Transesophageal Echocardiography (TEE)

Standard Views

• The 2013 ASE Guidelines proposed 4 standard views, but the updated guidelines for Structural included a 5th: ¹
  • upper esophageal (UE)
  • midesophageal (ME)
  • transgastric (TG)
  • deep transgastric (DT)
  • deep esophageal (DE) - 🆕
    • between the ME and TG levels, which is particularly useful for imaging right heart structures
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Midesophageal (ME) Views

• ME 5-chamber view
  • 
• ME 4-chamber view
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• ME Mitral Commissural view
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• ME 2-chamber view
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• ME Long Axis (LAX) view
  • 
• …

Simultaneous Multiplane Imaging (“2 for 1”)

• Simultaneous multiplane imaging permits the use of a dual screen to simultaneously display two real-time 2D images.

Understanding Angles ∠

• At a transducer angle of 0˚ (the horizontal or transverse plane), with the imaging plane directed anteriorly from the esophagus through the heart, the patient’s right side appears in the left of the image display
  • Turning the probe to the left (counterclockwise) allows imaging of primarily the left heart structures. Turning the probe to the right (clockwise) allows imaging of primarily right heart structures.
  • 
• Rotating the transducer angle forward to 90˚(vertical or longitudinal plane) moves the left side of the display inferiorly toward the spine.
  • 
• Rotating the transducer angle to 180˚ places the patient’s left side to the left of the display, i.e. the mirror image of 0˚.
  • 

Contraindications to TEE

Source: ²

Footnotes

1. https://www.asecho.org/wp-content/uploads/2022/01/PIIS0894731721005940.pdf ↩

2. https://www.asecho.org/wp-content/uploads/2014/05/2013_Performing-Comprehensive-TEE.pdf ↩