To the Editor:
The latest guideline document for performing a comprehensive echocardiographic examination suggests that analysis of the coronary arteries may be neglected.
1We provide examples of how transesophageal echocardiography can be used to visualize coronary circulation. Manipulation of the transesophageal echocardiography probe from the midesophageal aortic valve short-axis view will reveal the left main coronary artery and its bifurcation into the left circumflex and the left anterior descending coronary arteries (Fig 1, A). The right coronary artery take-off can also be seen by careful probe manipulation of the midesophageal aortic valve long-axis view. An example in this imaging plane is illustrated in Figure 1, B, in which a MitraClip is embolized to the right coronary ostium. Coronary artery stents that extend into the aortic root also may be observed rarely (Fig 1, C). Stent protrusion is thought to occur due to longitudinal stent deformation, anomalous origin of the coronary ostium, or after chest contusion events. Stent protrusion can lead to acute perforation of the aortic valve, severe aortic insufficiency, and pulmonary edema.
- Frommelt P
- Lopez L
- Dimas VV
- et al.
Recommendations for multimodality assessment of congenital coronary anomalies: A guide from the American Society of Echocardiography.
J Am Soc Echocardiogr. 2020; 33: 259-294
2Benign coronary anomalies may be interpreted as pathologic. For example, a small echodensity adjacent to the aortic valve in the midesophageal aortic valve long-axis view may represent an anomalous left circumflex coronary artery originating from the right coronary artery (Fig 1, D). Anomalous origin of the left main coronary artery from the right coronary artery also may be observed in the midesophageal aortic valve short-axis or long-axis view (Fig 1, E).
- Chen H-C
- Lee W-C
- Fu M.
Rail track picture’: Diagnosis of the protruding of left main coronary stent by transthoracic echocardiography especially with three-dimensional images.
Eur Heart J Cardiovasc Imaging. 2014; 15: 946
Conflict of Interest
- Recommendations for multimodality assessment of congenital coronary anomalies: A guide from the American Society of Echocardiography.J Am Soc Echocardiogr. 2020; 33: 259-294
- Rail track picture’: Diagnosis of the protruding of left main coronary stent by transthoracic echocardiography especially with three-dimensional images.Eur Heart J Cardiovasc Imaging. 2014; 15: 946
Published online: February 21, 2023
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- “Don't Mainstem that Left Main Coronary Artery!”Journal of Cardiothoracic and Vascular Anesthesia
- PreviewWe read with great interest the recent letter by Ghulam et al. As an institution with a considerable volume of minimally invasive robotic cardiac surgery, including the robotic aortic valve replacement, we regularly assess the left and right coronary arteries using transesophageal echocardiography (TEE) to assist with routine placement of coronary ostial cardioplegia cannulae. Following examination for anatomical abnormalities, we measure both ostial dimensions and share this information with our surgical colleagues to help size cannulae for optimal fit and cardioplegia delivery (Figures 1 and 2).