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This chapter focuses on isochemic heart disease (IHD) and an intervention-related analysis, combining all the utilities of transesophageal echocardiography (TEE) in a systematic approach towards the patient undergoing coronary artery bypass grafting (CABG) surgery. Patent foramen ovale (PFO) is the most frequently reported new diagnosis. It is a common observation in about 25% of postmortem studies, and TEE is able to detect it with about the same frequency in the clinical setting. TEE is a highly accurate method for identifying atrial thrombus. In most patients scheduled to undergo elective CABG surgery, the presence of mitral valve (MV) disease is well documented. The hallmark of myocardial ischemia is regional heterogeneity in the extent and time course of systolic wall motion. Intraoperative TEE is required for mitral valve repair during left ventricular (LV) restoration surgery, but caution should be exercised in grading the severity of mitral valve regurgitation.
This chapter deals with three-dimensional (3D) imaging and reconstruction techniques in echocardiography. Real-time 3D echocardiography (RT3D) is dependent on fast processor power and the latest generation of matrix transducer technology. In addition to the common ultrasound artifacts, two types of artifacts are characteristics of 3D echo. These are stitching artifacts and dropout artifacts. RT3D-transesophageal echocardiography (TEE) has been shown to be more useful in correctly diagnosing and localizing mitral valve (MV) prolapse and/or chordal rupture, and 3D image acquisition has been shown to be quick and easy. 3D-TEE is valuable for assessing the size and location of atrial septal defects and their relationship to neighboring structures and for measuring the defect and rim size. The merger of enhanced 3D technology with myocardial deformation imaging will facilitate rapid, accurate, and powerful functional analysis of the heart.
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