The capability of transesophageal (TEE) versus transthoracic (TTE) echocardiography as a diagnostic tool in clinical practice was prospectively examined in 86 consecutive cases. A conclusive diagnosis was possible in 95% with TEE, whereas the same result was achieved in 48% by TTE. Specifically, TEE provided a conclusive diagnosis in 14 of 16 cases of infective endocarditis, while TTE gave this result in 4 of the 16 cases (p < 0.001). Similarly, TEE allowed a conclusive diagnosis in 11 of 11 instances of aortic dissection, while TTE gave this indication in two cases (p < 0.001). TEE was similarly effective in eight of eight cases of atrial thrombl, whereas TTE gave the diagnosis in three of eight cases (p < 0.01). In five subjects with intracardiac masses, TEE gave a conclusive diagnosis in all five, whereas TTE was able to diagnose conclusively in one subject (p < 0.02). In seven patients with mitral regurgitation, TEE gave the conclusive diagnosis in all seven and TTE was able to provide this information in four (p = NS). TEE was able to provide a conclusive diagnosis in four patients with aortic insufficiency, and TTE gave the same information in two of the four (p = NS). In 14 patients with prosthetic valve dysfunction, TEE gave the diagnosis in 12 and TTE gave it in eight patients (p = NS). Both methods gave a conclusive diagnosis in 13 out of 13 cases of mitral stenosis (p = NS). Also, TEE provided a conclusive diagnosis in eight of eight patients with adult congenital heart disease and TTe gave this information in four (p = NS). TEE obviated five planned cardiac catheterizations, eight computed tomography scans, and one magnetic resonance imaging session, whereas TTE was only able to obviate two cardiac catheterizations (p < 0.001). Treatment was altered in 24% of cases by TEE versus the same result in 10% of cases with TTE (p < 0.02). When it is clinically indicated, TEE is a powerful diagnostic tool, with a significant impact on patient course and treatment. Nevertheless, TTE remained efficacious in 48% of this selective group of patients, and the two techniques are complementary. © 1990.
