Transesophageal echocardiography. A critical appraisal. How to avoid false diagnoses

: In this study the authors make a critical appraisal of transesophageal echocardiography. A retrospective analysis was made of the transesophageal echocardiographic performed in the Thoracic Surgery Center of S. Joao Hospital, Oporto, over a period of approximately five years. The authors report the limitations and complications of this diagnostic tool with particular emphasis on the leading causes of pitfalls. Between October 1990 and December 1995, 1282 examinations were performed in our echocardiographic laboratory, mean age 49.6 +/- 14 years (5-86), 57% of the patients were female and 43% male. A biplane transducer was used in these examinations. Patient absenteeism was 2% and only one major complication occurred in a patient with an aortic dissection. Pitfalls are of special concern with this technology. The new esophagic window over the heart and the high quality of the cardiac images, depicting structures and anatomic details inaccessible, or difficult to be observed by transthoracic echocardiographic, led to the major causes of transesophageal echocardiographic pitfalls. Once recognized, most of the pitfalls can be avoided. In what concerns our experience, examples of the most common pitfalls are illustrated.