Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

Fig. 1. Representative TEE views in swine. a TEE mid-esophageal modified four-chamber view, array at 0°. RA right atrium, ** tricuspid valve, RV right ventricle, IVS interventricular septum, PA pulmonary artery, LA left atrium, # mitral valve, LV left ventricle. b TEE transgastric two-chamber view, array at 62°. LVAW left ventricular anterior wall, LVIW left ventricular inferior wall, LA left atrium, # mitral valve. c TEE mid-esophageal three-chamber view, showing the left ventricle in a long axis, array at 112°. PA pulmonary artery, LA left atrium, # mitral valve, LVPW left ventricular posterior wall, LVOT left ventricular outflow tract, * aortic valve, AA ascending aorta, RVOT right ventricular outflow tract, IVS interventricular septum. d TEE upper-oesophageal view of ascending aorta and aortic valve, array at 67°. LVOT left ventricular outflow tract, * aortic valve, AA ascending aorta, RVOT right ventricular outflow tract, arrow pulmonary valve

Fig. 2. Representative TEE pulsed wave Doppler and tissue Doppler measurements. a Tissue Doppler beam aligned with the lateral tricuspidal annulus to measure tricuspidal annular plane systolic velocity (TASV). b TEE pulsed wave Doppler measurement in the right ventricular outflow tract. c TEE pulsed wave Doppler measurement in the left ventricular outflow tract

Fig. 3. Exemplary demonstration of speckle trasssscking and myocardial work analysis. a Analysis of left ventricular peak systolic longitudinal strain obtained from a modified apical 4-chamber view with parametric (color-coded) display of end-systolic strain (left upper panel); M-mode representation of peak systolic strain (left lower panel); and strain-time curves: each colored curve displays a different segmental strain while the dotted white curve represents the average peak systolic longitudinal strain (right upper panel). b myocardial work indices obtained from pressure-strain loops with the myocardial work curve and the Bull’s eye representing segmental myocardial work indices. GLS global longitudinal strain, GWI global myocardial work index, GCW global constructive work, GWW global wasted work, GWE global effective work, BP blood pressure

Fig. 4. Right ventricular myocardial work assessment. a 4CH view for the RV anterior wall at 0°. RA right atrium, ** tricuspid valve, RV right ventricle, IVS interventricular septum, PA pulmonary artery, LA left atrium, # mitral valve, LV left ventricle. b modified upper LAX RV in- and outflow view showing the RV free wall at 112°. PA pulmonary artery, LA left atrium, # mitral valve, AV aortic valve, AA ascending aorta, LVOT left ventricular outflow tract, IVS interventricular septum, RVOT right ventricular outflow tract, LVPW left ventricular posterior wall. c mid-esophageal LAX RVOT view showing the posterior part of the RVOT at 0°. AA ascending aorta, RVOT right ventricular outflow tract, RVPW right ventricular posterior wall, ** tricuspid valve, PAC pulmonary artery catheter, PV pulmonary valve. d peak systolic longitudinal strain analysis of the anterior right ventricular obtained from a 4CH view (corresponding to panel a). e peak systolic longitudinal strain analysis of the right ventricular free wall obtained from a modified upper LAX RV in- and outflow (corresponding to panel b). f peak systolic longitudinal strain analysis of the right ventricular posterior part of the RVOT…

Fig. 5. Correlation plot of thermodilution, pulsed wave Doppler and volumetric derived cardiac output. Invasively obtained cardiac output measured by pulmonary artery catheter correlated well with TEE measurements. a Comparison of COTD and COPWD b Comparison of COTD and COvol. COTD = cardiac output determined using thermodilution via a Swan-Ganz catheter, COPWD = Ultrasound derived Cardiac output using pulsed wave Doppler, COvol = Ultrasound derived Cardiac output using volumetric calculations. Dotted lines represent 95%-confidence interval