Copyright © 2007, The European Society of Cardiology
Editorial comment
Oregon Health & Science University, L608, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3011, USA
Received 6 March 2007; .
sahnd{at}ohsu.edu
* Tel.:+1 503 494 2191; fax: +1 503 494 2190.
Building small things for small patients is tough, and sometimes expensive, but it really needs to be done. I was pleased to see the paper by Thierry Scohy et al., the Rotterdam Pediatric Cardiology, Anesthesiology and Surgery group, in a paper published in this issue of the European Journal of Echocardiography, a suitable venue for this report, since so much of the development of this device has been European. In this paper, the group reports their experience using a micromultiplane transesophageal probe during surgery in children and infants.
In 1984, I was a participant in a Bethesda Conference on pediatric cardiac imaging, published as a supplement to the Journal of the American College of Cardiology, Volume 5, in 1985. I have been known for having started a campaign to encourage ultrasound manufacturers to develop higher frequency transducers for studies of babies, and had a tremendous opportunity while I was training, to use the first 5MHz M-mode transducer and subsequently a very advanced 7MHz multi-element array built by Klaas Bom at Erasmus University in the early 1970s.
If it weren't for the evolution of small parts and carotid scanning, real-time high frequency probes for studies of babies would have been substantially disadvantaged. But you can only ride along the back of the small parts market for a limited period of time, and those of us who take care of small infants and children know that, while we are only a small fraction of the cardiac imaging market, our needs are different. I always continued talking to my friends in Rotterdam about my needs, both to Klaas Bom and Charles Lanceé, and in 1987, in conjunction with Scott Smith at GE Corporate Research & Development in Schenectady New York, I received a grant to develop a 7.5MHz miniaturized phased array probe for intraoperative epicardial use in babies and for studies of premature infants. As a result of renewal funding of that program, which existed until 1998, we built a 7.5MHz longitudinal array, and subsequently a miniaturized multiplane, 8mm and with a 7.5MHz center frequency. The array and flex was built by Scott Smith and Doug Wildes at GE Corporate Research & Development in Schenectady, New York. Kie Djoa, who, along with Charles Lanceé and Rob Smallenberg at Oldelft built the mini-multiplane TEE probe (10.2mm), which has subsequently become a commercial product for three of the major vendors, some of whom buy it from Oldelft in The Netherlands.
Our paper on the micromultiplane experience was published two years after the end of the funding period of the grant, in 1999.1 The partnership in that development continued to be Oldelft, Erasmus University, UCSD (with a subsequent move to OHSU). While we had interesting cooperation in terms of that initial micromultiplane, the connectors, cables and rotational table within that probe were quite delicate since the head shell was 3mm smaller than the mini-multiplane, and none of the major vendors wanted to build it. Our clinical experience was on an ATL 3000 and ATL 5000 – a company that had no relationship to the project and was eventually acquired by Philips, which then acquired Agilent. Similar probes were hosted by Acuson (now Siemens) and the second Micromultiplane built ran on a Vivid 5 from GE as well. Despite the passage of 10 years since we built the first one, and with major progress in array fabrication and connection, none of the vendors seem willing to step up to the plate and attempt to put the Micromultiplane into mass production.
I was very pleased to see the Rotterdam experience, since it was larger than our 25 patients. They had three babies at around 2.5kg and the smallest in our series was 2.8kg. It is clear to all of us who deal with congenital heart disease that the examination of the congenitally malformed heart is a multi-plane examination whether it is done transthoracically or by transesophageal echo.
Every innovation the industry has handed us, whether it was 2D, Doppler, color Doppler or 3D, we congenital heart specialists have jumped on the bandwagon first. It again states the need for further miniaturized evolution in transesophageal echo, the probe that we have used transnasally in adults, although we agree that more than 6–7cm of depth is the maximum that is really optimal for this device. We had in fact done some experiments with intracardiac imaging of miniaturized phased array TEE probes including the Micromultiplane.
I hope that any pediatric cardiologist or congenital heart specialist who reads this paper in this issue of the European Journal of Echocardiography will contact the vendor that serves his practice or his institution by furnishing advanced echocardiography equipment and let the representative of this company know that widespread availability of a Micromultiplane TEE probe is still an unfulfilled need in congenital heart surgery and critical care, especially for small infants and children. There may only be a few of us, and our patients may be small, but when necessary, we hopefully can make our voices loud.
My congratulations to Dr. Scohy and his colleagues from Erasmus University on their important study.
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- Shiota T., Lewandowski R., Piel J.E., Smith L.S., Lanceé C., Djoa K., et al. Micromultiplane transesophageal echocardiographic probe for intraoperative study of congenital heart disease repair in neonates, infants, children and adults. Am J Cardiol (1999) 83:292–295.[CrossRef][Web of Science][Medline]
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