TRANSESOPHAGEAL 3-DIMENSIONAL ECHOCARDIOGRAPHIC ASSESSMENT OF NORMAL AND STENOSED CORONARY-ARTERIES

We describe our preliminary experience in assessing normal and stenose d coronary arteries zcsilzg transesophageal three-dimensional echocard iography (3-D echo) in 27 adult patients. Multiplane transesophageal t wo-dimensional images of the coronary arteries (20 left, 3 right, 3 bo th left and right, and I posterior descending) were first acquired in the TomTec computer in 3 degrees sequential increments, from 0 degrees to 180 degrees, and then 3-D reconstruction was performed. The entire left main (LMC, measuring 0.5 to 1.7 cm, mean 1.0 cm) as well as vari able lengths of proximal or both proximal and middle segments of the L eft anterior descending (LAD, measuring 0.2 to 2.5 cm, mean 0.8 cm) an d circumflex (LCX, measuring 0.2 to 2.8 cm, mean 0.9 cm) coronary arte ries together with some of their branches could be visualized in 3-D i n 22 of 23 patients. In the remaining patient, the LMC was absent, and both LAD and LCX could be visualized in 3-D as having separate but ad jacent origins from the left sinus of Valsalva (proven by angiography) . In true patients, long segments of interventricular and great cardia c veins were also visualized accompanying the LAD and LCX, respectivel y. The right coronary artery (RCA, measuring 0.7 to 3.0 cm, mean 1.9 c m) was also successfully delineated in 3-D in all six patients in. who m an attempt was made to visualize it during echo examination. Using t he transgastric approach, a long (1.8 cm) segment of the posterior des cending branch (PDA) of RCA was imaged in one patient. In addition, ni l re significantly stenotic lesions (> 50% lumen diameter) were identi fied by 3-D in eight patients involving LMC (1), proximal LAD (I), mid LAD (1), proximal LCX (2), proximal RCA(3), and mid PDA (1). Eight of these 9 lesions were confirmed by coronary angiography. The remaining lesion (mid PDA) could not be confirmed since the patient did not und ergo angiography. Our preliminary study demonstrates the usefulness of transesophageal 3-D echo not only in delineating normal coronary arte ries but also diagnosing significant atherosclerotic stenosis in these vessels.