a small, clinical risk [1], it has a clear advantage over transthoracic echocardiography in selected patients. Due to higher transducer frequencies, TEE provides improved image quality for cardiac structures with close proximity to the esophagus. In patients with poor transthoracic image quality (those with emphysema, chest wall abnormalities, prior heart surgery or on artificial ventilation) TEE is also a clinically helpful alternative to the transthoracic technique. Finally, TEE currently offers the only available echocardiographic window during open heart surgery.
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References
Daniel WG, Erbel R, Kasper W et al. Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations. Circulation 1991; 83: 817–21.
Daly JJ. Venoarterial shunting in obstructive pulmonary disease. N Engl J Med 1968; 278: 952–3.
Meister SG, Grossman W, Dexter L, Dalen JE. Paradoxical embolism. Am J Med 1972; 53: 292–8.
Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984; 59: 17–20.
Strunk BL, Cheitlin MD, Stulbarg MS, Schiller NB. Right-to-left interatrial shunting through a patent foramen ovale despite normal intracardiac pressures. Am J Cardiol 1987; 60: 413–5.
Lynch JJ, Schuchard GH, Gross CM, Wann LS. Prevalence of right-to-left atrial shunting in a healthy population: Detection by Valsalva maneuver contrast echocardiography. Am J Cardiol 1984; 53: 1478–80.
Dubourg O, Bourdarias JP, Farcot JC et al. Contrast echocardiographic visualization of cough-induced right to left shunt through a patent foramen ovale. J Am Coll Cardiol 1984; 4: 587–94.
Webster MWI, Chancellor AM, Smith HJ, Swift DL, Sharpe DN, Bass NM. Patent foramen ovale in young stroke patients. Lancet 1988; 2: 11–2.
Lechat P, Mas JL, Lascault G et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988; 318: 1148–52.
Kronik G, Mösslacher H. Positive contrast echocardiography in patients with patent foramen ovale and normal right heart hemodynamics. Am J Cardiol 1982; 49: 1806–9.
Stoddard MF, Keedy DL, Dawkins PR. The cough test is superior to the valsalva maneuver in the delineation of right-to-left shunting through a patent foramen ovale during contrast transesophageal echocardiography. Am Heart J 1993; 125: 185–9.
Gin KG, Huckell VF, Pollick C. Femoral vein delivery of contrast medium enhances trans-thoracic echocardiographic detection of patent foramen ovale. J Am Coll Cardiol 1993; 22: 1994–2000.
Langholz D, Louie EK, Konstadt SN, Rao TL, Scanlon PJ. Transesophageal echocardiographic demonstration of distinct mechanisms for right to left shunting across a patent foramen ovale in the absence of pulmonary hypertension. J Am Coll Cardiol 1991; 18: 1112–7.
Cox D, Taylor J, Nanda NC. Refractory hypoxemia in right ventricular infarction from rightto-left shunting via a patent foramen ovale: Efficacy of contrast transesophageal echocardiography. Am J Med 1991; 91: 653–5.
Harpaz D, Motro M, Kaplinsky E, Vered Z. Right-to-left shunt through a patent foramen ovale caused by severe tricuspid regurgitation detected with color doppler echocardiography. J Am Soc Echocardiogr 1992; 5: 77–80.
Thompson RC, Finck SJ, Leventhal JP, Safford RE. Right-to-left shunt across a patent foramen ovale caused by cardiac tamponade: Diagnosis by transesophageal echocardiography. Mayo Clin Proc 1991; 66: 391–4.
Lang I, Steurer G, Weissei M, Burghuber OC. Recurrent paradoxical embolism complicating severe thromboembolic pulmonary hypertension. Eur Heart J 1988; 9: 678–81.
Inoue T, Yamaguchi H, Hayashi T, Morooka S, Takabatake Y. Right-to-left shunting through a patent foramen ovale caused by pulmonary hypertension associated with rheumatoid arthritis and Sjögren’s syndrome: a case report. Angiology 1990; 92: 1082–5.
Begin R, Gervais A, Guerin L, Bureau MA. Patent foramen ovale and hypoxemia in chronic obstructive pulmonary disease. Eur J Resp Dis 1981; 62: 373–6.
Kovacs GS, Hill JD, Aberg T, Blesovsky A, Gerbode F. Pathogenesis of arterial hypoxemia in pulmonary embolism. Arch Surg 1966; 93: 813–5.
Moorthy SS, Losasso AM. Patency of the foramen ovale in the critically ill patient. Anesthesiology 1974; 41: 405–7.
Levine BD, Grayburn PA, Voyles WF, Greene R, Roach RC, Hackett PH. Intracardiac shunting across a patent foramen ovale may exacerbate hypoxemia in high-altitude pulmonary edema. Ann Intern Med 1991; 114: 569–70.
Chen WJ, Kuan P, Lien WP, Lin FY. Detection of patent foramen ovale by contrast trans-esophageal echocardiography. Chest 1991; 101: 1515–20.
Valdes-Cruz LM, Pieroni DR, Roland JMA, Varghese PJ. Echocardiographic detection of intracardiac right-to-left shunts following peripheral vein injections. Circulation 1976; 54: 558–62.
Biller J, Johnson MR, Adams HP et al. Further observations on cerebral or retinal ischemia in patients with right-to-left intracardiac shunts. Arch Neurol 1987; 44: 740–3.
DiTullio M, Sacco RL, Gopal A, Mohr JP, Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med 1992; 117: 461–5.
Harvey JR, Teague SM, Anderson JL, Voyles WF, Thadani U. Clinically silent atrial septal defects with evidence for cerebral embolization. Ann Intern Med 1986; 105: 695–7.
Jeanrenaud X, Bogousslaysky J, Payot M, Regli F, Kappenberger L. Foramen ovale permeable et infarctus cerebral du sujet jeune. Schweiz Med Wschr 1990; 120: 823–9.
Siostrzonek P, Zangeneh M, Gössinger H et al. Comparison of transesophageal and trans-thoracic contrast echocardiography for detection of a patent foramen ovale. Am J Cardiol 1991; 68: 1247–9.
Wilmshurst PT, Byrne JC, Webb-Peploe MM. Relation between interatrial shunts and decompression sickness in divers. Lancet 1989; 2: 1302–6.
Guggiari M, Lechat P, Garen-Colonne C, Fusciardi J, Viars P. Early detection of patent foramen ovale by two-dimensional contrast echocardiography for prevention of paradoxical air embolism during sitting position. Anesth Analg 1988; 67: 192–4.
Wu CC, Chen WJ, Chen MF, Liau CS, Chu SH, Lee YT. Left-to-right shunt through patent foramen ovale in adult patients with left-sided cardiac lesions: A transesophageal echocardiographic study. Am Heart J 1993; 125: 1369–74.
Hausmann D, Mügge A, Becht I, Daniel WG. Diagnosis of patent foramen ovale by trans-esophageal echocardiography and association with cerebral and peripheral embolic events. Am J Cardiol 1992; 70: 668–72.
van Camp G, Schulze D, Cosyns B, Vandenbossche JL. Relation between patent foramen ovale and unexplained stroke. Am J Cardiol 1993; 71: 596–8.
Louie EK, Konstadt SN, Rao TL, Scanlon PJ. Transesophageal echocardiographic diagnosis of right to left shunting across the foramen ovale in adults without prior stroke. J Am Coll Cardiol 1993; 21: 1231–7.
de Belder MA, Tourikis L, Leech G, Camm AJ. Risk of patent foramen ovale for thromboembolic events in all age groups. Am J Cardiol 1992; 69: 1316–20.
Konstadt SN, Louie EK, Black S, Rao TL, Scanlon P. Intraoperative detection of patent foramen ovale by transesophageal echocardiography. Anesthesiology 1991; 74: 212–6.
Fisher DC, Fisher EA, Budd JH, Rosen SE, Goldman ME. The incidence of patent foramen ovale in 1000 consecutive patients. A contrast transesophageal echocardiography study. Chest 1995; 107: 1504–9.
Stöllberger C, Schneider B, Abzieher F, Wollner T, Meinertz T, Slany J. Diagnosis of patent foramen ovale by transesophageal contrast echocardiography. Am J Cardiol 1993; 71: 604–6.
Mügge A, Daniel WG, Klöpper JW, Lichtlen PR. Visualization of patent foramen ovale by transesophageal color-coded Doppler echocardiography. Am J Cardiol 1988; 62: 837–9.
de Beider MA, Tourikis L, Griffith M, Leech G, Camm AJ. Transesophageal contrast echocardiography and color flow mapping: Methods of choice for the detection of shunts at the atrial level? Am Heart J 1992; 124: 1545–50.
Berkompas DC, Sagar KB. Accuracy of color Doppler transesophageal echocardiography for diagnosis of patent foramen ovale. J Am Soc Echocardiogr 1994; 7: 253–6.
Spencer MP, Thomas GI, Nicholls SC, Sauvage LR. Detection of middle cerebral artery emboli during carotid endarterectomy using transcranial doppler ultrasonography. Stroke 1990; 21: 415–23.
Teague SM, Sharma MK. Detection of paradoxical cerebral echo contrast embolization by transcranial doppler ultrasound. Stroke 1991; 22: 740–5.
Karnik R, Stöllberger C, Valentin A, Winkler WB, Slany J. Detection of patent foramen ovale by transcranial doppler ultrasound. Am J Cardiol 1992; 69: 560–2.
Nemec JJ, Marwick TH, Lorig RJ et al. Comparison of transcranial doppler ultrasound and transesophageal contrast echocardiography in the detection of interatrial right-to-left shunts. Am J Cardiol 1991; 68: 1498–502.
Nikutta P, Schneider M, Hausmann D et al. How reliable is transcranial doppler ultrasound in the assessment of patent foramen ovale? J Am Coll Cardiol I993;21:135A.
Nikutta P, Claus G, Hausmann D, Mügge A, Niedermeyer J, Kühn, Daniel WG. Assessment of transpulmonary passage of echo-contrast agents by transesophageal echocardiographic spectral Doppler. J Am Coll Cardiol 1993; 21: 136A.
Klotzsch C, Janssen G, Berlit P. Transesophageal echocardiography and contrast TCD in the detection of a patent foramen ovale: Experience with 111 patients. Neurology 1994; 44: 1603–6.
Jauss M, Kaps M, Keberle M, Haberbosch W, Domdorf W. A comparison of transesophageal echocardiography and transcranial Doppler sonography with contrast medium for detection of patent foramen ovale. Stroke 1994; 25: 1265–7.
DiTullo M, Sacco RL, Venketasubramanian N, Sherman D, Mohr JP, Homma S. Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke 1993; 24: 1020–4.
Cohnheim J. Thrombose and Embolie, Vorlesungen über Allgemeine Pathologie, Vol. 1. Berlin: Hirschwald, 1877: 134.
Leonard RCF, Neville E, Hall RJC. Paradoxical embolism. A review of cases diagnosed during life. Eur Heart J 1982; 3: 362–70.
Loscalzo J. Paradoxical embolism: Clinical presentation, diagnostic strategies, and therapeutic options. Am Heart J 1986; 112: 141–5.
Robinson FJ. Lodging of an embolus in a patent foramen ovale. Circulation 1950; 2: 304–5.
Sardesi SH, Marshall RJ, Mourant AJ. Paradoxical systemic embolisation through a patent foramen ovale. Lancet 1989; 1: 732–3.
Nelson CW, Snow FR, Barnett M, McRoy L, Wechsler AS, Nixon JV. Impending paradoxical embolism: echocardiographic diagnosis of an intracardiac thrombus crossing a patent foramen ovale. Am Heart J 1991; 122: 859–62.
Gin KG, Thompson CR, hie J, Ling H. Embolic occlusion of a patent foramen ovale: A cause of false negative contrast echocardiogram. J Am Soc Echocardiogr 1992; 5: 444–6.
Nellessen U, Daniel WG, Matheis G, Oelert H, Depping K, Lichtlen PR. Impending paradoxical embolism from atrial thrombus: Correct diagnosis by transesophageal echocardiography and prevention by surgery. J Am Coll Cardiol 1985; 5: 1002–4.
Speechly-Dick ME, Middleton SJ, Foale RA. Impending paradoxical embolism: a rare but important diagnosis. Br Heart J 1991; 65: 163–5.
Barnard SP, Kulatilake ENP, Azzu AA, Ikram S. Straddle embolus - imminent paradoxical embolus diagnosed by echocardiography and treated surgically. Eur J Cardiothorac Surg 1991; 5: 105.
Ranoux D, Cohen A, Cabanes L, Amarenco P, Bousser MG, Mas JL. Patent foramen ovale: Is stroke due to paradoxical embolism. Stroke 1993; 24: 31–4.
Black S, Cucchiara RF, Nishimura RA, Michenfelder JD. Parameters affecting occurrence of paradoxical air embolism. Anesthesiology 1989; 71: 235–41.
Cucchiara RF, Seward JB, Nishimura RA, Nugent M, Faust RJ. Identification of patent foramen ovale during sitting position craniotomy by transesophageal echocardiography with positive airway pressure. Anesthesiology 1985; 63: 107–9.
Ellis JE, Lichtor JL, Feinstein SB et al. Right heart dysfunction, pulmonary embolism, and paradoxical embolization during liver transplantation. A transesophageal two-dimensional echocardiographic study. Anesth Analg 1989; 68: 772–6.
Moon RE, Camporesi EM, Kisslo JA. Patent foramen ovale and decompression sickness in divers. Lancet 1989; 1: 513–5.
Vik A, Jenssen BM, Brubakk AO. Paradoxical air embolism in pigs with a patent foramen ovale. Undersea Biomed Res 1992; 19: 361–74.
Pell AC, Hughes D, Keating J, Christie J, Busuttil A, Sutherland GR. Brief report: fulminating fat embolism syndrome caused by paradoxical embolism through a patent foramen ovale. N Engl J Med 1993; 329: 926–9.
Vasiljevic JD, Abdulla AK. Coronary embolism by metastatic choriocarcinoma of the uterus: An unusual cause of ischemic heart disease. Gynecol Oncol 1990; 38: 289–92.
Wilson T, Becker SN. Postoperative death from pulmonary and paradoxic emboli containing transitional epithelium. A case report. Obstet Gynecol 1972; 39: 286–91.
Rosenow EC, Osmundson PJ, Brown ML. Pulmonary embolism. Mayo Clin Proc 1981; 56: 161–78.
Stoliberger C, Slany J, Schuster I, Leitner H, Winkler WB, Karnik R. The prevalence of deep venous thrombosis in patients with suspected paradoxical embolism. Ann Intern Med 1993; 119: 461–5.
Hausmann D, Mügge A, Daniel WG. Identification of patent foramen ovale permitting paradoxical embolism. J Am Coll Cardiol 1995; 26: 1030–8.
Schneider B, Hofmann T, Justen MH, Meinertz T. Chiari’s network: Normal anatomic variant or risk factor for arterial embolic events? J Am Coll Cardiol 1995; 26: 203–10.
Bridges ND, Hellenbrand W, Latson L, Filiano J, Newburger JW, Lock JE. Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation 1992; 86: 1902–8.
Homma S, DiTullio MR, Sacco RL, Mihalatos D, Li Mandri G, Mohr JP. Characteristics of patent foramen ovale associated with cryptogenic stroke. A biplane transesophageal echo-cardiographic study. Stroke 1994; 25: 582–6.
Yoshida K, Yoshikawa J, Hoyumi T et al. Detection of left main coronary artery stenosis by transesophageal color Doppler and two-dimensional echocardiography. Circulation 1990; 81: 1271–6.
Yamagishi M, Yasu T, Ohara K, Kuro M, Miyatake K Detection of coronary blood flow associated with left main coronary artery stenosis by transesophageal Doppler color flow echocardiography. J Am Coll Cardiol 1991; 17: 87–93.
Redberg RF, Sobol Y, Chou TM et al. Adenosine-induced coronary vasodilatation during transesophageal Doppler echocardiography. Rapid and safe measurement of coronary flow reserve ratio can predict significant left anterior descending coronary stenosis. Circulation 1995; 92: 190–6.
von Bibra H, Stempfle HU, Poll A, Schlief R, Emslander H. Echo contrast agents improve flow display of color Doppler. Echocardiography 1991; 5: 533–40.
Geny B, Mettauer B, Muan B et al. Safety and efficacy of a new transpulmonary echo contrast agent in echocardiographic studies in patients. J Am Coll Cardiol 1993; 22: 1193–8.
Crouse LJ, Cheirif J, Hanly DE et al. Opacification and border delineation improvement in patients with suboptimal endocardial borer definition in routine echocardiography: Results of phase III Albunex multicenter trial. J Am Coll Cardiol 1993; 22: 1494–500.
Porter TR, Xie F, Kricsfeld A, Chiou A, Dabestani A. Improved endocardial border resolution during dobutamine stress echocardiography with intravenous sonicated dextrose albumin. J Am Coll Cardiol 1994; 23: 1440–3.
Schröder K, Agrawal R, Völler H, Schlief R, Schröder R. Improvement of endocardial border delineation in suboptimal stress-echocardiograms using the new left heart contrast agent SHU 508A. Int J Cardiac Imag 1994; 10: 45–51.
von Bibra H, Sutherland G, Becher H, Neudert J, Nihoyannopoulos P. Clinical evaluation of left heart Doppler contrast enhancement by a saccharide-based transpulmonary contrast agent. J Am Coll Cardiol 1995; 25: 500–8.
Iliceto S, Caiati C, Aragona P, Verde R, Schlief R, Rizzon P. Improved Doppler signal intensity in coronary arteries after intravenous peripheral injection of a lung-crossing contrast agent (SHU 508A). J Am Coll Cardiol 1994; 23: 184–90.
Aggarwal KK, Gatewood RP, Nanda NC, Chopra KL. Improved tranesophageal echocardiographic assessment of significant proximal narrowing of the left anterior descending and left circumflex coronary arteries using echo contrast enhancement. Am J Cardiol 1994; 73: 1131–3.
Kozakova M, Palombo C, Zanchi M, Distante A, L’Abbate A. Increased sensitivity of flow detection in the left coronary artery by transesophageal echocardiography after intravenous administration of transpulmonary stable echocontrast agent. J Am Soc Echocardiogr 1994; 7: 327–36.
Dittrich HC, Bales GL, Kuvelas T, Hunt RM, McFerran BA, Greener Y. Myocardial contrast echocardiography in experimental coronary artery occlusion with a new intravenously administered contrast agent. J Am Soc Echocardiogr 1995; 8: 465–74.
Cheirif J, Zoghbi WA, Raizner AE. Assessment of myocardial perfusion in humans by contrast echocardiography, I: Evaluation of regional coronary reserve by peak contrast intensity. J Am Coll Cardiol 1988; 11: 735–43.
Kaul S, Glasheen W, Ruddy TD, Pandian NG, Weyman AE, Okada RD. The importance of defining left ventricular area at risk in vivo during acute myocardial infarction: An experimental evaluation with myocardial contrast two-dimensional echocardiography. Circulation 1987; 75: 1249–60.
Voci P, Bilotta F, Merialdo P, Agati L. Myocardial contrast enhancement after intravenous injection of sonicated albumin microbubbles: A transesophageal echocardiography dipyridamole study. J Am Soc Echocardiogr 1994; 7: 337–46.
Angermann CE, Krüger TM, Junge R et al. Intravenous albunex during transesophageal echocardiography: Quantitative assessment by videodensitometry and integrated backscatter analysis from unprocessed radiofrequency signals. J Am Soc Echocardiogr 1995; 8: 839–53.
Voci P, Bilotta F, Caretta Q, Chiarotti F, Mercanti C, Marino B. Mechanisms of incomplete cardioplegia distribution during coronary artery surgery. An intraoperative transesophageal contrast echocardiography study. Anesthesiology 1993; 79: 904–12.
Allen BS, Winkelman JW, Hanafy H et al. Retrograde cardioplegia does not adequately perfuse the right ventricle. J Thorac Cardiovasc Surg 1995; 109: 1116–24.
Zaroff J, Aronson S, Lee BK, Feinstein SB, Walker R, Wiencek JG. The relationship between immediate outcome after cardiac surgery, homogeneous cardioplegia delivery, and ejection fraction. Chest 1994; 106: 38–45.
Aronson S, Lee BK, Wiencek JG et al. Assessment of myocardial perfusion during CABG surgery with two-dimensional transesophageal contrast echocardiography. Anesthesiology 1991; 75: 433–40.
Asamuna T, Tanabe K, Yoshitomi H, Murakami Y, Sano K, Morioka S. Improved anatomic delineation of left atrium and appendage with myocardial contrast enhancement evaluated by transesophageal echocardiography. Circulation 1995;92(suppl):I–193.
Lindert O, Mügge A, Tonduangu DK et al. Transösophageale Echocardiographie mit dem lungengängen Kontrastmittel BY963: Verbesserte Darstellng der linksventrikulären Wandbewegung. Z Kardiol 1995; 84 (suppl. 3): 9.
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Hausmann, D., Mügge, A., Kühn, H., Daniel, W.G. (1997). Contrast echo-enhancement during transesophageal echocardiography: indications and clinical benefits. In: Nanda, N.C., Schlief, R., Goldberg, B.B. (eds) Advances in Echo Imaging Using Contrast Enhancement. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5704-9_18
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