Novel ultrasonic insight into coronary arteries

Transesophageal echocardiography (TEE) has gained general acceptance as it provides valuable insights into various clinical situations, can be applied at bedside and in operating rooms, and is relatively inexpensive. 1–4 Besides for the standard cardiovascular examination, TEE has been used to investigate major epicardial coronary arteries in different clinical settings, both with and without the application of Doppler techniques. 4–11 Most previous TEE studies in coronary arteries concentrated on the assessment of the left main stem—the very proximal left coronary segment—as this is, with TEE, the best assessable segment of the coronary tree. 12 On the other hand, the accuracy of coronary angiographic assessment of lumen narrowing is particularly limited in the left main stem, 13 which makes complementary information on the lumen of this particular coronary segment particularly valuable. 14 In addition, it is well-known that significant left main stenoses have a particularly unfavourable clinical course unless adequately treated, 15–17 and that (on average) the severity of coronary atherosclerosis is conversely proportional to the distance between the coronary site of interest and the aorta-coronary ostium. 12 , 18 Multiplane TEE permits both, visualization of the coronary arteries far beyond the very proximal segment and reliable identification of coronary artery abnormalities. 8 In a recent study, the technique of fragment reconstruction of coronary arteries from two-dimensional TEE images allowed to obtain summation images of entire coronary vessels, which improved imaging of coronary artery length. 19