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. 2020 May;12(5):2955-2962.
doi: 10.21037/jtd.2020.02.04.

Transthoracic versus intra-operative transesophageal echocardiography in right heart assessment

Saberio Lo Presti  1 , Daniela Urina  2 , Tarec K Elajami  2 , Ivan A Arenas  3 , Steve Xydas  4 , Francesco Nappi  5 , Ana V Soto  3 , Esteban Escolar  6 , Christos G Mihos  3
Affiliations

Transthoracic versus intra-operative transesophageal echocardiography in right heart assessment

Saberio Lo Presti et al. J Thorac Dis. 2020 May.

Abstract

Methods: Fifty-four patients who had combined mitral and tricuspid valve surgery were included. Right heart measurements were performed in the TTE apical 4-chamber (A4C) and RV inflow views, and TEE mid-esophageal 4-chamber (ME4C) and transgastric RV inflow views at end-diastole. Spearman correlation coefficients (r) were applied to test for associations between the imaging modalities.

Results: The mean age was 65 years and 39% were male. All patients had ≥ moderate tricuspid regurgitation (TR), and a secondary/functional etiology was present in 89%. The median TAd and RV basal (RVd) diameters in the TTE-A4C view measured 37 mm [interquartile range (IQR), 34-44] and 43 mm (IQR, 40-51), respectively. The TTE-A4C TAd strongly correlated with the TEE-ME4C measurement (r=0.72), with an overestimation of 1 mm (IQR, -2 to 4) by TEE (P<0.01). For RVd, the TTE-A4C measurement correlated moderately with the TEE-ME4C view (r=0.61), underestimating the RVd by -1 mm (IQR, -4 to 3.3) (P<0.01). No correlation was observed between TAPSE measured by TTE and TEE (r=0.22, P=0.13).

Conclusions: Intra-operative TEE may reliably quantitate TA and RV size and geometry. The current findings are best interpreted as hypothesis-generating for future validative studies.

Keywords: Intra-operative transesophageal echocardiography (TEE); right ventricle; tricuspid valve; two-dimensional echocardiography.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd.2020.02.04). The series “Novel Concepts in Cardiopulmonary and Structural Heart Disease” was commissioned by the editorial office without any funding or sponsorship. CGM served as the unpaid Guest Editor of the series and serves as an unpaid editorial member of Journal of Thoracic Disease from Jan 2019 to Dec 2020. FN serves as an unpaid editorial member of Journal of Thoracic Disease from Aug 2019 to Jul 2021. The other authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Transesophageal echocardiographic right ventricular-focused mid-esophageal four-chamber view. (A) The tricuspid annulus septolateral diameter at end-diastole; (B) the right ventricular basal diameter at end-diastole.
Figure 2
Figure 2
Orientation of transesophageal (Top) and transthoracic (Bottom) imaging windows in measuring the tricuspid annulus septolateral diameter. Images reproduced and adapted with permission from “Virtual Transesophageal Echocardiography”. Toronto General Hospital, Department of Anesthesia. Available online: http://pie.med.utoronto.ca. Red line, tricuspid annulus septolateral diameter.
Figure 3
Figure 3
Spearman’s correlation coefficient scatterplot between measurements of the tricuspid annular diameter in the mid-esophageal four-chamber and apical four-chamber echocardiographic views. Units are in millimeters. Spearman’s Correlation Coefficient (r) =0.72; P<0.01. A4C, apical four-chamber; ME4C, mid-esophageal four-chamber; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography.
Figure 4
Figure 4
Spearman’s correlation coefficient scatterplot between measurements of the right ventricular basal diameter in the mid-esophageal four-chamber and apical four-chamber echocardiographic views. Units are in millimeters. Spearman’s correlation coefficient (r) =0.61; P<0.01. A4C, apical four-chamber; ME4C, mid-esophageal four-chamber; N, number; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography.
See this image and copyright information in PMC

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