Biplane Transesophageal Echocardiography: Anatomical Orientation and Suggestions for 'Standard Planes'

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Abstract
Transesophageal echocardiography (TEE) has so far been confined to only one plane transverse to the esophagus. A biplane probe with a second transducer enabling imaging in a longitudinal plane is a new development. We performed biplane TEE examinations intraoperatively in 30 patients (60 ± 11 years, 21 males and 9 females) in order to establish the diagnostic relevance of biplane compared to monoplane TEE. Structures which so far could not be imaged vertically and which were imaged for the first time in the longitudinal plane include (a) the anterior and posterior left ventricular wall in a 'two-chamber view'; (b) the right ventricular outflow tract); (c) the ascending aorta in its proximal two-thirds, and (d) the venae cavae in the region of their opening into the right atrium. More information is also provided by imaging in another plane from regions with hitherto only monoplane projection: (a) color-coded biplane Doppler échocardiographie imaging of regurgitations; (b) the mitral and aortic valves (or prostheses) in a second plane; (c) a longitudinal section through the papillary muscles; (d) the descending aorta cut longitudinally, including the origin of the left subclavian artery and the celiac trunk. For three-dimensional orientation, we prepared sections of pathological-anatomical heart preparations which correspond to five longitudinal échographie planes suggested as ‘standard planes’. Our experience indicates that the second longitudinal plane is of substantial advantage.

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