Transesophageal echocardiography

Harloff A, Handke M, Reinhard M, Geibel A, Hetzel A. Therapeutic strategies after examination by transesophageal echocardiography in 503 patients with ischemic stroke. Stroke 2006 37 859-864. 

After prior anticoagulation (or after transesophageal echocardiography demonstrated the absence of a thrombus, thereby obviating the need for warfarin) methods for restoring sinus rhythm in patients with AF or atrial... 

Transesophageal echocardiography is important in identifying and localizing valvular lesions in patients suspected of having IE. Transesophageal... 

Pearson AC, et al, Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with... 

There was a variety of significant nervous system adverse effects in six of 104 patients who underwent transesophageal echocardiography, including aggression, euphoria, depression, and intense hiccups (42). These effects occurred despite careful titration and relatively low doses of intravenous midazolam (mean 4.8 mg), and were generally reversible with intravenous flumazenil 0.25-0.5 mg. 

Wenzel RR, Bartel T, Eggebrecht H, Philipp T, Erbel R. Central-nervous side effects of midazolam during transesophageal echocardiography. J Am Soc Echocardiogr 2002 15(10 Part 2) 1297-300. 

Riaz K, Forker AD, Garg M, McCullough PA. Atypical presentation of cocaine-induced type A aortic dissection a diagnosis made by transesophageal echocardiography. J 108. Investig Med 2002 50(2) 140-2. 

Table 13.5. Comparison of transthoracic and transesophageal echocardiography for detecting potential cardiac sources of embolism...

Aortic arch atheroma is now increasingly diagnosed by transesophageal echocardiography in patients with TIAs or ischemic stroke, but so far there are no surgical, or indeed medical, treatment options over and above controlling vascular risk factors and antiplatelet drugs. One trial of medical treatment has been started, the Aortic Arch Related Cerebral Hazard (ARCH) trial (MacLeod et al. 2004). 

An elderly man received benzocaine 20% spray to the throat in preparation for transesophageal echocardiography. He became unwell 1 hour later, with lethargy, central cyanosis, hypoxia, dyspnea, tachypnea, and tachycardia (23). His arterial blood was burgundy-colored and the methemoglobin concentration was 41%. He was treated with two doses of methylthioninium chloride 2mg/kg and was weaned from oxygen within 10 hours. 

McGrath PD, Moloney JF, Riker RR. Benzocaine-induced methemoglobinemia complicating transesophageal echocardiography a case report. Echocardiography 1998 15(4) 389-92. 

Malhotra S, Kolda M, Nanda NC. Local anesthetic-induced methemoglobinemia during transesophageal echocardiography. Echocardiography 1998 15(2) 165-8. 

Ho RT, Nanevicz T, Yee R, Figueredo VM. Benzocaine-induced methemoglobinemia—two case reports related to transesophageal echocardiography premedication. Cardiovasc Drugs Ther 1998 12(3) 311-12. 

Fisher MA, Henry D, Gillam L, Chen C. Toxic methemoglobinemia a rare but serious comphcation of transesophageal echocardiography Can J Cardiol 1998 14(9) 1157-60. 

Stoiber TR. Toxic Methemoglobinemia comphcating transesophageal echocardiography. Echocardiography 1999 16(4) 383-5. 

Gregory PJ, Matsuda K. Cetacaine spray-induced methemoglobinemia after transesophageal echocardiography. Ann Pharmacother 2000 34(9) 1077. 

Mangion JR, Habboub AA, Kamat BR, Tam SK. Transesophageal echocardiography with pathological correlation in severe valvular disease associated with fenfluramine-phentermine. Echocardiography 1999 16(1) 27-30. 

Reduced hepatic clearance, as well as relative overdosage, of local anesthetics can lead to systemic toxicity, as illustrated by three patients who underwent topi-calization of the oropharynx for transesophageal echocardiography with lidocaine 10% spray or 2% viscous and subsequently became confused and drowsy (SEDA-21,135). 

Kikura M, Ikeda K. Comparison of effects of sevoflurane/ nitrous oxide and enflurane/nitrous oxide on myocardial contractility in humans. Load-independent and noninvasive assessment with transesophageal echocardiography. Anesthesiology 1993 79(2) 235-43. 

Kitahata H, Tanaka K, Kimura H, Saito T. [Effects of sevoflurane on left ventricular diastolic function using transesophageal echocardiography.] Masui 1993 42(3) 358-64. 

Ultrafast or cine-CT may be very useful in detecting ischemia based on calcium deposition. Transesophageal echocardiography is superior to transthoracic echocardiography. 

Seward JB, Khandheria BK, Oh JK, et al. Critical appraisal of transesophageal echocardiography Limitations, pitfalls, and complications. J Am Soc Echocardiogr 1992 5 288-305. 

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