[Advantages of transesophageal color Doppler echocardiography in the diagnosis and surgical treatment of cardiac masses].
To determine the clinical advantages of transesophageal color Doppler echocardiography (TEE) for imaging cardiac tumors and left atrial thrombi, 24 cases with intra- or extracardiac masses were examined by transthoracic color Doppler echocardiography (TTE) and TEE before and after cardiac surgery. Five with left atrial myxomas, two with lung tumors, five with mediastinal tumors and 12 with mitral stenosis coexisting left atrial thrombi were included in this study. The echocardiographic findings of the cardiac masses were compared with the surgical findings in all cases. In all of the five cases with left atrial myxomas, the tumors were detected. However, the sites of attachment and a stalk in three cases were not observed by TTE. TEE clearly imaged the left atrial myxomas, and evaluated the size and shape of the tumors, the sites of their attachment and a stalk arising from the interatrial septum, and mobility in four cases, except for one in which there was a broad attachment to the endocardium. Mitral regurgitation was detected in only two cases using the color Doppler mode of TTE, but in all cases using TEE. Both techniques failed to recognize tissue characterization. Among seven cases with secondary cardiac tumors or mediastinal tumors, extracardiac masses were detected in five; however, an intracardiac tumor attached to the interatrial septum and an extracardiac tumor extending to the superior vena cava and an upper part of the right atrium could not be imaged using TTE. TEE detected all tumors at all sites in the heart and vessels, and estimates of their extents were in accord with the operative findings in 17 of 18 sites. One exceptional case had a tumor which extended to the right ventricle. Neither technique could detect infiltration of the heart which was present in five of the seven cases. Multiple left atrial thrombi were observed in eight of 12 cases, resulting in 21 thrombi and they were diagnosed by TEE in six of 12 cases. Thrombi, when attached to the left atrial posterior or inferior walls, were easily detected in four of five cases, but were not identified in four of six and in eight of nine cases at the lateral wall or in the left atrial appendage by TTE. However, TEE detected all thrombi in every site in the left atrium and left atrial appendage in 11 of 12 cases. TEE was thus superior to TTE in detecting cardiac masses, recognizing abnormal flow and estimating anatomical relationship between tumors or thrombi and cardiac structures.(ABSTRACT TRUNCATED AT 400 WORDS)
Matsumura
M
M
First Department of Surgery, Saitama Medical School.
Takamoto
S
S
Kyo
S
S
Yokote
Y
Y
Omoto
R
R
D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging; D006338:Heart Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D007890:Leiomyosarcoma / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009232:Myxoma / Q000000981:diagnostic imaging*; D013927:Thrombosis / Q000000981:diagnostic imaging