Sub optimal window quality with Transthoracic Echocardiograms

Hello my friends, I will ask my EP this question in a letter, since it does concern me, but thought I would ask you first for your opinion.  

Often when I get a Transthoracic Echocardiogram, I see low parasternal window or sub optimal window quality printed on my results, although generally my Echocardiograms have always been reported as normal with regards to my Ejection Fraction and Chamber sizes.  

I noticed on my last Echocardiogram that I have a Sigmoid Septum which is new (common in the elderly I believe) but with no flow obstruction at the moment.  I also have some Mitral Annular Calcification and Mitral Valve regurgitation but nothing too serious apparently.  

Since my EP has seen my Echocardiogram and seems happy enough, I am not unduly concerned.  However, I do question whether I can rely on sub optimal Transthoracic Echocardiogram reports to give me an accurate picture of what is going on or whether I should ask about other forms of imaging in the future?  I should be grateful for any personal experience or advice you can give  

2 Comments

Transthoracic Echocardiogram difficulty

by Selwyn - 2023-06-02 11:12:42

The same happened to me because I am without a lot of 'padding' over my chest wall. I went from technician to consultant for echocardiography. They had difficulty seeing the aortic root  ( I think they could get the probe to sit properly on my anatomy). The result was me listed for a CT angiogram. 

The CT angiogram was probably life saving as it identified what could be a 90% narrowing on my anterior descending coronary artery. I had an angiogram, that confirmed this, and a stent. It also identified numerous lung nodules, and after many traumatic investigations a diagnosis of cryptogenic organising pneumonia was made.  All of the above were asymptomatic.

I expect' the proof of the pudding is in the eating' ie. can they see what they need to see from the point of your care? Things like the ejection fraction and chamber size would only be reported on if their visualisation was satisfactory. The problem is what they cannot see. You could ask?

Best wishes.

Transthoracic Echocardiogram

by Gemita - 2023-06-02 14:21:23

Thank you Selwyn.  Yes that was lucky they found your LAD narrowing.  Left a little longer and you might have been in real trouble.  It is amazing how much the body can hide before it reveals an illness and your cryptogenic organising pneumonia proves that point too.

I will certainly ask a few questions since this is happening time and time again and I am not sure why?  I am certainly not reassured that they have the complete picture with sub optimal window quality views.  I am very petite, small framed, with minimum padding over the chest too, although I do have Scoliosis (not significant though) and they have mentioned this once or twice.

I had an EP Study and an invasive coronary angiogram in 2017, prior to my pacemaker implant in 2018, which didn’t see anything sinister at that time and my Cardiologist is saying that it is unlikely that I would have developed any significant arterial disease since then. However I am getting some mid central chest pain coinciding with my intermittent periods of AF which can be quite uncomfortable, so I need to mention this.  I am due for another pacemaker check soon as well.  I will write to my new EP and ask a few questions and see where we go from there.  Can do no harm

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