INTRODUCTION :
With the development of digital imaging capabilities, the emergence of multiplane TEE,
and cine loop review, TEE has improved visualization of the coronary artery tree and enhanced
detection of its abnormalities. Although TEE is unlikely to replace coronary angiography as the
primary imaging modality in coronary artery disease, published reports over the past 12 years
have defined a role for TEE in coronary artery disease.
Although the diagnosis of ostial stenosis of the left main coronary artery usually is made
by coronary angiography, positioning of the catheter across the obstruction may obscure this
diagnosis during the contrast injection. Several authors have reported cases in which TEE was
able to make a correct diagnosis in patients with possible left main coronary artery stenosis, in
whom damping of the left main coronary artery wave form during catheterization did not allow
differentiation of significant left main artery.
The diagnosis of left main coronary artery disease is important in the management of
patients with symptomatic coronary artery disease. TEE can be considered when cardiac
catheterization suggests ostial stenosis but angiography is inconclusive. The diagnosis of a
proximal stenosis may be confirmed by direct visualization of the area of narrowing and
supported by color flow Doppler demonstration of flow aliasing.
Recent advances in TEE have enabled the direct evaluation of coronary flow especially
in the proximal and mid LAD where the culprit lesion of AWMI is present. TEE can potentially
enable direct evaluation of coronary perfusion at a site just distal to culprit lesion in AWMI.
We hypothesized that good reperfusion would be associated with less reduction in coronary
flow and therefore would have better ante grade flow visualization by color TEE and less
reduced ante grade flow velocity by pulsed TEE.
AIM :
1. Visualization and measurement of the size of Left main coronary in patients with
coronary artery disease by Transesophageal echocardiography.
2. Measurement of blood flow velocity in Left main and Proximal Left Anterior
Descending artery in patients with coronary artery disease by Transesophageal
echocardiography.
3. Measurement of intimal thickness and presence of plaque and its size in descending
thoracic aorta in patients with coronary artery disease by Transesophageal
echocardiography.
CONCLUSION :
1. Transesophageal echocardiography is a promising and effective non invasive diagnostic
method of visualizing and measuring the size of proximal left coronary artery in
patients with coronary artery disease.
2. TEE could visualize the LM in all the patients (100%). By TEE we can visualize
proximal LAD and proximal LCX in 93% and 87% respectively.
3. Patients with acute AWMI who had unsuccessful thrombolysis showed significantly
low coronary blood flow velocity by TEE compared to successfully thrombolysed
group who had relatively higher coronary flow.
4. Patients with LM and proximal LAD narrowing diagnosed by TEE showed
angiographic correlation with coronary narrowing in CAG.
5. Descending thoracic aortic plaque was present in 76% of patients with acute AWMI.
There was no statistically significant correlation between the presence of plaque and the
degree of presence and severity of CAD
