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European Association of Echocardiography recommendations for transoesophageal echocardiography: what the clinician should know

ESC Congress 2010

Non-Invasive Imaging

This Clinical Seminar illustrated the clinical value of transesophageal echocardiography (TEE), for which the European Association of Echocardiography (EAE) has just published updated recommendations. The technique is widely implemented and nowadays an integral part of routine echocardiography, but probably still underutilized. The recent refinements in valve surgery (e.g., in aortic valve reconstruction) and the emergence of percutaneous valvular interventions have reinforced the importance of highest quality imaging – both morphologic and functional – to select patients and procedures as well as to ensure safety and satisfactory outcome of such interventions.

In the session, M.J.Andrade (Lisbon, Portugal) discussed the role of TEE in delineating the functional anatomy of valves with the submillimeter spatial resolution that good TEE images furnish. Another well-documented area where TEE can be considered practically mandatory is prosthetic valve dysfunction. L.Badano (Padua, Italy) explained the role of TEE in identifying cardiac sources of embolism in the light of the also recently published EAE recommendations for echocardiography use in the diagnosis and management of cardiac sources.

G.Habib (Marseille, France), the lead author of the ESC guidelines and EAE recommendations on infective endocarditis, gave a detailed overview of typical findings, management implications, and timing of TEE in infective endocarditis, where this modality continues to be in practice the only useful imaging modality, stressing that this extends to the intra-operative use of TEE in such patients with their often complicated patho-anatomy. Speaker and audience agreed that TEE is probably still used too late or not at all in many cases of this highly malignant disease.

Finally, Mark Monaghan (London, UK) showed dramatic pictures of TEE guidance in cardiac interventions, including closure of patent foramen ovale, atrial and ventricular septal defect, transcatheter aortic valve implantation and mitral valve clip implantation, some of them with a critical role for 3D TEE to recognize and resolve complications. 3D imaging and intranasally applicable, smaller probes doubtlessly will further expand the already large role of TEE in the concert of imaging modalities.




European Association of Echocardiography recommendations for transoesophageal echocardiography: what the clinician should know

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.