Transesophageal echocardiogram

Positive echocardiogram (transesophageal echocardiography recommended in patients who have a prosthetic valve, who are rated as having at least possible IE by clinical criteria, or who have complicated IE)... 

Perform transesophageal echocardiogram (TEE) to exclude atrial clot. 

DCC, direct current cardioversion IV, intravenously LVEF, left ventricular ejection fraction TEE, transesophageal echocardiogram. 

Transesophageal echocardiogram A procedure used to generate an image of the heart using sound waves, via a probe introduced into the esophagus (rather than the traditional transthoracic view) in order to obtain a better image of the left atrium. 

A transesophageal echocardiogram is a more sensitive test for left atrial thrombus. It is also effective in examining the aortic arch for atheroma, another potential source of emboli. 

FIGURE 6-1. Algorithm for the treatment of atrial fibrillation (AF) and atrial flutter. °lf AF <48 hours, anticoagulation prior to cardioversion is unnecessary may consider transesophageal echocardiogram (TEE) if patient has risk factors for stroke. Ablation may be considered for patients who fail or do not tolerate one antiarrhythmic drug (AAD). Chronic antithrombotic therapy should be considered in all patients with AF and risk factors for stroke regardless of whether or not they remain in sinus rhythm. (BB, 8-blocker CCB, calcium channel blocker p.e., verapamil or diltiazem] DCC, direct-current cardioversion.)... 

A 52-year-old woman had a transesophageal echocardiogram 1 year before starting to take fen-phen, and had no significant valvular disease. She presented a year later with a new heart murmur and eventually required isolated aortic valve replacement. Pathological evaluation of the excised aortic valve was consistent with that described with fen-phen use. 

In preparation for transesophageal echocardiogram, a 73-year-old woman was given 15 ml of lidocaine solution 2% and lidocaine spray 4% to anesthetize the oropharynx, plus intravenous midazolam 1 mg and pethidine 12.5 mg. She very rapidly became cyanosed, but remained... 

Shapira MY et al (1999) Esophageal perforation after transesophageal echocardiogram. Echocardiography 16(2) 151-154. 

If the patient is hemodynamically unstable, synchronized electrical cardioversion should be performed right away. It s most successful if done within 48 hours after atrial fibrillation starts. A transesophageal echocardiogram may be obtained before cardioversion to rule out thrombi in the atria. 

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