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Objective: To report the role played by transesophageal echocardiography during implantation of self-expanding aortic endoprostheses (stent) at a hemodynamics laboratory., Methods: Thirteen patients underwent stent implantation in the descending thoracic aorta with the aid of transesophageal echocardiography during the entire procedure. Indications for stenting were as follows: 8 aortic dissections, 2 true aneurysms, 2 penetrating atherosclerotic ulcers, and 1 traumatic pseudoaneurysm., Results: No complications resulting from the use of transesophageal echocardiography were observed. In 12 patients, the initial result was considered appropriate, with total or partial resolution of the major lesion confirmed by a posterior examination. In 1 patient, the procedure was suspended after transesophageal echocardiography and angiography showed that the proximal aortic diameter was inappropriate. Transesophageal echocardiography contributed to clarifying relevant points, such as aortic diameter, anatomic detail of the intimal lesion, and location and size of the communicating orifice. In addition, it facilitated placing the stent in the target lesion, reduced the time of exposure to radiation and the use of contrast medium, and provided rapid identification of intercurrent events, possibly reducing the total duration of the procedure., Conclusion: The use of transesophageal echocardiography during placement of aortic stents seems appropriate. The actual advantages of the procedure will be defined in a comparative prospective study.

Purpose: To evaluate the different methods for grading mitral regurgitation (MR) by transesophageal echocardiography (TEE) in patients with clinical suspicion of mitral prosthesis dysfunction., Methods: Cardiac catheterization (Cath) was performed in 15 patients for grading the severity of prosthetic MR, divided in two groups based on the presence or absence of severe MR. Prosthetic MR was quantified by TEE using methods commonly used for MR of native valves: subjective assessment by color Doppler, objective assessment based on absolute jet area and on its relative area (jet area/left atrial area) and assessment based on the presence of systolic flow reversal in pulmonary vein., Results: Prosthetic MR was mostly transprosthetic (14 patients) and eccentric (11 patients). There was significant correlation (p < 0.05) between Cath and TEE for identification of severe MR based on subjective assessment and on the presence of systolic flow reversal in pulmonary vein. Identification based on absolute (jet area > 7 cm2) and relative (jet area > 35% of left atrial area) jet areas did not reveal significant correlation with the angiographic grade and showed clear underestimation by TEE when the last method was used. However, there was good correlation (p < 0.05) if relative jet areas > 30% were considered as cut point., Conclusion: TEE correctly identified angiographic severe mitral prosthesis regurgitation, mainly by the presence of systolic flow reversal in pulmonary vein and subjective assessment. The estimation of severity of the prosthetic MR by absolute or relative jet area seems to be limited and should be used with caution due to eccentricity of the regurgitant jet, frequently seen in mitral prosthesis dysfunction.