Modified TAPSE (m-TAPSE) is a new method in which TAPSE is measured by taking the
difference between the apical and lateral tricuspid annulus distance during diastole and
systole. It can be measured using transesophageal echocardiography (TEE) in the
mid-esophageal four-chamber (ME 4CH) view and is an alternative easily measurable
parameter for intraoperative assessment of RV systolic function as long as optimal
imaging quality is achieved.

Our study will begin between 01.02.2024 and 01.01.2025 at Adnan Menderes University
Practice and Research Hospital, after receiving the approval of the Ethics Committee of
the patients. In this prospective observational study, it was planned to include all
patients between the ages of 1 and 18 who underwent transcatheterization procedures using
TTE and TEE under anesthesia by pediatric cardiologist. Written and verbal consent will
be obtained from the parents/guardians of the patients. Patients will be anesthetized for
transcatheter procedures and TAPSE and FAC values will be recorded during TTE and TEE
echocardiography for the procedure. Two practitioners will make the measurements and each
of their own values will be recorded. After the data collection process for the study is
completed; The data will be compared statistically. TTE and TEE values of the patients
will be compared among themselves.

All patients will undergo TEE and TTE under general anesthesia with an Echocardiography
Device. The values of all parameters will be recorded by taking the average values of
three cardiac cycle measurements. Measurement methods will be performed in accordance
with the American Society of Echocardiography Guidelines. M-Mode, 2D images, color,
pulse, Continuous Wave Doppler and Tissue Doppler measurements will be taken from all
subjects complying with standard echocardiographic application methods. TAPSE will be
calculated by placing an M-mode cursor across the Tricuspid Annulus and measuring the
amount of longitudinal movement at peak systole.

m-TAPSE by TOE: m-TAPSE will be calculated as the 'difference between the apical to
lateral tricuspid annular distance' during diastole and systole measured in the ME 4CH
view. Within this cycle, the maximum and minimum dimensions will be obtained and the
difference will be used to measure m-TAPSE. Longitudinal movement during systole will be
measured by performing enhanced Doppler alignment with a modified transgastric RV inlet
view and lower tricuspid annular motion.

End-diastolic area (EDA) and end-systolic area (ESA) are the FAC measurements that will
be used in the TTE apical four-chamber view, while the same measurement will be made in
the TEE four-chamber view, which also shows EDA and ESA.