title: The Use of Standard Gastrointestinal Endoscopic Ultrasound to Assess Cardiac Anatomy.
abstract: In this prospective observational study, conducted at an academic medical center, we evaluated the feasibility of performing a basic transesophageal echocardiography (TEE) examination using endoscopic ultrasound (EUS) technology to determine what cardiac structures could be assessed. This may be potentially beneficial during hemodynamic emergencies in the endoscopy suite resulting from hypovolemia, depressed ventricular function, aortic dissection, pericardial effusions, or aortic stenosis. Of the 20 patients enrolled, 18 underwent EUS with a linear echoendoscope for standard clinical indications followed by a cardiac assessment performed under the guidance of a TEE-certified cardiac anesthesiologist. Eight of the 20 standard views of cardiovascular structures per the 1999 American Society of Echocardiography/Society of Cardiovascular Anesthesiologists guidelines for TEE could be obtained using the linear echoendoscope. The following cardiac valvular structures were visualized: aortic valve (100%), mitral valve (100%), tricuspid valve (33%), and pulmonic valve (11%). Left ventricular and right ventricular systolic function could be assessed in 89% and 67% of patients, respectively. Other structures such as the ascending and descending aorta, pericardium, left atrial appendage, and interatrial septum were identified in 100% of patients. Doppler-dependent functions could not be assessed. Given that the EUS images were not directly compared with TEE in these patients, we cannot comment definitively on the quality of these assessments and further studies would need to be performed to make a formal comparison. Based on this study, EUS technology can consistently assess the mitral valve, aortic valve, aorta, pericardium, and left ventricular function. Given its limitations, EUS technology, although not a substitute for formal echocardiography, could be a helpful early diagnostic tool in an emergency setting.
authors.affiliation: From the *Department of Anesthesiology and Perioperative Medicine, Brigham and Women's Hospital, Boston, Massachusetts; †Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ‡Department of Gastroenterology, Hawthorne Medical Center, Darmouth, Massachusetts; §Gastroenterology and Endoscopy Unit, Hospital Alemán, CABA, Buenos Aires, Argentina; ∥Department of Anesthesiology and Perioperative Medicine, UCLA, Los Angeles, California; ¶Center for Anesthesia Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Kinza
authors.initials: K
authors.lastname: Sentissi
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sawhney
authors.forename: Douglas
authors.initials: D
authors.lastname: Pleskow
authors.forename: Paul
authors.initials: P
authors.lastname: Sepe
authors.forename: Jose M
authors.initials: JM
authors.lastname: Mella
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kwittken
authors.forename: Gyanprakash
authors.initials: G
authors.lastname: Ketwaroo
authors.forename: Balachundhar
authors.initials: B
authors.lastname: Subramaniam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006321:Heart / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*