Transesophageal echocardiography: what is it?

Pathologies of the cardiovascular system are one of the most common causes of mortality. This group of diseases is especially common among the elderly. Early diagnosis of cardiac abnormalities helps reduce the risk of complications and mortality. One of the research methods is echocardiography. This diagnostic method is necessary to evaluate the activity of the heart. Often, echocardiography is performed using an ultrasound transducer located on the chest wall. In some cases, this study is performed during surgery. Then transesophageal echocardiography is performed. This method allows you to visualize the heart in more detail.

Transesophageal echocardiography - what is it?

Echocardiography is one of the main ways to diagnose diseases of the cardiovascular system. It can be carried out at any age, as it is not accompanied by radiation exposure to the body. Thanks to this instrumental study, it is possible to visualize the size and thickness of the heart chambers, to assess the condition of the valves. Transesophageal echocardiography (PE Echocardiography) is different in that it is performed as if from the inside, and not from the outside (chest wall). Thanks to this, the quality of visualization is improved. This examination is prescribed not to everyone, but only according to special indications. To perform echocardiography through the cavity of the esophagus, you must first conduct it transthoracically. This diagnostic method is carried out by a specially trained specialist in a hospital setting.

What is the method of transesophageal echocardiography based on?

Transesophageal echocardiography of the heart is a visualization method based on ultrasound. Ultrasound is performed using a special sensor and gel. The device creates high-frequency sound waves. Tissues “respond” to these signals as echolocation. Given that each organ has a certain density and structure, they are displayed differently on the screen of a monitor connected to the device. The study is carried out in real time. This means that the doctor of functional diagnostics can assess the condition of the heart chambers, while the sensor glides over the surface of the organ. Unlike transthoracic echocardiography, transesophageal examination allows you to see even minimal structural impairment. The fact is that when conducting an ultrasound scan on the chest wall, it is not always possible to achieve sufficient visualization of the heart. This is due to the fact that the device “picks up” echo signals from other organs: ribs, adipose tissue, muscle tissue. When performing PEEchoKG, the "ultrasonic window" is significantly reduced, so this method is more informative.

Indications for the study

The main indication for the study is the inability to make a diagnosis based on the data of transthoracic echocardiography. Typically, this diagnostic procedure is performed for patients who are suspected of having serious cardiac abnormalities. It is also necessary when examining an organ cavity. Given that ultrasound through the surface of the chest wall in these cases is uninformative, transesophageal echocardiography is performed. Indications for the study:

1. Complications after prosthetics of heart valves. In some cases, the implant takes root for a long time, resulting in inflammation, abscesses.
2. Stratification of the aneurysm of the heart or aorta.
3. Poor functioning of prosthetic valves.
4. Infectious lesions of the heart muscle - endo-, myo-, pericarditis.
5. Aortic abscess.
6. Ventricular thrombosis.
7. The need for research at the time of surgery.

In addition to the above indications, transesophageal echocardiography is a mandatory procedure before valve replacement. The study is also performed with increased airiness of the lungs (emphysema), obesity.

Contraindications for transesophageal echocardiography

Despite the advantages of CHP echocardiography, this examination method is not widespread. This is because it is invasive, and not all patients agree to the procedure. In addition, there are a number of contraindications for transesophageal echocardiography. Among them:

1. Inflammatory diseases of the oral cavity and pharynx.
2. Anomalies in the development of organs (short esophagus, diverticulum).
3. Cicatricial changes, strictures. Often found after poisoning with acids or alkalis.
4. Erosive esophagitis.
5. Bleeding from an ulcer of the cardiac section of the stomach.
6. Expansion of the veins of the esophagus with cirrhosis.
7. Oncological diseases of the oral cavity and pharynx.
8. Cancer of the esophagus or cardiac section of the stomach.

In the absence of gastrointestinal diseases, ChPEchoKG can be performed for patients of any age. Also, the study is not contraindicated in pregnant women and people suffering from somatic pathologies. It is not accompanied by irradiation of the body.

Preparation for transesophageal echocardiography

Before prescribing transesophageal echocardiography, the patient must be sent to undergo a series of laboratory tests. Among them: biochemical blood test, OAK and OAM, coagulogram. In this case, changes such as an increase in white blood cells, platelets, and an acceleration of ESR can be observed. In addition, before conducting this examination, transthoracic ultrasound is often performed. In addition, with suspected pathology of the heart, ECG removal is necessary.

Transesophageal echocardiography is a safe procedure, therefore, does not require special preparation. If the patient is taking any medications, then cancel them before the study is not necessary. A prerequisite for the procedure is the refusal to eat during the 6 hours preceding CHF. If the patient has dentures, they must be removed. Sometimes, premedication is performed before the study. To reduce salivation, Atropin is administered intravenously. If the patient is in an excited state, prescribe tranquilizers (medication "Diazepam").

Technique for transesophageal echocardiography

To avoid discomfort, the oral cavity and pharynx are anesthetized. For this purpose, the drug "Lidocaine" or "Dikain" is used. The patient is placed on his left side. In order not to damage the probe and facilitate its insertion into the pharynx, a special mouthpiece is used. The end of the device must be treated with a special gel, which is used in ultrasound studies. After that, a probe with an endoscope is inserted into the cavity of the esophagus. To facilitate the process, the patient must perform swallowing movements. Within 5-10 minutes, the device is in the cavity of the esophagus. The endoscope lamp is directed towards the heart. Through the wall of the esophagus, the device picks up echoes. In real time, they are displayed on the monitor and recorded on tape.

What can be detected with transesophageal echocardiography

Thanks to echocardiography performed through the cavity of the esophagus, it is possible to assess the condition of the heart muscle, endocardium and valvular apparatus. This study is crucial in making a diagnosis. Given the high information content of the method, even minor damage to the heart cavity can be detected. CPEKhKG allows to detect the presence of blood clots, inflammatory changes, aortic dissection. Three-dimensional research is particularly informative. Thanks to 3D ultrasound cardiography, you can not only assess the condition of the heart muscle, but also prepare the patient for valve replacement surgery. This method belongs to high-tech research and is carried out in specialized clinics.

Possible complications of transesophageal echocardiography

One of the diagnostic methods is considered to be transesophageal echocardiography of the heart. Where is this procedure done? This study is carried out in dispensaries with a cardiology department, as well as in private clinics equipped with modern medical equipment. It is worth remembering that, despite safety, in rare cases complications can develop. These include cardiac arrhythmias, as well as allergic reactions to drugs (anesthetics, tranquilizers). To avoid serious consequences, you must have a resuscitation kit ready.

Transesophageal echocardiography of the heart: reviews of patients and doctors

This study is safe and painless, so patients tolerate it well. For the diagnosis of serious pathologies, transesophageal echocardiography is performed. Reviews of doctors about this examination method are positive. Doctors note its high information content and safety.