Diagnosis of heart tumours by transoesophageal echocardiography: a multicentre study in 154 patients

In a retrospective multicentre study, the diagnostic potential of transoesophageal 2D-echocardiography (TEE) as compared to precordial 2D-echocardiography (TTE) was determined in 154 patients with primary or secondary tumours of the heart. Additionally, the value of standard diagnostic parameters, such as symptoms, X-ray of the chest and electrocardiogram were evaluated. In 84 patients (24 male, 60 female; age 20–85, mean 56.6 years) intracardial tumours were present, and 70 patients (37 male, 33 female; age 18–79, mean 44.3 years) presented with peri- or paracardial tumours. The main symptoms of patients with intracardial tumours were dyspnoea (60.7%), vena cava syndrome (22.2%) and chest pain (20.2%). Embolization was found in 11.9%. Left or right atrial enlargement was observed on chest X-ray in 23 patients, and echocardiographic abnormalities in 17 cases. The patients with peri- or paracardial tumours presented with dyspnoea in 51.4% of cases, loss in body weight in 20.0% and with vena cava syndrome and chest pain in 17.1%. The chest X-ray was abnormal in 56 patients. Unspecific ST segment changes in the electrocardiogram were observed in five, and arrhythmias in seven cases. Diagnosis of atrialmyxomas was achieved by TTE in 95.2%, by TEE in 100%, by angiography in 78.4%, by computed tomography (CT) or magnetic resonance tomography (NMR) in 70%. Identflication of the attachment point was made by angiography in 8.1%, by TTE in 64.5% and by TEE in 95.2%. In 22 patients with intracardial tumours (myxomas excepted) diagnosis was achieved by TTE in 90.9%, by TEE in 100% by CT or NMR in 88.9% and by angiography in 50%. Diagnosis of peri- or paracardial tumours was made by TTE in 67.1%, by TEE in 97.1% by CT in 90.3% and by angiography in 54.5%. Compression of the pulmonary vein, the pulmonary artery or superior vena cava was diagnosed by TTE in 0, 4, and 10 patients respectively and by TEE in 2, 11, and 15 patients respectively. Infiltration of the pulmonary vein, and of the ascending or descending aorta was missed by TTE and detected by TEE in three cases each. Thus, TEE is superior to TTE in the diagnosis of intracardial and peri- or paracardial tumours. Details such as attachment point of myxomas, compression of cardiac structures or infiltration of the great vessels by a malignant disease in close contact with the heart can be better identified by TEE.