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Submitted by Dr. Yasser Mokhtar, MD. Dept. of internal medicine. School
of medicine, University of South Dakota.
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TEE improves diagnostic information in various cardiovascular diseases compared to conventional echo.
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Transesophageal Doppler echocardiography was first reported by Side
and Gosling in 1971, they used a dual element construction mounted on
a standard gastroscope to obtain continuous wave Doppler information about
the velocity of cardiac blood flow
(Side and Gosling 1971).
It was also reported by Daigle et al. in 1975 who described pulsed
wave Doppler interrogation from within the esophagus
(Daigle
et al., 1975).
In 1976, Frazin et al. reported transesophageals M-mode echocardiography
as a means of assessing ventricular function. Their work did not attract
clinicians because of the problems associated with swallowing of the probe
in conscious patients (Frazin
et al., 1976).
Since this was not a problem in unconscious patients, further research
was directed towards intra-operative monitoring of left ventricular function.
This was mainly undertaken by Japanese investigators and particularly
by Matsumoto and his colleagues
(Matsumoto et al., 1980).
In 1977, Hisanaga et al. reported cross section real time imaging using
a scanning device that consisted of a rotating single element in an oil-filled
balloon mounted at the tip of a gastroscope
(Hisanaga et al., 1977).
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One year after their first report, Hisanaga et al. also described a
linear mechanical scanner that was suitable for transesophageal echocardiographic
studies but its applications were limited due to rigidity of the mechanical
sector scanning device
(Hisanaga
et al., 1978).
To overcome the logistical difficulties of introducing a rigid endoscope,
transducers were subsequently mounted on flexible endoscopes. In 1980
DiMagno et al. first reported the use of a linear phased array flexible
endoscope. This instrument had a frequency of 10 MHz and was intended
to be used for ultrasonic detection of gastrointestinal disorders such
as diseases of the pancreas
(DiMagno et al., 1980).
In 1982, Souquet et al. first produced a clinically usable flexible
endoscope mounted on a sector phased array two-dimensional echocardiographic
transducer that a frequency of 2.25 MHz ? a frequency equal to that of
the standard precordial transducer. This represented the definitive breakthrough
for the transesophageal approach
(Souquet et al., 1982).
The initial applications studied by investigators were outpatient clinic
use (Schl?/span>ter
et al. in 1982), intra-operative monitoring of air embolism
in upright neurosurgical operations (Cucchiara
et al. in 1984)
and intra-operative monitoring of left ventricular function (Kremer
et al. in 1982).
In 1989, Currie reported that introduction of high resolution TEE probes
with color flow Doppler capability received much interest and established
the beginning of the era of ?invasive echocardiography? (Currie
1989). Currently, between 7-10% of all precordial examinations
are completed by TEE examination (Seward
1994).
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