Real-Time Three-Dimensional Transesophageal Echocardiography

Abstract

In the 1970s, pioneers explored the esophagus with ultrasound in patients with chronic lung disease. They obtained M-Mode recordings of the left ventricle, the aortic root, the mitral valve, and the left atrium. In 18 of 38 patients examined, recordings were of sufficient quality to allow precise measurements of linear dimensions.¹ Thirty years later, transesophageal echocardiography has become an essential diagnostic tool and has contributed to the understanding of the pathology, clinical diagnosis, management, and prognosis of many cardiovascular conditions such as aortic dissection, mitral valve disease, and ischemic stroke.^{2, 3} Transesophageal echocardiography provides, along with excellent spatial resolution, the possibility of obtaining views of anatomical structures of the heart that are not accessible by a transthoracic approach. For example, in the horizontal long axis view of the right cardiac chambers, we can visualize the opening of the caval veins in the right atrium. It was in the operating room and in the interventional lab where the development of three-dimensional capabilities for transesophageal imaging was carried out. The consolidation and expansion of reparative mitral valve surgery in patients with prolapse led to the involvement of top surgical and imaging groups to detail the anatomy of mitral prolapse using cardiac ultrasound.⁴ Three-dimensional transesophageal echocardiography allows the operator to move from the practice of imagining the stereoscopic appearance of the mitral valve (largely based on his/her experience and skill) to visualizing the valve in its correct anatomical orientation (the so-called surgeon’s view), providing newer, realistic views. As our approach with mitral valve prolapse and cardiac surgery, one can do the same with interventional cardiology and percutaneous procedures: ostium secundum atrial septal defect closure, partial or total periprosthetic leak closure, transcatheter aortic prosthesis implant, mitral clips, and left atrial appendage closure.