VALUE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN DIAGNOSIS OF VALVULAR HEART-DISEASE

In the clinical management of patients with valvular heart disease, tr ansthoracic echocardiography (TTE) combined with Doppler has become th e central diagnostic tool during the past decades. The development of transesophageal echocardiography (TEE) has led to an improved image qu ality especially of structures distant to the chest wall. However, sin ce TEE is a semi-invasive technique, its use has to be considered care fully. In aortic valve disease, TEE facilitates a detailed study of va lve morphology and allows sufficiently reliable planimetry of aortic v alve area, at least when the multiplane approach is used. This is part icularly helpful in those patients where Doppler interrogation from pr ecordial windows fails. Aortic regurgitation is diagnosed more frequen tly by TEE color-flow imaging than by TTE; however, both techniques al low only semiquantitative assessment of the severity of regurgitation. TEE is also superior to TTE in defining the exact origin site, number and configuration of regurgitant jets in patients with mitral insuffi ciency. In particular minimal and mild mitral regurgitation is more ea sily detected by TEE than by TTE. The same is true for flail mitral le aflets, chordal and papillary muscle rupture, and potentially also for discrete forms of mitral valve prolapse. During surgery, TEE can be c onsidered as an ideal tool for immediate assessment of the results of mitral valve reconstruction. Calculation of pressure gradients and val ve area by TEE Doppler analysis shows comparable results to precordial studies. When multiplane TEE is available, Doppler beam alignment may become even improved in selected cases with severely excentric flow j et orientation. In addition, TEE provides of course clinically importa nt information concerning presence or absence of atrial and particular ly atrial appendage thrombi as well as of spontaneous echo contrast in patients with stenotic mitral valve. This is not only helpful regardi ng the decision for anti-coagulation but it may also be critical in th e selection of candidates for percutaneous mitral balloon valvuloplast y. TEE does also allow the morphological and functional evaluation of tricuspid and pulmonic valves. In this context, the use of biplane or multiplane TEE probes is superior to that of monoplane devices. Howeve r, currently available data does not provide unequivocal evidence that the analysis of tricuspid and pulmonic valve disease by TEE is superi or to the conventional transthoracic approach.