Usual mistakes in transesophageal echocardiography

pp 221-225

Abstract

Among the newest applications of the ultrasound in cardiology, transesophageal echo became undoubtedly the most widely used. Nowadays between 1.4 and 23.6 % of the studies performed in an echo laboratory are transesophageal approaches. The complexity of the anatomical planes obtained from this study, and the insufficient experience of the operator could induce mistakes when interpreting the images. The present article summarizes the difficulties the authors found in the first 105 studies performed along 6 months. In the atrium it is pivotal to differentiate normal structures (v.g. pectinase muscles, Eustachian valve) from thrombi or tumors. It is possible to find normal adipose deposits in both AV valves. Sometimes a calcified mitral annulus shows an atypical appearance which must be differentiate from thrombus; The oblique planes of the aortic valve can produce false images of bicuspid valve or aneurysm of the sinus of Valsalva. The diagnosis of aortic dissection in challenging, since a surgical treatment, without previous hemodynamic study in most of the cases, will depend on the results. The evaluation of a mitral repair is the basic application of the intra-operative echo, and it can be altered by hypovolemia, hypotension or systolic anterior movement of the valve. The experience with this method, the comparison with hemodynamic studies or surgical findings, and previous echocardiographic expertise of the operator will reduce the interpreting mistakes.