[Transesophageal and transthoracic echocardiography--their diagnostic contributions].

Of 815 patients referred for echocardiographic examination 77 were examined also by the transoesophageal route. The most frequent reason were pathological processes where standard echocardiography provides relatively limited information as well as technically inadequate transthoracic examinations, if the echogenicity of the patient is low. The reasons for examination were complications of myocardial infarctions, a cardiac source of embolization bacterial endocarditis, congenital heart defects, cardiac formations, aortal disease and comatose conditions. Transthoracic echocardiography was positive in 25 cases (32.4%), transoesophageal echocardiography in 44 cases (57.1%). In 15 patients the transthoracic approach was not conclusive from the diagnostic aspect (19.5%). From the results ensues that transesophageal echocardiography has a ca 30% higher sensitivity than transthoracic echocardiography, the specificity being equal. The authors emphasize that the transoesophageal approach is the method of choice in the diagnosis of sources of embolization (auricular appendage), in evaluation of the mitral apparatus, in affections of the thoracic aorta, in the diagnosis of intracardiac formations and defects of the atrial septum. It is very useful in the critically ill, in particular in patients with poor echogenicity. It helps in a significant way to rule out falsely positive transthoracic findings. The examination is safe, relatively well tolerated by out- and in-patients. Transoesophageal echocardiography supplements in an effective way the transthoracic approach but does not replace it.