Copyright © 1993 by the European Society of Cardiology.
© 1993 The Europen Society of Cardiology
Apical transgastric echocardiography: new imaging projections
*Department of Cardiac Surgery, ‘La Sapienza’ University of Rome Rome, Italy
Section of Cardiology II, ‘La Sapienza’ University of Rome Rome, Italy
Department of Cardiology and Pulmonary Sciences, ‘La Sapienza’ University of Rome Rome, Italy
Received 20 January 1993; revised 26 May 1993; .
Correspondence. Paolo voci, MD, PhD, via San Giovanni Eudes, 27, 00163, Roma, Italy
Abstract
New transgastric echocardiographic projections, obtained by monoplane transoesophageal echocardiography are presented. Starting from the transgastric short-axis view, the probe is first advanced 3–5 cm and slightly rotated clockwise. From this projection either a tricuspid valve long-axis or a subcostal-like 4-chamber view is obtained. Advancing the probe 48–55 cm from the incisor teeth and rotating it counter clockwise with maximal anterior flexion, an apical long-axis view is obtained. The left ventricle, including the apex, the left ventricular outflow tract, the aortic valve, the proximal ascending aorta and the left atrium are imaged. In this projection the Doppler beam is parallel to the left ventricular outflow tract, resulting in more accurate flow velocity measurements than from the oesophagus. Additional morphological and Doppler information on right ventricular outflow tract obstruction are obtained by slight changes in transducer position.
The feasibility of these new transgastric imaging projections was assessed in 196 consecutive patients undergoing diagnostic TEE (104 conscious patients) or peroperative TEE monitoring (92 anaesthetized patients). Eighty-nine patients had coronary heart disease, 55 had valvular heart disease, nine had congenital heart disease, 22 had aortic aneurysm or dissection and 21 were studied for detection of cardiac sources of embolism.
The morphology of the right ventricular outflow tract was visualized in detail in all patients, and high quality Doppler tracings parallel to tile direction of flow were obtained. The subcostal-like view was successful in 86 out of 196 subjects (44%). The apical 4 andlor 5-chamber view was obtained in 139 subjects (71%).
These new transgastric projections are particularly useful in the intra-operative setting and in the early postoperative period, when other imaging modalities are not feasible and when conventional transoesophageal echocardiography does not yield conclusive results. Technical improvement in probe flexibility and changes in transducer frequency may increase the success rate of transgastric imaging. Biplanar and multiplanar transgastric scanning may further extend the potential of this approach.
Key Words: Transoesophageal echocardiography • transgastric echocardiography • apical projections