Detection of intraoperative segmental wall-motion abnormalities by transesophageal echocardiography: the incremental value of additional cross sections in the transverse and longitudinal planes.

Because biplane and multiplane transesophageal echocardiography (TEE) are more complex and expensive than single-plane TEE, we performed this study to determine whether the use of multiple single-plane (transverse) cross sections is as reliable for detection of left ventricular segmental wall-motion abnormalities (SWMA) as biplane TEE. We used biplane TEE to acquire nine standard cross sections of the left ventricle in 41 consecutive adults undergoing cardiac or vascular surgery. Six of these cross sections were in the transverse plane (i.e., achievable with single-plane TEE) and three in the longitudinal plane (i.e., achievable only with biplane or multiplane TEE). Each cross section was divided into myocardial segments for analysis. A total of 1810 segments were analyzed by independent investigators using a standardized evaluation system. Seventeen percent of all SWMA detected in this study were in the midpapillary transverse-plane cross section, an additional 48% in other transverse-plane cross sections, and 35% exclusively in the longitudinal-plane cross sections. Thus, most (65%), but not all, SWMA were in cross sections achievable with single-plane TEE. We conclude that the MP-T cross section should be the foundation for assessment of segmental function, but additional cross sections in the transverse and longitudinal planes are required for detection of the majority of segmental wall-motion abnormalities.