Value of transesophageal echocardiography during complex or high-risk coronary interventions in the cardiac catheterization laboratory

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      The increasing complexity of coronary intervention and the limitations of hemodynamic and electrocardiographic monitoring have facilitated the introduction of new imaging techniques in the cardiac catheterization laboratory. Transesophageal echocardiography (TEE) has proved valuable for left ventricular (LV) monitoring during high-risk surgery, but its reported use in the cardiac catheterization laboratory has been limited. Accordingly, we assessed the feasibility and value of TEE during complex or high-risk coronary intervention in the catheterization laboratory.
      The TEE probe was successfully introduced in 53 of 54 (98%) attempted cases. The primary imaging goals were LV monitoring in 39 (74%), left main coronary artery (LMCA) imaging in 9 (17%) and both in 5 (9%) cases. LV monitoring was successful in 43 of the 44 (98%) attempted cases. In 25 (58%) of these, additional important observations were made by TEE that were not apparent by symptoms, or hemodynamic, electrocardiographic or radiographic monitoring. These included unexpected changes in regional myocardial function (n = 20), alteration in LV size (n = 2), exclusion of considered pericardial tamponade (n = 2) and detection of unsuspected mitral regurgitation (n = 1). Management of the interventional procedure was directly influenced by the findings of TEE in 11 of the 43 (26%) monitored cases. The LMCA was successfully visualized in 13 of the 14 (93%) attempted cases. In 11 of these, measurement of the stenotic lesion diameter by TEE correlated well with quantitative angiography both before (r = 0.83, standard error of the estimate = 0.01, p < 0.002) and after (r = 0.80, standard error of the estimate = 0.03, p < 0.005) intervention. All patients tolerated TEE well without complications.
      TEE during complex or high-risk coronary intervention is a feasible, safe and valuable tool for rapid detection of altered myocardial function and thus may influence clinical decisions during interventional procedure. In patients undergoing LMCA intervention, TEE accurately measures stenotic lesion diameter before and after intervention, providing a feasible noninvasive means for follow-up.
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        • Sibley DH
        • Millar HD
        • Hartley CT
        • Whitlow PL
        Subselective measurement of coronary blood flow velocity using a steerable Doppler catheter.
        J Am Coll Cardiol. 1986; 8: 1332-1340
        • Pandian NG
        • Kreis A
        • Brockway B
        • Isner JM
        • Sacharoff A
        • Boleza E
        • Caro R
        • Muller D
        Ultrasound angioscopy: real-time, two-dimensional, intraluminal ultrasound imaging of blood vessels.
        Am J Cardiol. 1988; 62: 493-494
        • Mizuko K
        • Miyamoto A
        • Satomura K
        • Kurita A
        • Arai T
        • Sakurada M
        • Yanagida S
        • Nakamura H
        Angioscopic coronary macromorphology in patients with acute coronary disorders.
        Lancet. 1991; 337: 809-812
        • Abel M
        • Nishimura R
        • Callahan M
        • Rehder K
        • Ilstrup DM
        • Tajik J
        Evaluation of intraoperative transesophageal two-dimensional echocardiography.
        Anesthesiology. 1987; 66: 64-68
        • Clements FM
        • deBrujin NP
        Perioperative evaluation of regional wall motion by transesophageal two-dimensional echocardiography.
        Anesth Analg. 1987; 66: 249-261
        • Vandenberg BF
        • Kerber RE
        Transesophageal echocardiography and intraoperative monitoring of left ventricular function.
        Anesthesiology. 1990; 73: 799-801
        • Smith J
        • Cahalan M
        • Benefiel D
        • Byrd BF
        • Lurz FW
        • Shapiro WA
        • Roizem MF
        • Bouchard A
        • Schiller NB
        Intraoperative detection of myocardial ischemia in high-risk patients. Electrocardiography versus two-dimensional transesophageal echocardiography.
        Circulation. 1985; 72: 1015-1021
        • vanDaele M
        • Sutherland GR
        • Mitchell MM
        • Fraser AG
        • Prakash O
        • Rulf EN
        • Roelandt J
        Do changes in pulmonary capillary wedge pressure adequately reflect myocardial ischemia during anesthesia?.
        Circulation. 1990; 81: 865-871
        • Hauser AM
        • Gangadharan V
        • Ramos RG
        • Gordon S
        • Timmis GS
        Sequence of mechanical electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings.
        J Am Coll Cardiol. 1985; 5: 193-197
        • Taams MA
        • Gussenhoven EJ
        • Cornel JH
        • The SHK
        • Roelandt JR
        • Lancee CT
        • VanBrand M
        Detection of left coronary artery stenosis by transesophageal echocardiography.
        Eur Heart J. 1988; 9: 1162-1166
        • Memmola C
        • Marangelli V
        • DeMartino G
        • Piccinni G
        • D'Ambrosio G
        • Iliceto S
        • Rizzon P
        Evaluation of coronary anatomy and coronary circulation by transesophageal echocardiography.
        Cardiologia. 1990; 35: 319-325
        • Aschenberg WG
        • Schluter M
        • Kremer P
        • Schroder E
        • Siglow V
        • Bleifeld W
        Transesophageal two-dimensional echocardiography for the detection of left atrial appendage thrombus.
        J Am Coll Cardiol. 1986; 7: 163-166
        • Matsumoto M
        • Oka Y
        • Strom J
        • Frishman W
        • Kadish A
        • Beeker RM
        • Frater RW
        • Sonnenblick EH
        Application of transesophageal echocardiography to continuous intraoperative monitoring of left ventricular performance.
        Am J Cardiol. 1980; 46: 95-105
        • Topol EJ
        • Weiss JL
        • Guzman PA
        • Dorsey-Lima S
        • Blanck TJ
        • Humphrey LS
        • Baumgartner WA
        • Flaherty JT
        • Reitz BA
        Immediate improvement of dysfunctional myocardial segments after coronary revascularization: detection by intraoperative transesophageal echocardiography.
        J Am Coll Cardiol. 1984; 4: 1123-1134
        • Yoshida K
        • Yoshikawa J
        • Hozumi T
        • Yamaura Y
        • Akasaka T
        • Fukaya T
        • Kato H
        Detection of left main coronary artery stenosis by transesophageal color Doppler and two-dimensional echocardiography.
        Circulation. 1990; 81: 1271-1276