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Transoesophageal Echo-Doppler in cardiology
  1. Peter Hanrath
  1. Medical Clinic I, University Hospital RWTH Aachen, Germany
  1. Professor Peter Hanrath, Medical Clinic I/University Hospital RTWH Aachen, Pauwelsstraβe 30, D-52074 Aachen, Germanyphan{at}

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Transoesophageal echocardiography (TOE) has opened a new sonographic window to the heart and the thoracic aorta. The technical development of this ultrasound based diagnostic tool, as well as its clinical application in a large variety of important cardiovascular diseases, has been cultivated scientifically mainly by European cardiologists within the last 15 years. Miniaturised electronic phased array transducer technology incorporated in a gastroscope-like instrument formed the basis for the breakthrough of TOE in clinical cardiology.1 The wide clinical application of TOE in the past has without doubt significantly improved our diagnostic possibilities and contributed much to a better understanding of the pathophysiology of many diseases such as aortic dissection or cardiogenic stroke. Both factors influenced significantly the therapeutic management and led to a better outcome of a variety of cardiovascular diseases.

This review will focus on the clinical application of TOE. There is general agreement that a TOE examination is indicated in all patients where conventional transthoracic echocardiography (TTE) fails to provide conclusive diagnostic information (for example, emphysema) or where TTE is impossible (during surgery). Beyond that TOE is generally performed when it is expected to add important information to the data first obtained by TTE, because of the higher image resolution or the potential to acquire images of cardiac or vascular structures that usually are not accessible by the transthoracic approach.

Determining the sources of embolism

Stroke and peripheral embolisation are major causes of morbidity and mortality. Stroke is the third leading cause of death in the USA. Around 80–85% of all strokes are of ischaemic origin, and a fifth of these strokes are caused by cardiogenic embolism. The higher diagnostic sensitivity of TOE in determining sources of embolism is mainly based on the proximity of the oesophagus and the heart, thus allowing unique sonographic views of the atria (especially the left atrial appendage), …

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