Highlights of Transesophageal Echocardiography During Interventions for Adult Congenital Heart Disease

Figures

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  Figure 1. Baseline TEE images of a 43-year-old female with ostium secundum ASD closure during the percutaneous ostium secundum ASD closure procedure. Looking at the defect with the deficient rims at different angles, all with left-to-right shunt shown by color Doppler imaging: (1) At 0 degrees—atrioventricular valve rim with posterior rim. (2) At 40–60 degrees—retro-aortic rim with posterior rim. (3) At 70–90 degrees—superior rim and posterior/inferior vena cava rim. (4) At 90–130 degrees—superior vena cava rim and posterior/inferior vena cava rim.

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  Figure 2. The same patient from Figure 1 during the same procedure, after deployment of the ASD closure device, confirming the position of the device in the different positions and its interaction with nearby structures and confirming no residual leak by color Doppler. (1) At 0 degrees—interaction with the aortic valve and mitral valve (not seen in the image). (2) At 40–60 degrees—interaction with the tricuspid valve and the aortic valve. (3) At 70–90 degrees—interaction with the superior vena cava and inferior vena cava. (4) At 90–130 degrees—again, looking at the interaction with the SVC and IVC from different angles.

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  Figure 3. Baseline and interventional imaging during PFO closure of a 62-year-old male with a history of embolic stroke. (1) Looking at the interatrial septum with color Doppler and showing the PFO (arrow). (2) Looking at the pulmonary veins ensuring no anomalous pulmonary veinous return. In the image, the left lower pulmonary vein is seen at 136 degrees with flow towards the left atrium (arrow) with no anomalous connection. (3) Guiding the procedure—showing the wire crossing through the PFO (arrow). (4) Balloon inflation in the PFO and color Doppler confirming no other defects in the septum. (5) Deployment of the left atrial disc, confirming stable position and no interaction with the left atrial appendage and the aortic/mitral valve. (6) Deployment of the right atrial disc, confirming its stability, and using color Doppler to confirm no other shunts or defects in the interatrial septum.

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  Figure 4. Guiding the percutaneous closure of the SSVD of a 70-year-old female. (1) The SVC right atrium (RA) and the sinus venosus defect seen with and without color Doppler with right upper anomalous pulmonary vein (RUPV) return in red at 120 degrees. (2) The same defect at 0 degrees with the wire (arrow) in the SVC and confirming its position in the RA and not through the defect. (3) Confirming the position of the wire (arrow) from the interatrial septum and in the right upper pulmonary vein (the anomalous vein) to check pressures during the intervention. (4) Post implantation of the covered stent in the SVC showing closure of the SSVD with no obstruction to pulmonary vein flow (in red).

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  Figure 5. TEE of a percutaneous muscular VSD closure in a 54-year-old male with symptomatic significant left-to-right shunt. (1) Transgastric view of the muscular VSD with and without color Doppler showing left-to-right shunt. (2) X-plane on the defect with color Doppler at different angles to decide on the best angle for guiding the intervention. (3) X-plane of a transgastric view with color Doppler showing the wire (red arrow) across the VSD at 75 and 165 degrees. (4) X-plane of a transgastric view showing the VSD closure device (red arrow) in position and still attached to the wire at 80 and 170 degrees. (5) The same view from (4), now with color Doppler showing no residual left-to-right shunt. (6) Transgastric view at 55 degrees with color Doppler showing the VSD closure device (red arrow) after release in a stable position.

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  Figure 6. A 69-year-old male patient with a congenitally corrected transposition of the great arteries with severe tricuspid valve (systemic atrioventricular valve) regurgitation (TR). (1) Confirming the severity of the TR with and without color Doppler at 0 degrees and with X-plane color Doppler at 35 and 125 degrees in (2). (3) Measuring the size of the left atrium to confirm the feasibility of the clip procedure. (4) Guiding the crossing of the interatrial septum with X-plane color Doppler and confirming the position of the wire in the left atrium. (5) Three-dimensional view of the clipping device (red arrow) crossing the tricuspid valve from the left atrial view. (6) Looking at the tricuspid valve at 0 degrees after releasing the clip (red arrow), with and without color Doppler, and confirming the reduction in TR severity.

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  Figure 7. Paravalve leak plugging in a 51-year-old male with symptomatic paravalve leak. (1–3) Looking at the posterior paravalve area and the leak at different angles, with and without color Doppler—0 degrees in (1), 42 degrees in (2), and 79 degrees in (3). The intervention. (4) Guiding the wire across the paravalve leak and confirming its position with and without color Doppler. (5) Seeing the catheter inside the paravalve leak area with color Doppler. (6) The catheter (red arrow) in the paravalve leak area in 3D.

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  Figure 8. Baffle leak occlusion in a 46-year-old male patient with D-transposition of the great arteries post Mustard atrial switch operation and with a significant inferior systemic baffle leak. (1) Mid esophageal view at 90 degrees showing the systemic baffle leak with and without color Doppler, with flow crossing from the pulmonary venous baffle towards the IVC baffle. (2) Mid esophageal view at 0 degrees showing widely patent pulmonary venous baffle—easily recognized from the tricuspid valve (systemic AV-valve) with and without color Doppler. (3) Showing wire (arrow) across the systemic baffle leak. (4) Balloon sizing (1.13 cm) and occlusion of the defect with and without color Doppler. (5) Deploying the pulmonary venous baffle disc (arrow). (6) Deployment of the systemic venous baffle disc. (7) Final result with the device in a stable position and no more leaks visible by color Doppler.

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  Figure 9. Fontan fenestration device closure in a 37-year-old male with lateral tunnel Fontan. (1) Mid esophageal view at 90 degrees with X-plane showing the fenestration closure device (red arrow) in stable position. (2) Showing the same device from (1) with and without color Doppler.