title: Harmonic imaging for endocardial visualization and myocardial contrast echocardiography during transesophageal echocardiography.
abstract: BACKGROUND
  Although harmonic imaging (HI) improves endocardial visualization and is necessary for myocardial perfusion imaging, it has yet to be implemented in transesophageal echocardiography. Our goal was to determine whether HI implemented in a prototype transesophageal echocardiography probe improved endocardial visualization and allowed perfusion imaging.
  
  
  METHODS
  In 23 patients, fundamental and harmonic images were obtained in the transgastric short-axis (TSAX) and midesophageal 4-chamber views, and reviewed for endocardial visualization by 3 readers blinded to imaging mode. In 14 additional patients, perfusion imaging was performed in the TSAX view during contrast infusion.
  
  
  RESULTS
  HI improved overall endocardial visualization, most noticeably in the anterior and lateral segments (P <.004) in the TSAX view, and in the lateral segments (P <.01) in the midesophageal 4-chamber view. The salvage rate was 8.3% in the TSAX view and 12.6% in the midesophageal 4-chamber view. Myocardial perfusion was consistently confirmed in the inferior (86%), posterior (100%), and lateral (79%) segments, but rarely in the septal (21%), anteroseptal (0%), and anterior (14%) segments.
  
  
  CONCLUSIONS
  Use of HI with transesophageal echocardiography improves endorcardial visualization and allows partial assessment of myocardial perfusion.
authors.affiliation: University of Chicago Medical Center, 5841 S Maryland Ave, MC5084, Chicago, IL 60637, USA. pward@medicine.bsd.uchicago.edu
authors.forename: R Parker
authors.initials: RP
authors.lastname: Ward
authors.forename: Keith A
authors.initials: KA
authors.lastname: Collins
authors.forename: Beth
authors.initials: B
authors.lastname: Balasia
authors.forename: Kirk T
authors.initials: KT
authors.lastname: Spencer
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Decara
authors.forename: Victor
authors.initials: V
authors.lastname: Mor-Avi
authors.forename: Lissa
authors.initials: L
authors.lastname: Sugeng
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: D003326:Coronary Circulation / Q000502:physiology; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004699:Endocardium / Q000000981:diagnostic imaging* / Q000648:ultrastructure*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000648:ultrastructure*; D015588:Observer Variation