Significance of transesophageal echocardiography in the evaluation of aortic valve stenosis

Background/Aim. Transesophageal echocardiography (TEE) is a relatively new diagnostic method offering better resolution of cardiac anatomy than the conventional transthoracal two-dimensional echocardiography (TTE). Clinical indications for TEE have been expanding, thus the technique as a diagnostic procedure is used in numerous cardiac diseases such as endocarditis, congenital heart defect, aortic dissection, prosthetic valves dysfunction, as well as in calculation of aortic valve surface in aortic stenosis. The aim of the study was to prove TEE as a more precise method in determination of the level of seriousness of aortic valve stenosis. Methods. All the patients went through TTE and TEE. Evaluating of the aortic valve surface was performed by the use of Gorlin's formula in TTE while it was planimetric in TEE examination. Results. Comparative analysis of all parameters obtained by TTE and TEE showed a difference between them. All the parameters values except that for surface area of the aortic valve orifice confluence were higher in TEE than in TTE examination, but no difference was statistically significant (p > 0.05; t-test for a dependant specimens). By the use of the TTE method, the size of aortic orifice stenosis was 1.22 ± 0.54 cm2, and by the TEE method it was 1.08 ± 0.54 cm2. Conclusion. Multiplain TEE is reliable in quantification of an aortic valve area in patients with aortic stenosis. It offers useful clinical information, particularly in patients with non-adequate evaluation with TTE, as well as in seriously ill patients or those with a confirmed valvular defect

Diagnosis and results of treatment of heart myxoma

Background/Aim. Myxoma is the most common benign primary cardiac neoplasm, and usually originates from the left atrial septum. Early diagnosis of cardiac myxomas depends on a high index of a clinical suspicion. Surgical management must be done as soon as possible after diagnosis. The aim of this retrospective study was to present diagnostics and treatment outcome data of 61 patients with cardiac myxoma treated in the Military Medical Academy, Belgrade during a 49-years period. Methods. Intrahospital diagnosis was established in all the patients by the cardiologist. Diagnostic methods were various, in dependence on the examination period and suspected diagnosis. Results. Within a 49-years period (1961-2009) heart myxoma was diagnozed and treated in 61 patients in the Military Medical Academy, Belgrade. Most of the operated patients were females (38 or 62.3%). The operated patients were 19-68 years old. Average age of all the patients was 47.9%. The great majority of them (98.4%) had atrial, and only one operated patient had ventricular myxoma. In 13 (21.3%) of the patients heart myxoma was found out accidentally due to no previous cardiologic symptomatology. In most patients (27.44%) symptomatology was presented as thromboembolic disease. Because of the suspected ventricular myxoma in one patient, the patient was operated on, but Hodgkin's lymphoma was found out which, according to the subsequent course of the disease, could be justifiably recognized as primary heart lymphoma. This study presented brief descriptions of the course of the disease in 4 patients with myxomas in each of the cardiac cavities. Conclusion. The only diagnostic difficulty in cardiac myxoma is due to its asymptomatic and oligosymptomatic presence within the longer period of time, namely, its growth period. Echocardiography should be the standard method of cardiologic examination of these patients, which could considerably contribute to early diagnosis and treatment of heart myxoma. Surgical extirpation of myxoma is the only and very successful therapeutic method

The role of transesophageal echocardiography in planimetric assessment of the significance of isolated aortic stenosis

Cilj studije je da se ispita mogućnost primene planimetrijske transezofagealne metode (TEE) upotrebom multipleinske transezofagealne (TEE) sonde za pouzdano utvrđivanje površine ušća aortne valvule (AVA) u aortnoj stenozi (AS). Rotacijom multipleinske sonde dobija se presek površine i mogućnost centriranja pregleda u dugoj osi stenotične valvule i precizan pregled u kratkoj osi bez pokretanja vrha sonde. Tako se može prikazati AVA u preseku i na nivou duge ose. Rezultati merenja TEE-AVA metodom su poređeni sa podatcima dobijenim invazivnim merenjem u toku kateterizacije upotrebom Gorlinove formule i podatcima dobijenim korišćenjem neinvazivne planimetrijske transtorakalne (TTE-AVA) metode upotrebom kontinuirane jednačine. AVA je merena planimetrijskom metodom upotrebom multipleinske TEE sonde kod 54 pacijenta (65(36-85) god)sa poznatom kalcifikovanom aortnom stenozom. Ispitivanje je obuhvatilo 25 muškaraca i 29 žena. Kod tri pacijenta gde je AVA bila izrazito smanjena ( ≤ 0,4 cm²), primenom TEE nije bilo moguće egzaktno proceniti AVA i ona je mogla biti određena samo Gorlinovom formulom. Postoji značajna korelacija između TEE-AVA (0.885(0.76) cm²) i podataka dobijenih priemnom Gorlinove formule (0.689(0.58) cm²)(r= 0.402; p<0.01).Postoji značajna korelacija AVA određene Gorlinovom metodom i TTE-AVA (0.689(0.58) cm²) (r= 0.298; p<0.05). Multiplein planimetrijska TEE metoda je praktična i pouzdana klinička metoda za procenu značajnosti AS.The aim of the study was to assess if the aortic valve orifice area (AVA) can be precisly assessed with planimetric transeesophageal (TEE) method using multiplain transesophageal probe in patients with aortic stenosis (AS).Multiplain probe can be rotated and this gives better assessment of area and possibility for focusing in t he l ong a xis o f s tenotic a ortic v alve a nd precise view in the short axis without additional probe movements. This method presents the aortic valve orifice area and also the view of AVA at the level of long axis. Data based on planimetric TEE (TEE-AVA) method using continuous equatation were compared with data obtained by using invasive catheterisation method based on Gorlin’s formula and AVA measured with transthoracic echocardiography method (TTE-AVA). The study included 54 patients (65(36-85) ys), 25 man and 29 women with known AS. The AVA was assessed with with planimetric transeesophageal method using multiplain transesophageal probe (TEE-AVA). In three patients with severe AS (AVA ≤ 0,4 cm²) it was impossible to use planimetric TEE, so Gorlin’s formula was used. In our study, strong correlation exists between TEE-AVA (0.885(0.76) cm²) and AVA assessed with catheterisation and calculated with Gorlin’s formula (0.689(0.58) cm²) (r= 0.402; p<0.01). Signifficant correlation was found between AVA obtained by catheterisation and TTE-AVA (0.689(0.58) cm2) (r= 0.298; p<0.05). Multiplain planimetric TEE method is practical noninvasive method for preoperative AS assessment