Trans-esophageal echocardiography (TEE) uses a probe inserted down the esophagus to obtain high-quality images of the heart and blood vessels. It provides more detailed views than a standard echocardiogram. TEE is used to assess conditions such as infective endocarditis, valve disease, tumors, and aortic dissection. The procedure involves preparing equipment, positioning and monitoring the patient, inserting the lubricated probe, and obtaining standardized views of the heart. TEE allows for very close visualization of posterior heart structures but requires special expertise and carries a risk of injury.

1. Trans-esophageal
echocardiography :
MS.SYED ALI AFRIN (CARDIAC CARE
TECHNOLOGY)

2. Introduction:
 TEE uses sound waves to create high quality moving pictures of heart and
its blood vessels.
 It involves a flexible tube or probe with a transducer at its tip
 Probe is guided down the throat and esophagus
 More detailed pictures of heart as esophagus is directed behind heart

4. Indications:
Assessment of prosthetic
valves, infective
endocarditis,native valve
disease
Assessment of a suspected
cardioembolic event
Assessment of cardiac tumors
Assessment of atrial septal
abnormalities.
Assessment of aortic dissection,
intramural hematomas.
Evaluation of CHD : CAD,
pericardial disease
Evaluation of critically ill
patients
Intraoperative monitoring
Monitoring during
interventional procedure
Stress echocardiography
Nondiagnostic TTE.

5. Procedure:
 Preparation of equipment and supplies :
1. Medications,normal saline flushes,and
contrast medium
2. Intravenous supplies, lidocaine spray
and tongue blade, maintain and check
suction, o2, basic life support
3. Scope lubricant: lubricating jelly or
viscous lidocaine/ gloves, safety
glasses,tee probe and bite block.
 Patient preparation :
1. Confirm that patient has had no oral take
for 4-6 hrs before TEE.
2. Obtain brief history of drug allergies and
current medications
3. Explain procedure to patient
4. Obtain baseline vital signs and monitor
rhythm
5. Remove pt’s dentures,oral prostheses and
eyeglasses
Before the procedure :

6. Procedure :
Patient preparation:
1. Establish intravenous catheter
for administration of
medications
2. Place patient in the left lateral
decubitus position with wedge
support and safety restraints.
3. Assist patient during
esophageal intubation,such as
head position, breathing and
reassurance
Drugs :
1. pharyngeal anesthesia
2. Drying agent (optional)
3. Sedation or analgesia
4. Endocarditis prophylaxis

7. Procedure :
During the procedure :
1. Position and maintain bite
block
2. Monitor vital signs : rhythm,
respiration, blood pressure
and oxygen saturation.
3. Use oral suction if necessary
4. Have basic life support
equipment available.
After the procedure :
1. Assist patient during recovery
period
2. Remove intravenous catheter
3. Instruct patient not to drive
for 12hrs if sedation was used.
4. Record vital signs and
patient’s condition on
dismissal.

8. About TEE probe:
1. Modification of standard gastroscope,with transducer in place
of fibre optics.
2. Conventional rotatary controls with inner and outer dials
3. Inner dial guides antiflexion and retroflexion.
4. Outer dial controls medial and lateral movement
5. Multiplane probe has a lever control to guide rotation.

11. Principles of TEE probe:
1. Probe insertion
2. Probe manipulation
3. Image display

12. Types of plane :
Monoplane Tee- provides images in horizontal plane only
Biplane Tee – orthogonal longitudinal plane also
Multiplane TEE tranducer:
1. single array of crystals [phased array tranducers with 64-
256 piezoelectric elements]
2. That can be electronically and mechanically rotated in an
arc of 180°.
3. To produce a continuum of transverse and longitudinal
images from a single probe position.

13. Imaging plane levels:
1. Upper or high esophageal (25 -28cm)
2. Mid-esophageal (29-33cm)
3. Transgastric (38-42cm)
4. Deep-transgastric(>42cm)

15. Tranducer manipulation options:

16. Tranducer manipulation options:

17. Orientation of TEE probe:

18. Orientation of TEE probe:

19. Basic views :
Prior guidelines developed by theASE and the SCA have
described the technical skills for acquiring 20 views in the
performance of a comprehensive intraoperative multiplane
transesophageal echocardiographic examination.
But current guidelines recommend that a basic PTE examination
should focus on encompassing the 11 most relevant views.

20. Basic 20 views :

24. UE aortic arch long axis :
0°
Aortic arch, left
brachiole
Upper esophageal Views :

25. UE aortic arch Short axis :
90°
Aortic arch, pa,pv,left
brachiole
Upper esophageal Views :

26. Mid esophageal Views :
ME four chamber:
0°-20°
~15°
La,lv,mv,ra,rv,tv,IAS

27. ME two chamber:
80° – 100°
~ 90°
Lv, la, laa,mv
Mid esophageal Views :

28. ME long axis:
120 ° - 160°
~ 120°
La,lv,mv,lvot,Av,asc aorta
Mid esophageal Views :

29. Mid esophageal Views :
ME mitral commisural:
60 °- 70°
~ 80°
La, lv, mv

30. ME Bicaval view:
80° - 110°
~ 110°
Ra,svc,ivc,ias,la
Mid esophageal Views :

31. ME Rv inflow-outflow view:
60 °– 90 °
~ 80°
Ra,Rv,Tv,Rvot,pv,pa
Mid esophageal Views :

32. ME aortic valve short axis:
30 °– 60 °
~ 60°
Av, IAS,rvot,pv,coronary
ostia
Mid esophageal Views :

33. ME aortic valve long axis:
120° - 160°
~ 130°
Av,lvot,proximal asc
aorta,rpa
Mid esophageal Views :

34. ME asc aorta short axis :
0 °– 60 °
~ 20 °
Asc aorta, svc, pa, rpa
Mid esophageal Views :

35. ME asc aorta long axis :
100 °– 150 °
~ 100 °
Asc aorta, rpa
Mid esophageal Views :

36. ME decending aorta long
axis:
90° – 110 °
~ 90 °
Descending thoracic
aorta,Left pleural space
Mid esophageal Views :

37. ME Descendingaorta
shortaxis :
0°
Descending thoracic
aorta,Left pleural space
Mid esophageal Views :

38. TG mid short axis:
0° - 20 °
0°
Lv,rv,papillary muscle
Transgastric Views :

39. TG basal short axis:
0° - 20°
~0°
Lv,mv,rv,tv
Transgastric Views :

40. TG long axis :
90° – 120 °
~ 120 °
Lvot,av,mv
Transgastric Views :

41. TG two chamber :
80 °– 100°
~ 90 °
La,Lv, mv,
chordae,papillary muscle
Transgastric Views :

42. TG Rv inflow :
100° – 120°
~ 120 °
Ra,rv,tv,tv
chordae,papillary muscle
Transgastric Views :

43. Deep TG long axis :
0°- 120°( anteflexion)
0 °
Lvot,Av,asc aorta
Deep Transgastric Views :

44. Scalops :

45. Scalops :

46. Scalops :

47. RIMS in ASD condition :

48. RIMS in ASD condition :

49. Pulmonary veins :

50. Contraindications:
Absolute :
1. Oesophageal obstruction.
2. Suspected or known perforated viscus
3. Instability cervical vertebrae
4. GI bleeding not evaluated
Relative:
1. Esophageal varices or diverticula
2. Cervical arthritis
3. Oropharyngeal distortion
4. Bleeding diathesis or over-anticoagulation .

51. Frequent use:
Advantages
1. Transducer: 2-3mm from the
heart
2. Closer posterior
structures:better visualization
of LA,LA
APPENDAGE,PV,MV,LV,AORTA
.
3. High resolution images.
Disadvantages
1. Semi invasive procedure:
chances of injury.
2. Needs special
setup,technique, preparation,
instrumentation.
3. Needs orientation and
expertise