Epiq 7 ultrasound machine

TOE studies were executed by certified echocardiographers (second-degree accreditation in echocardiography of the Section of Echocardiography of the Polish Cardiac Society (PCS)). TOE examinations are conducted directly or a few hours before the scheduled procedure (usually at 48 hours prior to the procedure) in all engaged reference cardiology centers. To the examination was used the EPIQ 7 Ultrasound Machine (Philips Medical Systems, Andover, MA) or the iE33 ultrasound machine (Philips Medical Systems) with the X72t TOE ultrasound transducer (Philips Medical Systems). LAAT was defined as a well circumscribed echogenic mass with a unique echotexture contrasting with the surrounding endocardium or pectinate muscles and detected in more than 1 imaging plane. Spontaneous echocardiographic contrast, defined as a dynamic “smoke-like” signal with a distinctive swirling motion, occurs due to increased ultrasonic density without creating a discrete mass. In the case of suspected LAAT occurrence, the examination was consulted with additional echocardiographer. In a doubtful event, 3 qualified echocardiographers evaluated the study to establish a correct diagnosis. Written informed consents for TOE examination were obtained from each engaged individual.

In all the centers, transthoracic echocardiography examinations were conducted prior to the scheduled ECV in most patients. All exams were performed by certified echocardiographers (second-degree accreditation in echocardiography of the Section of Echocardiography of the Polish Cardiac Society [PCS]), using the General Electric Vivid 7 or E95 Ultrasound System (General Electric, Milwaukee, Wisconsin), the EPIQ 7 Ultrasound Machine (Philips Medical Systems, Andover, Massachusetts, USA), or the iE33 Ultrasound Machine (Philips Medical Systems, Andover, Massachusetts, USA). The analysis included the left atrial anteroposterior diameter, the left ventricular end-diastolic diameter, the left ventricular end-systolic diameter and the left ventricular ejection fraction (LVEF).

TEE Imaging was performed using Phillips EPIQ 7 ultrasound machine and Phillips IE33 ultrasound transducer (Andover, Massachusetts). Standard TEE images were acquired including focused imaging of the LA and LAA. Technique routinely used at our institution involves acquisition of at least two orthogonal views of the LAA. All TEEs were reviewed by at least one of two echocardiographers with strong agreement between observers (Cohen’s kappa: 0.89). A thrombus was reported if a well-circumscribed, echo-reflective mass distinct from the LA endocardium or pectinate muscles was present in the appendage or body of the LA[4 (link)]. Spontaneous echo contrast (SEC) was classified as dense, clearing, or absent correlating with 3-4+, 1-2+, or 0 as graded by Fatkin et al[25 (link)] SEC was classified as dense if a dense swirling pattern was observed in the LAA and was detectable throughout the cardiac cycle (with variable intensity). SEC was classified as clearing if minimal echodensity was observed in the LAA and was detectable transiently during the cardiac cycle. LAA velocities were determined based on peak velocities averaged over a minimum of two full cardiac cycles in the view which was most parallel to the LAA ostium. LA size was assessed semi-quantitatively and documented as normal, mildly, moderately, or severely dilated.