Is There a Role for Trans-esophageal Echocardiography in Patients with Non-compaction Cardiomyopathy?

Transthoarcic echocardiography (TTE) is the standard modality for the diagnosis of left ventricular (LV) noncompaction cardiomyopathy (NCCMP) followed by confirmatory magnetic resonance cardiac imaging. However, structures in the far field of TTE are not always amenable for evaluation. Aim: Evaluation of the role of transesophageal echocardiography (TEE) in the diagnosis of NCCMP. Methods: Two young hospitalized patients were referred for TTE. The first was a 28 years old man with juvenile diabetes mellitus who presented with flank pain and had kidney embolic lesions and the TTE did not detect significant abnormality. The other patient was a 27 years old woman who developed pulmonary edema after cesarean section and TTE diagnosed dilated LV with severely reduced LV systolic function. Results: TEE was performed in the young man to search for a source of emboli. The trans-gastric view revealed heavy LV trabeculations at the mid-distal posterior and inferior LV regions consistent with NCCMP. In the young woman, because of fever, TEE was performed to check for vegetations. Againg the trans-gastric view revealed heavy LV trabeculations at the mid-distal posterior and inferior LV regions consistent with NCCMP. Reviewing the previously done TTE studies in both patients and after increasing the gain to almost unacceptable levels, fine trabeculations could be detected in the far field of the transducer. Conclusions: Conventional TTE studies may miss LV trabeculations in the far field of the transducer while, in the TEE these regions are in the near field of the transducer making detection LV trabeculations and NCCMP straightforward