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With rising focus on interventional treatment of the tricuspid valve (TV), the need for good echocardiographic imaging increases. Aim of this study was to develop a scoring system describing how accurate three dimensional (3D) echocardiographic imaging of TV and its anatomical structures is. Methods and results In this retrospective exploratory cohort study, we analysed data from consecutive patients undergoing transoesophageal echocardiography (TOE) and transthoracic echocardiography (TTE). 3D sequences were stored using eight different views. In each view, scoring focused on visualisation of five (in TOE 6) anatomical structures with a maximum of three points per structure for excellent imaging quality. We compared the scores of patients with and without relevant tricuspid regurgitation (TR) (cut-off effective regurgitant orifice 0.4 cm² measured in two-dimensional (2D) TTE using velocity time integral and proximal isovolumetric velocity area). 108 consecutive patients were examined, 40.7% presented with relevant TR. With the exception of coaptation, a higher score was achieved for all structures in TOE than in TTE. TV ring (TVR) was easiest to visualise with TOE in four-chamber view (4 CV) (2.42±0.67 points) presenting the highest score independent of anatomical structure and view. Posterior leaflet had best imaging scores in TOE in 4 CV (2.0±0.86) compared with TTE in 4 CV (1.64±0.80), p=0.001. Patients with relevant TR had significantly better 3D imaging scores in 4 CV compared with patients without relevant TR (TTE p

ObjectiveThe role of transoesophageal echocardiography (TOE) in identifying ischaemic stroke aetiology is debated. In 2018, the American Heart Association/American Stroke Association (AHA/ASA) issued class IIa recommendation for echocardiography, with the qualifying statement of use in cases where it will alter management. Hence, we sought to determine the rate at which TOE findings altered management in cases of confirmed ischaemic stroke.MethodsWe retrospectively analysed TOE cases with confirmed ischaemic stroke at our centre between April 2015 and February 2017. We defined a change in management as the initiation of anticoagulation therapy, antibiotic therapy or patent foramen ovale closure as a direct result of TOE findings.ResultsThere were 185 patients included in this analysis; 19 (10%) experienced a change in management. However, only 7 of the 19 (4% of all subjects) experienced a change in management due to TOE findings. The remaining 12 were initiated on oral antigoagulation as a result of discoveries during routine workup, mainly atrial fibrillation on telemetry monitoring.ConclusionsThis work suggests an overuse of TOE and provides support for the 2018 AHA/ASA stroke guidelines, which recommend against the routine use of echocardiography in the work up of cerebrovascular accident due to a cardioembolic source.

Sinus venosus Atrial Septal Defect (ASD) is the abnormal drainage of pulmonary veins to right atrium, which can present with symptoms of pulmonary hypertension. Sinus venosus ASD presents a diagnostic challenge considering low detection rates using transthoracic echocardiography. We report a case of a 36-year-old female in whom the sinus venosus ASD was wrongly diagnosed as primary pulmonary hypertension. Also, the role of transoesophageal and bubble contrast saline echocardiography in detecting an adequate closure of sinus venosus ASD after the surgical repair was presented. Based on transthoracic echocardiography and ECG findings, the patient was diagnosed with primary pulmonary hypertension. Because of the persistent symptoms and failure to improve with Bosentan, Sildenafil and diuretics, the patient was advised Transoesophageal Echocardiography (TEE), which revealed superior venacava sinus venosus ASD. The patient had surgical closure of the defect but she developed cyanosis and hypoxemia after the surgery. The bubble contrast saline echocardiography was performed for detecting adequate closure of the defect. The bubble contrast echocardiography showed simultaneous opacification of all the four chambers of heart. Thereby, a repeat surgery was done and patient experienced improvement in her symptoms. The present case concludes that bubble contrast saline echocardiography can be used to detect the presence of intra and extra-cardiac shunt.

BackgroundAtrial fibrillation (AF) carries the risk of thrombus formation in the left atrium and especially in the left atrial appendage (LAA). A transoesophageal echocardiography (TOE) is routinely performed in these patients to rule out thrombi before cardioversion or structural interventions like LAA closure or pulmonary vein isolation. However, in a certain number of cases, inconclusive results of the TOE may result. This study was performed to analyse whether the routine use of ultrasound contrast agent (UCA) has an influence on the frequency of thrombus detection.MethodsIn patients with AF who were scheduled for a subsequent interventional procedure, a TOE was initially performed without contrast agent. Then, the TOE was repeated with the use of UCA. The percentage of diagnostic findings regarding the prevalence of thrombus in the LAA with and without UCA were compared (thrombus present (T+), no thrombus (T−) and inconclusive result (T+/−)).Results223 patients were prospectively included into the trial. The numbers of thrombus detection were as follows: without UCA: 17 T+ (7.6%), 154 T− (69.1%), 52 T+/− (23,3%); with UCA: 16 T+ (7.2%), 179 T− (80.3%), 28 T+/− (12.6%; χ2: pConclusionsThe use of UCA during TOE in patients with AF has a significant impact on the subsequent patient management especially due to an improved rule out of LAA thrombi.

The update of the Echocardiography Core Syllabus of European Association of Cardiovascular Imaging (EACVI) is now available online. The Echocardiography Core Syllabus enumerates the elements of knowledge to be taught, represents a framework for the development of local training curricula and provides expected learning outcomes to the echocardiography learner.

Previous studies demonstrate that it is possible to evaluate a heart graft rejection condition using a bioimpedance technique by means of an intracavitary catheter. We propose to use a less invasive technique consisting in the use of a transoesophageal catheter and two standard ECG electrodes on the thorax. The aim of this work is to evaluate, using the finite element method, several parameters affecting the transoesophageal impedance measurement, including sensitivity to electrical conductivity and permittivity of different organs in the thorax, changes in magnitude and phase due to a lesion producing a scar, a global ischaemia of the heart, pleural effusion in the lungs, fat thickness increase, displacement of the catheter inside the oesophagus and movement of one electrode on the thorax surface. From these results, we deduce the best estimator for cardiac rejection detection and obtain the tools to identify eventual cases of false positives due to other factors. To achieve these objectives we have created a thoracic model and we have simulated different situations at the frequencies of 13, 30, 100, 300 and 1000 kHz. Our simulation demonstrates that the phase, at 100 and 300 kHz, would be a better estimator than the magnitude to evaluate a heart rejection condition.