Dilated left ventricle

Intraoperative TEE transgastric LV short-axis (panel A) and long-axis (panel B) X-plane cross-sectional images at end-diastole (small arrow immediately after the p-wave of the ECG) for measuring the diastolic left ventricular internal diameter (LVIDd), as shown by the double-headed arrow. This patient has a severely dilated left ventricle and severely reduced left ventricular systolic function. According to guidelines, the LVIDd measurement should be taken at the mitral chordal level to provide a measurement consistent with the corresponding transthoracic echocardiogram. In the TEE transgastric views, X-plane imaging can be used to align the LV long-axis plane perpendicular to the ultrasound transducer to achieve a true LV short-axis cross section and to adjust the depth of the transducer so that the measurement is performed at the mitral chordal level of the left ventricle. X-plane imaging is also helpful in discerning the boundary of trabeculations and compacted endocardium, which improves accuracy of measurement. In this patient, the LVIDd measured 7.2 cm. Measurements of LV dimension are typically performed the axial direction of the ultrasound beam for maximum resolution; in this TEE view, the measurement is from the LV inferior to anterior wall.

TEE: transesophageal echocardiography; LV: left ventricle; ECG: echocardiography.

Courtesy of Igor Feinstein, MD, PhD and Albert T Cheung, MD.

Graphic 120168 Version 2.0

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Dilated left ventricle