Transesophageal Echocardiography in Clinical Practice
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Over the last 30 years the technological advances in TEE have been exponential and have been reflected by its increasing utilization. Currently almost all echocardiography labs undertake TEE and the vast majority of valve operations are performed with TEE guidance.
When imaging a patient’s heart the number of modalities available to choose from seems to be ever increasing and the clinician needs to be aware of the strengths and weaknesses of each modality in order to best answer the question posed. Those in cardiac imaging know that the spatial and temporal resolution of the modality is unsurpassed and that it is relatively easy to get good images with minimal training.
The purpose of this book is thus to give practical guidance to those undertaking training in the art of TEE. It is not an exhaustive text to be used for reference but one that should be used in conjunction with hands-on experience. If used correctly it will help in realizing the true potential of TEE.
valve cusp nomenclature, it can cause confusion when identifying which PV cusp is which. The PV is the most anteriorly situated of the valves and thus the least well imaged using transesophageal echocardiography. The assessment of the valve is, therefore, usually limited to leaflet thickness and mobility in 2D followed by a search for regurgitation using color Doppler. 6.4.1 Mid Esophageal View The one view in which the pulmonary valve can be consistently visualized in is the RV inflow-outflow
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obtained. At the level of T4 (Fig. 1.1), the aortic arch is anterior to the esophagus and (sometimes with the left brachiocephalic vein and distal right pulmonary artery) can be visualized with appropriate probe manipulation. The superior vena cava is anterior and to the right at this level but cannot be visualized due to the interposition of the trachea. Between T4 and T8 (Fig. 1.2), the ascending aorta, superior vena cava, pulmonary trunk, and right pulmonary artery lie anterior to the
structures being covered in later chapters. 10 1. Introduction Figure 1.3. Thoracic CT slice taken at the level of T10 showing the relationship of the esophagus to the left atrium and descending aorta. When considering the assessment of specific cardiac structures, it should always be remembered that there can be marked interindividual variability such that any text can only be a guide. With each study undertaken adjustments to probe depth, degree of rotation and flexion and image plane
objective, it is necessary to have a systematic approach to ensure the appropriate images are obtained. 2.1 Standard Image Planes The standard image planes that are required to assess the left ventricle are the mid esophageal (ME) 4 chambers (4Ch; Fig. 2.1), 2 chambers (2Ch; Fig. 2.2) and long axis (LAX; Fig. 2.3) views and transgastric (TG) basal short axis (bSAX; Fig. 2.4), mid short axis (mSAX; Fig. 2.5), 2 chambers (2Ch; Fig. 2.6), and long axis (LAX; Fig. 2.7) views. For those familiar