Transesophageal Echocardiographic Assessment of Lesions of the Right Ventricular Outflow Tract and Pulmonic Valve

To establish the role of biplane transesophageal echocardiography (TEE) in the assessment of congenital and acquired lesions involving the right ventricular outflow tract (RVOT) and pulmonic valve (PV), 28 consecutive RVOT and PV lesions in 22 consecutive patients were studied by two-dimensional and color Doppler transthoracic echocardiograms (n = 22), horizontal (n = 22) and vertical (n = 22) plane TEEs, cardiac catheterization (n = 15), cardiac surgery (n = 6), and magnetic resonance imaging (n = 1). Sixteen patients had congenital lesions, and six had acquired lesions. Longitudinal TEE clearly imaged 25 of 28 abnormalities, transverse TEE clearly imaged 12 of 28, and transthoracic echocardiography clearly imaged 9 of 28. Two-dimensional TEE scanning revealed the lesion or site of stenosis. Color Doppler revealed conspicuous mosaic jets in relation to a structural abnormality in most cases. Longitudinal TEE was more sensitive in the detection of small vegetations of the PV, in the depiction of PV doming in cases of valvar pulmonic stenosis, and in the display of the RVOT and PV so that the longitudinal extent of involvement of larger masses could be appreciated. However, longitudinal TEE was not able to assess the gradient of a stenosis at the RVOT or PV level in any case. Biplane TEE is helpful in the anatomic assessment of congenital and acquired lesions of the RVOT and PV in adults. (ECHOCARDIOGRAPHY, Volume 13, January 1996)