Transoesophageal echocardiography in congenital heart disease

Transesophageal imaging of the mid to distal left pulmonary artery in congenital heart disease

We assessed how well transesophageal echocardiography (TEE) images the left pulmonary artery (LPA) in congenital heart disease (CHD). Seventy-nine consecutive patients with CHD were studied. Ideal imaging displayed the mid to distal LPA from the takeoff of the upper lobe artery through the second bifurcation. Imaging quality was graded from 1 (excellent) to 5 (not visualized). Imaging quality was excellent in 8 (10%) patients, good in 25 (32%), fair in 23 (29%), and poor in 12 (15%); the LPA was not visualized in 11 (14%) patients. Imaging grade averaged 2.9 +/- 1.2 (SD) and correlated poorly with weight (r = 0.24) but was better in patients without prior operation (grade 2.8 vs 3.3, P <.05). In 2 patients, TEE showed residual stenosis. Thus informative LPA imaging by TEE can be achieved in many patients with CHD and has the potential to change intraoperative or postoperative treatment.

Advances in echocardiographic diagnostic modalities for the pediatrician

Two-dimensional Doppler echocardiography has become the primary diagnostic tool in the assessment of infants and children with congenital and acquired heart disease. Over the past 10 years, specialized echocardiographic techniques have also become critical components in the evaluation and treatment of these patients. Using fetal echocardiography enables us to image the heart early in gestation and have begun to understand those lesions that can develop and progress in utero. Transesophageal echocardiography has allowed you to image the patient with congenital heart disease during repair in the operating room and in the cardiac catheterization laboratory so that adequacy of the repair can be assess and any residual lesions addressed immediately. Both of these specialized techniques are discussed in detail, with a brief overview at the three-dimensional future of echocardiography in the pediatric patient.