Transesophageal Echocardiography for Pediatric and Congenital Heart Disease

Preface
Acknowledgments
Introduction
Contents
Contributors
1: Science of Ultrasound and Echocardiography
	Introduction
	Background
	Physics of Sound and Ultrasound
		Sound: Definition and Properties
		Reflection: The Key to Ultrasonic Imaging
		Attenuation and Ultrasonic Imaging
	Important Principles of Echocardiographic Image Formation
		Transducers
		Transducer Beam Formation and Geometry
		Arrays
		TEE Transducers
		Pulse Repetition Frequency
		Generation of an Echocardiographic Image
		Image Resolution
			Spatial Resolution
			Axial Resolution
			Lateral Resolution
			Elevational Resolution
		Optimizing Spatial Resolution
			Contrast Resolution
			Temporal Resolution
			Tissue Harmonic Imaging
	Doppler Echocardiography
		The Doppler Principle
		Spectral Doppler
			Continuous Wave Doppler
			Pulsed Wave Doppler
		Aliasing and the Nyquist Limit
			Combining the Spectral Doppler Modalities
			Avoidance of Artifacts with Spectral Doppler
		Spectral Doppler for Hemodynamic and Myocardial Assessment
			Pressure Gradients and Intracardiac Pressures
			Cardiac Flow
			Myocardial Function
		Color Flow Doppler
			Importance of Color Flow Doppler
		Audible Doppler
	Overview of the Echocardiography Machine
	Artifacts
		Mirror Image Artifacts
		Reverberation Artifacts
		Side Lobes and Grating Lobes
		Acoustic Shadowing
	Digital Image Storage and DICOM
	Summary
	Questions and Answers
	References
2: Instrumentation
	Introduction
	Evolution of TEE
		History of TEE Probes for Children
		Single-Plane Probes
		Biplane Probes
		Multiplane Probes
			Mini-multiplane Pediatric TEE Probe
			Micro-multiplane Pediatric TEE Probe
		Current Probes for TEE
		3D TEE Probe
		Principles of the TEE Transducer
		Current TEE Transducer Technology
		Sector Size
		Frame rate
		Zoom
		Image Optimization
		Color flow Imaging Optimization
		M-Mode
		Quantitative Assessment
		3D TEE Imaging
		Clinical Applications: TEE for Children with CHD
	Care and Maintenance of TEE Probes
		TEE Probe Handling During the Study
		Cleaning, Disinfection, and Storage
		TEE Probe Maintenance
	Other Techniques Applicable to TEE: Interactive and Intraprocedural Imaging
		Epicardial Echocardiography
		Intracardiac Echocardiography
	Recent Advances in Echocardiography
		Artificial intelligence
		High Frame Rate Cardiac Imaging
		New Beamforming Techniques
		The Future
	Questions and Answers
	References
3: Indications and Guidelines in Pediatric and Congenital Heart Disease
	Introduction
	Indications for Transesophageal Echocardiography
		Adult-Based Indications Related to Congenital Heart Disease
		Pediatric and Congenital-Based Indications
			Diagnostic Indications
			Perioperative Indications
				During Cardiovascular Surgery
				During Noncardiac Surgery
			TEE-Guided Interventions
	Applications of Three-Dimensional Transesophageal Echocardiography
	Applications of Transesophageal Echocardiography in the Ambulatory Setting
	Role of the Sonographer in Transesophageal Echocardiography
	Guidelines for Training and Maintenance of Competence in Transesophageal Echocardiography
		Knowledge Base and Skills
		Training Guidelines
			For Physicians Who Practice Pediatric Cardiology and Adult Congenital Heart Disease
			For Physicians Not Formally Trained in Pediatric Cardiology or Adult Congenital Heart Disease
	Certification in Transesophageal Echocardiography
	Safety Considerations and Complications
		Data Regarding Safety
		Probe Insertion Failure
		Trauma to the Gastrointestinal Tract
		Airway and Hemodynamic Concerns
		Risk of Bacteremia and Endocarditis Prophylaxis
	Contraindications
	Summary
	Questions and Answers
	References
4: Structural Evaluation of the Cardiovascular System
	Introduction
	Approach to Structural Evaluation
		General Principles for Cardiovascular Assessment
		Probe Orientation and Manipulation
		Cross-Sectional TEE Views Used for CHD Evaluation
			TEE Probe Locations and Views Used in This Textbook
			Image Display Conventions Used in This Textbook
	Method of Structural Evaluation of CHD by TEE
		Initiation of TEE Study, Establishment of Atrial Situs and Systemic/Pulmonary Venous Return
		Atria and Atrial Septum
		Atrioventricular Valve Evaluation
		Ventricles and Ventricular Septum
		Outflow Tracts and Semilunar Valves
	Coronary Artery Evaluation
		Main and Branch Pulmonary Arteries, Aortic Arch
		Descending Aorta
		Evaluation of Cardiac Malposition
	Tabular Synopsis of the Segmental Approach by TEE
	Summary
	Questions and Answers
	References
5: Functional Evaluation of the Heart
	Introduction
	Transesophageal Echocardiographic Evaluation of Ventricular Function in Congenital Heart Disease
		Indications
		Imaging Planes
	Echocardiographic Assessment of Global Systolic Ventricular Function
		Left Ventricular Shortening Fraction and Fractional Area Change
		Left Ventricular Ejection Fraction
		Velocity of Circumferential Fiber Shortening and the Stress–Velocity Index
		Doppler Parameters of Global Left Ventricular Systolic Function
		Left Ventricular dP/dt
		Myocardial Performance Index (Tei Index)
	Echocardiographic Assessment of Regional Systolic Ventricular Function
		Two-Dimensional Imaging
		Tissue Doppler Imaging and Strain Imaging
	Assessment of Diastolic Ventricular Function by Transesophageal Echocardiography
		Mitral Inflow Doppler
		Pulmonary Venous Doppler
		Tissue Doppler Imaging
		Tissue Doppler Studies in Normal Children
		Color M-Mode Flow Propagation Velocity
		Atrial Assessment of Diastolic Function
	Echocardiographic Assessment of Right Ventricular Function
		Right Ventricular Myocardial Performance Index
		Right Ventricular dP/dt
		Right Ventricular Tissue Doppler Imaging
		Acoustic Quantification and Right Ventricular Function
		Three-Dimensional Echocardiography and Right Ventricular Function
	Echocardiographic Assessment of Single Ventricular Function in Patients with Complex Congenital Heart Disease
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
		Case #2
			TEE Findings:
		Case #3
			TEE Findings:
	Questions and Answers
	References
6: Systemic and Pulmonary Venous Anomalies
	Introduction
	Systemic Veins
		General Considerations
			Normal Systemic Venous Anatomy
		Transesophageal Examination of Normal Systemic Veins
			Two-Dimensional Imaging
			Systemic Venous Flow Doppler: Normal and Abnormal Patterns
	Systemic Venous Anomalies
		Persistent Left Superior Vena Cava Draining into the Coronary Sinus
			General Considerations
			Transesophageal Echocardiography
		Anomalous Subaortic Position of the Innominate Vein (Retroaortic Innominate Vein)
			General Considerations
			Transesophageal Echocardiography
		Persistent Left Superior Vena Cava Draining into the Left Atrium
			General Considerations
			Transesophageal Echocardiography
		Persistent Left Superior Vena Cava Draining into a Coronary Sinus with a Coronary Sinus–Left Atrial Fenestration
			General Considerations
			Transesophageal Echocardiography
		Right Superior Vena Cava Connection to the Left Atrium
			General Considerations
			Transesophageal Echocardiography
		Interrupted Inferior Vena Cava with Azygos Continuation
			General Considerations
			Transesophageal Echocardiography
		Left-Sided Inferior Vena Cava
			General Considerations
			Transesophageal Echocardiography
	Pulmonary Veins
		General Considerations
			Normal Pulmonary Venous Anatomy
		Transesophageal Imaging of Normal Pulmonary Veins
			Two-Dimensional Imaging
			Pulmonary Venous Flow Doppler: Normal and Abnormal Patterns
	Pulmonary Venous Anomalies
		Partial Anomalous Pulmonary Venous Connection
			General Considerations
			Transesophageal Echocardiography
			Postoperative Considerations in PAPVC
		Scimitar Syndrome
			General Considerations
			Transesophageal Echocardiography
		Partial Anomalous Pulmonary Venous Drainage Due to Malposition of Septum Primum
			General Considerations
			Transesophageal Echocardiography
		Total Anomalous Pulmonary Venous Connection
			General Considerations
			Transesophageal Echocardiography
		Supracardiac TAPVC
			General Considerations
			Transesophageal Echocardiography
		Infracardiac TAPVC
			General Considerations
			Transesophageal Echocardiography
		Cardiac-Type of TAPVC
			General Considerations
			Transesophageal Echocardiography
		Mixed TAPVC
			General Considerationss
			Transesophageal Echocardiography
			Postoperative Considerations in TAPVC
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
			Suggested Reading/References
		Case #2
			TEE Findings:
			Suggested Reading/References
	Questions and Answers
	References
7: Atrial Septal Defects and Atrial Anomalies
	Introduction
	Atrial Septal Defects
		General Considerations
			Secundum Atrial Septal Defect
			Primum Atrial Septal Defect
			Sinus Venosus Atrial Septal Defect
			Coronary Sinus Atrial Septal Defect
			Patent Foramen Ovale
		Transesophageal Echocardiographic Examination
		Goals of the Transesophageal Echocardiographic Examination
			Pre-procedure Assessment: Surgical and Transcatheter Considerations
			Post-procedure Assessment: Surgical and Transcatheter Considerations
	Juxtaposition of the Atrial Appendages
		General Considerations
		Transesophageal Echocardiographic Examination
		Goals of the Transesophageal Echocardiographic Examination
			Surgical and Transcatheter Considerations
	Cor Triatriatum
		General Considerations
		Transesophageal Echocardiographic Examination
		Goals of the Transesophageal Echocardiographic Examination
			Surgical and Transcatheter Considerations
			Preoperative Assessment
			Postoperative Assessment
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
			Suggested Reading/References
		Case #2
			TEE Findings:
			Suggested Reading/References
		Case #3
			TEE Findings:
			Suggested Reading/References
		Case #4
			TEE Findings:
			Suggested Reading/References
		Case #5
			TEE Findings:
			Suggested Reading/References
	Questions and Answers
	References
8: Atrioventricular Septal Defects
	Introduction
	General Considerations
	Nomenclature and Classification
		Complete and Incomplete (Partial) Defects
		Intermediate and Transitional Forms
		Congenital Heart Surgery Nomenclature and Database Project Classification
		Rastelli Classification
		Balanced Versus Unbalanced Defect Classification
	Morphological Features
		Atrioventricular Septal Defects
			Common Atrioventricular Valve
			Papillary Muscles
			Aortic Valve Position Relative to the Atrioventricular Valve(s)
			Left Ventricular Outflow Tract
	Pathophysiology
		Shunting Patterns
		Hemodynamic Consequences
	Management
	Transesophageal Echocardiographic Assessment
		Preoperative TEE Evaluation
			Two-Dimensional Imaging of Complete Defects
				The Atrioventricular Septum and the Common Atrioventricular Valve
				Papillary Muscles
				The Interatrial Communication
				The Ventricular Communication
				The Left Ventricular Outflow Tract
				Commitment of the Atrioventricular Junction to the Ventricles
			Two-Dimensional Imaging of Partial Defects
			Doppler Evaluation of Defects
			Associated Cardiac Defects
		Postoperative TEE Evaluation
			Residual Left Atrioventricular Valve Problems
				Left Atrioventricular Valve Regurgitation
				Left Atrioventricular Valve Stenosis
			Intracardiac Shunts
			Left Ventricular Outflow Tract Obstruction
		Three-Dimensional Echocardiographic Imaging
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
				Preoperative Examination
				Postoperative Examination
			Suggested Reading/References
		Case #2
			TEE Findings:
				Preoperative Examination
				Postoperative Examination
			Suggested Reading/References
		Case #3
			TEE Findings:
				Preoperative Examination
				Postoperative Examination
				Postoperative Examination (After Revision of the Repair)
			Suggested Reading/References
	Questions and Answers
	References
9: Mitral and Tricuspid Valve Anomalies
	Introduction
	Congenital Mitral Valve Anomalies
		General Considerations Regarding Transesophageal Imaging of the Mitral Valve
		Congenital Anomalies Associated with Mitral Stenosis and/or Regurgitation
			Typical Congenital Mitral Valve Dysplasia
				Morphology
				Management Considerations
				Transesophageal Echocardiography
			Parachute Mitral Valve
				Morphology
				Management Considerations
				Transesophageal Echocardiography
			Supravalvar Mitral Membrane
				Management Considerations
				Transesophageal Echocardiography
			Double Orifice Mitral Valve
				Morphology
				Management Considerations
				Transesophageal Echocardiography
			Mitral Arcade
				Morphology
				Management Considerations
				Transesophageal Echocardiography
			Congenital Mitral Valve Regurgitation
				Morphology
				Management Considerations
				Transesophageal Echocardiography
			Isolated Cleft of the Mitral Valve
				Morphology
				Management Considerations
				Transesophageal Echocardiography
			Straddling Mitral Valve
				Morphology
				Management Considerations
				Transesophageal Echocardiography
			Mitral Valve Prolapse
				Morphology
				Management Considerations
				Transesophageal Echocardiography
		Infective Endocarditis
	Congenital Tricuspid Valve Anomalies
		Ebstein Anomaly
			Morphology
			Management Considerations
			Transesophageal Echocardiography
		Dysplastic Tricuspid Valve
			Morphology
			Management Considerations
			Transesophageal Echocardiography
		Assessment of Tricuspid Regurgitation
		Postoperative TEE Evaluation
	Summary
	Case-Based Studies
		Case #1
			TEE Findings:
			Suggested Reading/References
		Case #2
			TEE Findings:
				Preoperative Study
				Postoperative Study After Initial Surgery
				Postoperative Study At Subsequent Surgery
			Suggested Reading/References
		Case #3
			TEE Findings:
				Preoperative Study
				Postoperative Study
			Suggested Reading/References
		Case #4
			TEE Findings:
				Preoperative Study
				Postoperative Study
			Suggested Reading/References
		Case #5
			TEE Findings:
				Preoperative Study
				Postoperative Study
			Suggested Reading/References
		Case #6
			TEE Findings:
				Preoperative Study
				Postoperative Study
			Suggested Reading/References
	Questions and Answers
	References
10: Ventricular Septal Defects
	Introduction
	Morphologic Classification of Ventricular Septal Defects
	Evaluation of Ventricular Septal Defects by TEE
		Goals of the TEE Evaluation for VSDs
			Preoperative or Preinterventional Assessment
			Postoperative or Postinterventional Assessment
		Method of TEE Evaluation of VSDs
	Intraoperative Evaluation of VSDs
		Preoperative Assessment
		Postoperative Assessment
	TEE in the Cardiac Catheterization Lab
	Three-Dimensional TEE
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
				Preoperative Study (Fig. 10.17a, b; Video 10.17)
				Postoperative Study #1 (Fig. 10.18; Video 10.18)
				Postoperative Study #2 (Fig. 10.19; Video 10.19)
		Case #2
			TEE Findings:
				Preoperative Study (Fig. 10.20a, b; Video 10.20)
				Postoperative Study #1 (Fig. 10.21; Video 10.21)
				Postoperative Study #2 (Fig. 10.22; Video 10.22)
		Case #3
			TEE Findings:
				Preoperative Study (Fig. 10.23; Video 10.23)
				Postoperative Study #1 (Fig. 10.24; Video 10.24)
				Postoperative Study #2 (Fig. 10.25; Video 10.25)
		Case #4
			TEE Findings:
				Postoperative Study #1 (Fig. 10.26; Video 10.26)
				Postoperative Study #2 (Fig. 10.27; Video 10.27)
	Questions and Answers
	References
11: Single Ventricle
	Introduction
	Single Ventricle: Anatomic Types
		General Considerations for TEE Evaluation
		Hypoplastic Left Heart Syndrome
		Hypoplastic Right Heart Syndrome
		Tricuspid Atresia
		Univentricular Atrioventricular (AV) Connection
		Heterotaxy
		Other Types of Single Ventricle
	Surgery for the Single Ventricle
		Preoperative Assessment
		Surgical Interventions for Single Ventricle and their Assessment by TEE
			Modified Blalock-Taussig and Central Shunts
			Pulmonary Artery Band
			Damus-Kaye-Stansel Procedure
			Norwood Procedure
			Bidirectional Cavopulmonary (Glenn) Anastomosis
			Fontan Procedure
	Additional Evaluation and Long-Term Considerations
	Summary
	Case-Based Examples
		Case #1
			TEE findings:
		Case #2
			TEE findings:
			Suggested Reading/References
		Case #3
			TEE findings:
			Suggested Reading/References
	Questions and Answers
	References
12: Cardiac Malposition and Heterotaxy
	Introduction
	Demographics of Cardiac Malpositions and Heterotaxy
	Heterotaxy
	Transesophageal Echocardiography Imaging
	Cardiac Position, Viscero-Atrial Situs, Atrial Anatomy
	Systemic and Pulmonary Venous Return
	Atrioventricular Valve(s) and Ventricular Assessment
	Ventriculo-Arterial Junction and Outflow Tracts
	Great Artery Evaluation
	Coronary Artery Evaluation
	Postoperative TEE Evaluation
	Summary
	Case-Based Examples
		Case #1
			TEE findings:
		Case #2
			TEE findings:
		Case #3
			TEE findings:
	Questions and Answers
	References
13: Outflow Tract Anomalies
	Introduction
	Utility of Transesophageal Echocardiography
	Normal Anatomy
	Left Ventricular Outflow Tract Anomalies
		Valvar Aortic Stenosis
		Subvalvar Aortic Stenosis
		Supravalvar Aortic Stenosis
		Aortic Regurgitation
		Aneurysm of the Proximal Aorta
	Right Ventricular Outflow Tract Anomalies
		Valvar Pulmonary Stenosis
		Subvalvar Pulmonary Stenosis (Double Chamber Right Ventricle)
		Pulmonary Regurgitation
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
			Suggested Reading/References
		Case #2
			TEE Findings:
			Suggested Reading/References
	Questions and Answers
	References
14: Conotruncal Anomalies
	Introduction
	General Considerations
	Specific Lesions
		Tetralogy of Fallot
			Anatomy
			Transesophageal Echocardiographic Evaluation
			Surgical Considerations
		Double Outlet Right Ventricle
			Anatomy
			Transesophageal Echocardiographic Evaluation
			Surgical Considerations
		Truncus Arteriosus
			Anatomy
			Transesophageal Echocardiographic Evaluation
			Surgical Considerations
	Conclusion
	Case-Based Examples
		Case #1
			TEE Findings:
			Suggested Reading/References
		Case #2
			TEE Findings:
			Suggested Reading/References
		Case #3
			TEE Findings:
			Suggested Reading/References
	Questions and Answers
	References
15: Transposition Complexes
	Introduction
	Specific Lesions
		Transposition of the Great Arteries
			General Considerations
				Etiology and Epidemiology
				Embryology
				Morphology
				Pathophysiology
			Surgical Considerations
			Imaging Considerations
				Preoperative TEE
				Postoperative TEE Assessment after the Arterial Switch Operation
				Postoperative TEE Assessment after Senning or Mustard Procedure
				Postoperative TEE Assessment after Complex Repairs (Rastelli and Nikaidoh Procedure)
				Role of TEE in Late Reintervention/Reoperation after Arterial Switch Operation
				Role of TEE in Late Reintervention/Reoperation after Atrial Switch Operation
		Congenitally Corrected Transposition of the Great Arteries
			General Considerations
				Etiology and Epidemiology
				Embryology
				Morphology
				Pathophysiology
			Surgical Considerations
			Imaging Considerations
				Preoperative TEE
				Role of TEE in Physiologic Repair
				Role of TEE in Anatomic Repair
				Role of TEE During PA Banding
				Role of TEE During Double-Switch Operation
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
			Suggested Reading/References
		Case #2
			TEE Findings:
			Suggested Reading/References
			Acknowledgement
		Case #3
			TEE Findings:
			Suggested Reading/References
	Questions and Answers
	References
16: Great Artery and Vascular Anomalies
	Introduction
	Abnormal Vascular Connections
		Patent Ductus Arteriosus
			Anatomic Features
			Associated Defects
			Pathophysiology
			Management Considerations
			Applications of Transesophageal Echocardiography
				Goals of TEE Prior to Catheter or Surgical Intervention
				Goals of TEE After Catheter or Surgical Intervention
		Aortopulmonary Window
			Anatomic Features
			Associated Defects
			Pathophysiology
			Management Considerations
			Applications of Transesophageal Echocardiography
				Goals of TEE Prior to Surgical Intervention
				Goals of TEE After Surgical Intervention
	Anomalies of the Branch Pulmonary Arteries
		Anomalous Origin of the Left Pulmonary Artery from the Right Pulmonary Artery
			Anatomic Features
			Associated Defects
			Pathophysiology
			Management Considerations
			Applications of Transesophageal Echocardiography
				Goals of TEE Prior to Surgical Intervention
				Goals of TEE After Surgical Intervention
		Anomalous Origin of a Branch Pulmonary Artery from the Aorta
			Anatomic Features
			Associated Defects
			Pathophysiology
			Management Considerations
			Applications of Transesophageal Echocardiography
				Goals of TEE Prior to Surgical Intervention
				Goals of TEE After Surgical Intervention
	Anomalies of the Aortic Arch
		Coarctation of the Aorta
			Anatomic Features
			Associated Defects
			Pathophysiology
			Management Considerations
			Applications of Transesophageal Echocardiography
				Goals of TEE Prior to Surgical Intervention
				Goals of TEE After Surgical Intervention
		Interrupted Aortic Arch
			Anatomic Features
			Associated Defects
			Pathophysiology
			Management Considerations
			Applications of Transesophageal Echocardiography
				Goals of TEE Prior to Surgical Intervention
				Goals of TEE After Surgical Intervention
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
				Preoperative Study
				Postoperative Study
			Suggested Reading/References
		Case #2
			TEE Findings:
				Preoperative Study
				Postoperative Study
			Suggested Reading/References
		Case #3
			TEE Findings:
				Preoperative Study
				Postoperative Study
			Suggested Reading/References
	Questions and Answers
	References
17: Congenital Coronary Artery Anomalies
	Introduction
	Role and Utility of Transesophageal Echocardiography in the Evaluation of Congenital Coronary Artery Anomalies
		Anomalous Aortic Origin of a Coronary Artery
			Anatomy
			Transesophageal Echocardiographic Evaluation
		Anomalous Origin of Left Coronary Artery from Main Pulmonary Artery
			Anatomy
			Transesophageal Echocardiographic Evaluation
		Coronary Artery Fistula
			Anatomy
			Transesophageal Echocardiographic Evaluation
		Kawasaki Disease
			Anatomy
			Transesophageal Echocardiographic Evaluation
	Summary
	Case-Based Example
		Case #1
			TEE Findings:
			Suggested Reading/References
	Questions and Answers
	References
18: Intraoperative and Postoperative Applications
	Introduction
	Evolution of Intraoperative Echocardiography in CHD
		Epicardial Echocardiography
		Transesophageal Echocardiography
			Early Developments
			Monoplane TEE
			Biplane TEE
			Multiplane TEE
			Intracardiac Catheters
			Three-Dimensional TEE
			TEE Probe Selection
	Role of Intraoperative Echocardiography
		Impact on Surgical Management
		Impact on Medical Management
			Guiding Catheter Placement
			Identifying Intracardiac Air and Confirming Cardiac Deairing
			Assessing Ventricular Loading Conditions
			Assessing Systolic Left Ventricular Function
			Assessing Systolic Right Ventricular Function
			Assessing Diastolic Ventricular Function
			Detecting Myocardial Ischemia
		Impact on Anesthetic and Hemodynamic Management
	Cost-Effectiveness of Intraoperative TEE
	Limitations and Pitfalls of Intraoperative TEE
	Return to Cardiopulmonary Bypass Decisions
	Correlation of Intraoperative and Postoperative Echocardiographic Findings
	TEE for Evaluation in the Postoperative Setting
	Summary
	Questions and Answers
	References
19: Other Applications, Including the Critical Care Setting
	Introduction
	Infective Endocarditis
	Echocardiographic Manifestations of IE
	Goals of TEE Imaging in IE
	Cardiac Thrombi
	Prosthetic Valves
		Echocardiographic Evaluation of Prosthetic Valves
		Doppler Evaluation of Prosthetic Valves
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
		Case #2
			TEE Findings:
	Questions and Answers
	References
20: Applications for Non-Congenital Heart Disease in Pediatric Patients
	Introduction
	Solid Organ Transplantation
		Heart Transplantation
			Evaluation of Cardiac Transplant Recipients
			Screening of Cardiac Transplant Donors
			Intraoperative TEE Evaluation
				Intraoperative Monitoring and Assessment
				Intraoperative Post-Transplant Evaluation
		Lung Transplantation
			Intraoperative TEE Evaluation
		Heart and Lung Transplantation
			Intraoperative TEE Evaluation
		Liver Transplantation
			Safety of TEE in Liver Transplantation
			Preoperative Liver Transplant Evaluation
			Intraoperative Management During Liver Transplantation
	Mechanical Circulatory Support in Children
		Extracorporeal Membrane Oxygenation
			General Considerations
			Most Common Types of ECMO
				Veno-arterial (VA) ECMO
				Veno-venous (VV) ECMO
				Veno-venous-arterial (VVA) ECMO
			TEE Evaluation
			Cannula Position
				Veno-arterial ECMO
				Veno-venous ECMO
			Mechanical Support Complications
				Pericardial Effusion
				Cannula Malposition/Thrombi
				Inadequate Decompression
			Weaning
		Ventricular Assist Devices
			General Considerations
			Types of Devices
				Pulsatile and Continuous-Devices
				Temporary Devices
			TEE Evaluation
				Chamber Size and Ventricular Function
				Intracardiac Structure and Valvular Function
				Inflow and Outflow Cannula Position
				Thrombi and Cardiac De-Airing
				Effusions
	Pulmonary Hypertension
		TEE Evaluation
			Right Ventricular Function
			Estimation of Hemodynamics
	Pulmonary Embolism
		Role of Echocardiography
		TEE Evaluation
	Pericardial Diseases
		General Considerations
		Specific Conditions
			Acute Pericarditis
			Pericardial Effusion
			Constrictive Pericarditis
			Pericardial Tumors
		TEE Evaluation
			Pericardial Effusion and Tamponade Physiology
				Evaluation of Constrictive Pericarditis
	Aortic Dissection
		General Considerations
		Classification of Aortic Dissection
		TEE Imaging of Thoracic Aorta
			Standard Views
				Imaging of Aortic Dissection
	Cardiac Tumors
		General Aspects of the TEE Evaluation
		Rhabdomyoma
			TEE Evaluation
		Fibroma
			TEE Evaluation
		Myxoma
			TEE Evaluation
		Other Cardiac Tumors
			TEE Evaluation
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
			Suggested Reading/References
		Case #2
			TEE Findings:
			Suggested Reading/References
		Case #3
			TEE Findings:
			Suggested Reading/References
		Case #4
			TEE Findings:
			Suggested Readings/References
		Case #5
			TEE Findings:
			Suggested Readings/References
	Questions and Answers
	References
21: Applications in the Cardiac Catheterization and Electrophysiology Laboratories
	Applications in the Cardiac Catheterization and Electrophysiology Laboratories
	Introduction
	Communication Between Teams
		General Concepts
		Pre-Procedural Communication (“Time-Out”)
		Intra-Procedural Communication
		Post-Procedural Communication
	Specific Applications of TEE During Interventions for Congenital Heart Disease
		Electrophysiologic Studies
		Valve Procedures
		Septal Interventions: Closure and Creation
			Transcatheter Closure of Atrial Septal Defects
			Creation or Enlargement of an Atrial Communication
			Transcather Occlusion of Ventricular Septal Defects
		Baffle Interventions, Closure and Creation
			Closure of Fontan Fenestrations or Baffle Leaks
		TEE for Guidance of Dilation of Other Congenital Heart Lesions
	Summary
	References
22: Congenital Heart Disease in the Adult
	Indications for TEE in the Adult with CHD
	Evaluation of the Patient Prior to TEE
	Diastolic Dysfunction
	Anatomic Assessment in the Adult Patient with Complex CHD
	Thromboembolic Complications
	Endocarditis
	Prosthetic Valve
	Evaluation and Guidance for Transcatheter Interventions
		Transcatheter Mitral Valve Repair
	Tricuspid Valve
	Ruptured Sinus of Valsalva Aneurysm
	Ventricular Septal Defect
	Left Atrial Appendage Occlusion
	Summary
	Questions and Answers
	References
23: Three-Dimensional Transesophageal Echocardiography in Congenital Heart Disease
	Introduction
	History and Development
	General Concepts
		3D TEE Probe Technology
		Advantages of Real-Time 3D TEE
	3D Image Display
	3D TEE for CHD Evaluation
		Considerations for 3D TEE in the Evaluation of CHD
		Clinical Application for 3D TEE in the Evaluation of CHD
	Evaluation of Atrioventricular Valves
	Evaluation of Semilunar Valves
	Evaluation of Atrial and Ventricular Septal Defects
	Evaluation of Other Congenital Cardiac Defects
	Further Applications and Development of 3D TEE
	3D Imaging: Limitations, Artifacts, and Pitfalls
	Summary
	Case-Based Examples
		Case #1
			TEE Findings:
		Case #2
			TEE Findings:
		Case #3
			TEE Findings:
		Case #4
			TEE Findings:
	Questions and Answers
	References
24: Clinical Applications of Three Dimensional Transesophageal Echocardiography in Congenital Heart Disease
	Introduction
	Defining Three-Dimensional Cardiac Anatomy
	3D TEE Imaging Techniques
	Image Display
	Guidelines-Based Recommendations
	Imaging During Interventional Cath Procedures
	Assessment of Surgical Interventions
	Imaging Related to Electrophysiology Procedures
	Case Examples
		Congenitally Corrected Transposition (L-Transposition) of the Great Arteries
		Cor Triatriatum
		Bicuspid Aortic Valve
		Parachute Mitral Valve
		Ventricular Septal Defects
		Double Inlet Left Ventricle
		Atrial Septal Defects
		Applications During Interventional Cardiac Catheterization
		Transcatheter Closure of Secundum Atrial Septal Defect
		Transcatheter Closure of Muscular Ventricular Septal Defect
		Surgery for Left Sided Obstructive Lesions
		Surgery for Atrioventricular Valves
		Right Ventricular to Pulmonary Artery Conduit
		Atrial Switch Procedures
		Atrial Flutter
		Implantable Cardioverter-Defibrillator
		Resynchronization Therapy
		Tetralogy of Fallot with Melody Valve
		Double Outlet Right Ventricle Repair
		Congenitally Corrected Transposition Palliated with ASD stent and PA band
		Truncus arteriosus
		Hypoplastic Left Heart S/P Fontan Procedure
		Bioprosthetic Mitral Valve
		Congenital Mitral Valve Stenosis
		Subaortic Stenosis
		Tricuspid Atresia and Extracardiac Fontan
	Summary
	Questions and Answers
	References
Index