Outflow Tract Anomalies

Anomalies of the aortic and pulmonary outflow tracts are usually associated with obstruction, regurgitation, and/or aneurysmal dilation of the proximal great arteries, and they represent some of the conditions most frequently encountered by congenital heart disease specialists. In most instances, a full preoperative diagnosis is performed by standard transthoracic echocardiography and other imaging modalities such as cardiac catheterization and magnetic resonance imaging. However, transesophageal echocardiography (TEE) serves an important role in the perioperative management of these patients. Preoperative TEE can provide information regarding the morphology of the outflow tracts and the degree of obstruction and regurgitation; postoperative TEE can evaluate the success of a surgical procedure and exclude residual obstruction, regurgitation, or other potential complications. In addition, TEE is sometimes necessary outside of the operating room setting for older patients with poor transthoracic echocardiographic windows, particularly if the patient has undergone prior surgery. This chapter discusses the use of TEE for the evaluation of both right and left sided outflow tract anomalies.