Transgastric imaging: a valuable addition to the assessment of congenital heart disease by transverse plane transesophageal echocardiography.

Multiview transgastric imaging was performed with standard single transverse plane transesophageal probes in 16 patients to assess its potential additional value in defining the complexities of congenital heart disease. The age of patients studied ranged from 1.1 to 32 years (mean of 10.4 years). Their body weight ranged from 8.3 kg to 69 kg (mean of 29 kg). In all studies, a complete range of transesophageal and transgastric views could be obtained. The information thus obtained was correlated with the findings of prior precordial echocardiography and subsequent cardiac catheterization or surgical inspection. The pathologic conditions studied included tetralogy of Fallot, (4), isolated ventricular septal defect (4), valvular aortic stenosis (1), subvalvular and valvular aortic stenosis (1), supraaortic stenosis (1), total atrioventricular septal defect (1), secundum atrial septal defect (1), double-outlet right ventricle (1), double-chambered right ventricle (1), and pulmonary atresia, ventricular septal defect, and superoinferior ventricles (1). The single-plane data provided by transgastric scanning were compared and contrasted with that obtained from transesophageal scanning. Transgastric views were shown to be superior to transesophageal imaging in demonstrating the anatomy of the right ventricular outflow tract, the left ventricular outflow tract, and the apical and anterior aspects of the ventricular septum. In addition, these views offered a favorable angle of incidence for spectral wave Doppler studies of flow in both outflow tracts. We conclude that transverse plane transgastric imaging is an important addition to the transesophageal assessment of congenital cardiac disease. Its main additional benefit is in the study of lesions that involve either the right or left ventricular outflow tract or the anteroapical ventricular septum. Its main clinical value is likely to be in the evaluation of the perioperative patient in whom diagnostic precordial imaging is frequently impossible.