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Two-dimensional transesophageal echocardiography generally has superior sensitivity and image quality compared with precordial echocardiography. Its unique anatomic perspective posterior to the heart often provides important clinical information not obtainable by other imaging approaches and technologies. It is particularly useful in the diagnosis of mitral valve disease, left atrial masses, endocarditis and its sequelae, and aortic dissections. It is also useful for examination of the left main coronary artery, left ventricular outflow tract, atrial and ventricular septa, and congenital defects. In addition to its application as a diagnostic tool in conscious patients, it can be employed intraoperatively to evaluate and guide surgical intervention. Detection of ventricular wall motion abnormalities by transesophageal echocardiography has been shown to be the most sensitive indicator of myocardial ischemia available in the clinical setting. It has potential for wide application for safely monitoring left ventricular fuction in patients in intensive care or under anesthesia.

The diagnostic value of t1 ansesophageal two-dimensional echocardiography is described in 32 patients in whom precordial echocardiography or angiography, or both, failed to establish a definitive diagnosis. All attempted transesophageal studies were completed without complication and the referral question was definitively answered. Nineteen patients were subsequently submitted to surgery. In 18 of them, the transesophageal echocardiographic diagnoses were proven correct; in 1 patient, the diagnosis was proven partially incorrect. In the 13 unoperated patients the transesophageal echocardiography diagnoses were not independently confirmed but were assumed correct because incontrovertible images were obtained. These results indicate that transesophageal echocardiography significantly extends the diagnostic capabilities of echocardiography.

Regurgitant blood flow of mitral valves was studied by transesophageal Doppler color flow echocardiographic imaging in 11 healthy volunteers (Group 1), 25 cardiac patients with a native mitral valve (Group 2), 10 patients with a normally functioning Björk-Shiley mitral prosthesis without clinical evidence of mitral regurgitation (Group 3) and 10 patients with angiography or surgical evidence of Björk-Shiley mitral valve regurgitation (Group 4). Holosystolic regurgitant color jets were classified as type I or type II. The data were compared with results obtained with precordial techniques, i.e., continuous wave and Doppler color flow echocardiographic imaging (Groups 1 to 4) and left ventricular angiography or surgery (Groups 2 and 4).