Trans Nasal Transesophageal Echocardiography - Project Summary: Transesophageal echocardiography (TEE) is an essential diagnostic tool in cardiology. There are over one million TEEs performed annually in the United States. A major advantage of TEE over transthoracic echo (TTE) is superior resolution of posterior structures such as the mitral valve and the left atrial appendage (LAA). TEE also substantially reduces ultrasound scatter from the lungs, which provides better images than transthoracic imaging, making TEE an essential imaging modality in critically ill patients. Examples of the clinical usefulness of TEE include diagnosing and managing infectious endocarditis (infection of the valves of the heart), diagnosing acute cardiovascular events in critically ill patients, trauma patients, and patients before and after cardiovascular surgery. TEE requires the use of sedation (anesthesia). Sedation requires specialized procedural space and skilled providers, which increases procedural cost, burdens the workflow, increases the risk to the patient, and overall limits the availability of TEE. Sedation accounts for the majority of the harm associated with TEE including cardiovascular (hypotension, arrythmia) and respiratory compromise. The serious risks of anesthesia are amplified by the high prevalence of co-morbidities in patients undergoing TEE. Alternative TEE methods that do not require anesthesia, will reduce cost, enhance workflow, expand availability, reduce risk, and in some cases will provide more accurate information compared to conventional TEE in such cases as non-sedated exercise mitral valve assessment, and assessment of cardiac causes of cryptogenic stroke. The nasal orifice is an alternative to the oral approach, and nasal-TEE can eliminate the need for sedation. Hence, nasal-TEE represents a unique opportunity to reduce cost, improve workflow, expand availability, and improve safety. However, prior attempts utilizing nasal-TEE systems have considerable gaps to making nasal- TEE an effective tool over traditional TEE. Prior attempts at nasal-TEE resulted in poor image quality, unacceptable rates of nasal bleeding, and thermal burns to the esophageal wall from overheated ultrasound probes. Therefore, innovative strategies are needed to overcome previous limitations of nasal-TEE. We are proposing to develop a novel, innovative nasal-TEE system to acquire high quality cardiac imaging without the need for anesthesia. The overall objective of this project is to develop an innovative nasal-TEE prototype with the potential to revolutionize cardiovascular diagnostic imaging. The proposed nasal-TEE platform will be faster, less expensive, expand availability, safer, and in some cases provide more accurate information compared to conventional TEE.
