[Value of transesophageal echocardiography in diagnosis of diseases of native heart valves].

In the clinical management of patients with valvular heart disease, transthoracic echocardiography (TTE) combined with Doppler has become the central diagnostic tool during the past decades. The development of transesophageal echocardiography (TEE) has led to an improved image quality especially of structures distant to the chest wall. However, since TEE is a semi-invasive technique, its use has to be considered carefully. In aortic valve disease, TEE facilitates a detailed study of valve morphology and allows sufficiently reliable planimetry of aortic valve area, at least when the multiplane approach is used. This is particularly helpful in those patients where Doppler interrogation from precordial windows fails. Aortic regurgitation is diagnosed more frequently by TEE color-flow imaging than by TTE; however, both techniques allow only semiquantitative assessment of the severity of regurgitation. TEE is also superior to TTE in defining the exact origin site, number and configuration of regurgitant jets in patients with mitral insufficiency. In particular minimal and mild mitral regurgitation is more easily detected by TEE than by TTE. The same is true for flail mitral leaflets, chordal and papillary muscle rupture, and potentially also for discrete forms of mitral valve prolapse. During surgery, TEE can be considered as an ideal tool for immediate assessment of the results of mitral valve reconstruction. Calculation of pressure gradients and valve area by TEE Doppler analysis shows comparable results to precordial studies. When multiplane TEE is available, Doppler beam alignment may become even improved in selected cases with severely excentric flow jet orientation. In addition, TEE provides of course clinically important information concerning presence or absence of atrial and particularly atrial appendage thrombi as well as of spontaneous echo contrast in patients with stenotic mitral valve. This is not only helpful regarding the decision for anticoagulation but it may also be critical in the selection of candidates for percutaneous mitral balloon valvuloplasty. TEE does also allow the morphological and functional evaluation of tricuspid and pulmonic valves. In this context, the use of biplane or multiplane TEE probes is superior to that of monoplane devices. However, currently available data does not provide unequivocal evidence that the analysis of tricuspid and pulmonic valve disease by TEE is superior to the conventional transthoracic approach.