Rajasekhar Nekkanti

Volume quantification of intracardiac mass lesions by transesophageal three-dimensional echocardiography

As compared with two-dimensional (2-D) transesophageal echocardiography (TEE), 3-D echocardiography now permits more realistic visualization of cardiac anatomy and of intracardiac lesions. The aim of this study was to apply newer 3-D echocardiographic techniques to quantify volumes of intracardiac masses undergoing surgical resection seen during an intraoperative TEE. The calculated volumes were compared with actual in vitro measurements of surgically resected masses. A total of 14 patients (9 men; 5 women; age range between 21 and 77 years) with intracardiac mass lesions (4 tumors: 3 left atrial myxomas and 1 mitral valve fibroelastoma, and 10 vegetations: 5 aortic valve, 3 mitral valve, 1 tricuspid and 1 pulmonary valve) were studied. Using commercially available 3-D reconstruction software (TomTec v. 4.1), the volumes of intracardiac masses were estimated using both the average rotation (rotation around the long axis, AR) and disk summation (parallel short axis cuts, DS) methods. Volumes of these lesions were also measured in vitro by water submersion. They ranged from 0.20 mL to 24 mL (mean +/- SD = 8.07 +/- 9.21 mL). Both 3-D TEE AR and 3-D TEE DS calculated volumes correlated excellently with in vitro measured volumes (r = 1.00 and r = 0.98, respectively, p = < 0.0001). The correlation between 3-D TEE AR and 3-D TEE DS calculated volumes was also excellent (r = 0.98, p = < 0.0001). In conclusion, the volume assessments by 3-D TEE of intracardiac mass lesions correlated well with in vitro measured volumes of surgical specimens. This technique may prove to be valuable in further defining intracardiac pathology and is a further advancement toward the application of clinically useful 3-D echocardiography.

Transesophageal Three‐Dimensional Echocardiographic Demonstration of Ebstein's Anomaly

We report three‐dimensional transesophageal echocardiographic findings in an adult patient with Ebsteins anomaly. Using the anyplane technique and multiple views, especially the short‐axis view of tricuspid valve, three‐dimensional transesophageal echocardiography clearly demonstrated the intermittent tethering of all three leaflets of tricuspid valve to the right ventricular walls giving a “bubble‐like” appearance. On the other hand, two‐dimensional transesophageal echocardiography demonstrated well the tethering of the septal tricuspid leaflet, but tethering of the other two leaflets was not well seen. To our knowledge, these findings have not been demonstrated by three‐dimensional transesophageal echocardiography before. (ECHOCARDIOGRAPHY, Volume 20, April 2003)

Contrast Transesophageal Echocardiographic Detection of a Pulmonary Arteriovenous Malformation Draining Into Left Lower Pulmonary Vein

We report the identification of a pulmonary arteriovenous malformation draining into the left lower pulmonary vein by contrast two‐dimensional transesophageal echocardiography in an adult with no evidence of hereditary hemorrhagic telangiectasia. To our knowledge, this has not been reported previously. This study also emphasizes the importance of transesophageal echocardiographic examination of the left lower pulmonary vein in the detection of a pulmonary arteriovenous malformation. (ECHOCARDIOGRAPHY, Volume 20, May 2003)

Platypnea-Orthodeoxia in a Patient With Ostium Primum Atrial Septal Defect With Normal Right Heart Pressures

We describe an adult patient with an ostium primum atrial septal defect (ASD) and a patent foramen ovale (PFO) with normal right heart pressures who presented with platypnea and orthodeoxia. A dilated aortic root encroaching into the region of the ASD and PFO, along with a tricuspid regurgitant jet moving into the left atrium through the ASD found on the transesophageal echocardiogram may have been responsible for orthodeoxia. Surgical closure of these defects resulted in the disappearance of both platypnea and orthodeoxia. (ECHOCARDIOGRAPHY, Volume 20, April 2003)

Transpharyngeal Echocardiographic Imaging of the Right and Left Carotid Arteries

We present a technique for transpharyngeal imaging of the bilateral carotid arteries completed towards the end of a transesophageal echocardiogram. To our knowledge, this is the first report that demonstrates the bifurcation of the right common carotid artery into the right internal and external carotid arteries with a transesophageal echocardiographic probe.

Transesophageal Three‐Dimensional Color Doppler Echocardiographic Reconstruction of the Left Vertebral Artery

We present a patient in whom we successfully reconstructed a long segment of the proximal left vertebral artery in three dimensions using color Doppler transesophageal echocardiography (TEE). Three‐dimensional (3‐D) color Doppler TEE may complement two‐dimensional (2‐D) TEE by its ability to view cross sections of the left vertebral artery at any desired level from the 3‐D data stored in the computer.

Transesophageal three-dimensional echocardiographic assessment of left main coronary artery fistula.

We describe a patient with a left main coronary artery fistula with an opening at the superior vena cava‐right atrial junction in whom three‐dimensional transesophageal echocardiography permitted more accurate assessment of the shape and size of the communication site than two‐dimensional transesophageal echocardiography.

Transesophageal Echocardiographic Diagnosis of Traumatic Rupture of the Noncoronary Cusp of the Aortic Valve

We report a patient with traumatic aortic valve injury in whom a large defect in the noncoronary cusp of the aortic valve was clearly visualized by multiplane TEE and confirmed at surgery.

Three‐Dimensional Transesophageal Echocardiographic Demonstration of Innominate Artery Dissection

We describe an adult patient with type I aortic dissection in whom it was feasible to demonstrate the extension of the dissection into the innominate artery using color Doppler three‐dimensional transesophageal echocardiography. (ECHOCARDIOGRAPHY, Volume 20, August 2003)

Transesophageal echocardiographic identification of thrombus producing obstruction of left pulmonary artery descending lobar branches and bronchial artery dilatation.

We report an elderly patient in whom a thrombus in the distal left pulmonary artery was shown by transesophageal echocardiography to extend and produce obstruction of the descending lobar branches as well as dilatation of the left bronchial artery.