(12) Transesophageal Echocardiography (TEE) Study Notes

What is the required preparation time for a patient before a TEE procedure?

NPO for at least $6\,hours$.

Who is responsible for performing a TEE exam?

A physician.

Which technique is highly sensitive and specific for CAD when used with TEE?

Atrial pacing.

Which drug can be administered with a TEE for stress evaluation?

Dobutamine.

What is used as contrast for shunt evaluation in TEE?

Saline contrast.

What is the standard patient position during a TEE?

Left lateral decubitus.

What degree should the patient's head be elevated during TEE to prevent aspiration?

$30$ degrees.

What is the frequency range of the transducers used in TEE?

$5-7\,MHz$.

How does the spatial resolution of TEE compare to transthoracic imaging (TTE)?

TEE provides higher spatial resolution images.

What is the primary view obtained from the deep transgastric position?

Long-axis view of the left ventricle.

At which positions are short-axis views of the left ventricle obtained from the stomach?

Basal and mid levels.

Which high esophageal views are used to evaluate the aortic arch?

Long-axis and short-axis views.

From which esophageal level are most TEE views obtained besides the high esophageal and transgastric levels?

Mid-esophageal level.

Why is the transducer temperature monitored during a TEE?

Temperatures above $40$ degrees Celsius can damage digestive organ tissues.

Why is TEE superior to TTE for evaluating small vegetations?

Higher-resolution imaging.

TEE is especially helpful for thrombus formation in which specific heart locations?

The atrium and the atrial appendage.

Which part of the heart is not seen as well on TEE compared to TTE?

The cardiac apex.

What is an advantage of TEE regarding the evaluation of prosthetic valves?

It may avoid valve masking.

List two common risks associated with the TEE procedure.

Airway compromise and esophageal perforation.

Mention another risk related to the TEE probe during the procedure.

Vasovagal reaction or infection from a contaminated probe.

What is an indication for TEE regarding infection?

Endocarditis.

What is an indication for TEE regarding structural heart issues from birth?

Congenital heart disease.

For which vascular pathology is TEE indicated?

Aortic pathology, including dissection.

What is an indication for TEE in trauma?

Chest trauma patients.

Which clinical assessment might require TEE post-surgery?

Post-surgical assessment.

Name a contraindication for TEE related to the upper digestive tract.

Tumors of the mouth, esophagus, or stomach.

What esophageal condition is a contraindication for TEE?

Stricture, diverticula, or varices.

Why would severe dysphagia be a contraindication for TEE?

It makes the insertion of the probe difficult or dangerous.

Which spinal condition is a contraindication for TEE?

Cervical spine disorders that prevent cervical flexion.

Which view evaluates the aortic valve, mitral valve, $LV$, and $LA$ from the high esophageal position?

Long Axis $LV$.

Which view evaluates the $RA$, $RV$, $TV$, $IVC$, and coronary sinus?

Long Axis $RV$ Inflow.

What anatomy is evaluated in the Long Axis $RV$ Outflow view?

$RV$, $RVOT$, $PV$, and $MPA$.

What level is the probe placed to see the $MPA$, $RPA$, and $LPA$ in long axis?

Very high esophageal.

What anatomy is evaluated in the Short Axis Base of Heart view?

$AV$, $PV$, $RA$, $LA$, interatrial septum, $RV$, $RVOT$, and $MPA$.

Where is the probe located for the Short Axis Mid $LV$ view?

Transgastric.

Which view is used to evaluate the papillary muscles?

Short Axis Apical $LV$, Transgastric.

What anatomy is seen in the Four Chamber view?

$RV$, $LV$, $RA$, $LA$, $MV$, $TV$, and interatrial/interventricular septums.

How is the coronary sinus viewed in a four-chamber view?

Using posterior angulation.

What anatomy is evaluated in the TEE Two Chamber view?

$LV$, $MV$, $LA$, atrial appendage ($LA\,appendage$), and $LUPV$.

What extra structures are visible in the Five Chamber view that are not in the Four Chamber view?

The aortic valve ($AV$).

What structures are evaluated in the Bicaval View?

$IVC$, $SVC$, $RA$, interatrial septum, and $LA$.

In the TEE Short Axis View Mid $LV$, what does the label AS represent?

Anteroseptal.

In the TEE Short Axis View Mid $LV$, what does the label ANT represent?

Anterior.

In the TEE Short Axis View Mid $LV$, what does the label AL represent?

Anterolateral.

In the TEE Short Axis View Mid $LV$, what does the label IL represent?

Inferolateral.

In the TEE Short Axis View Mid $LV$, what does the label INF represent?

Inferior.

In the TEE Short Axis View Mid $LV$, what does the label IS represent?

Inferoseptal.

What abbreviation is used for the atrial appendage in the basal view?

$LA\,app$.Tokenization error prevention.

At what angle is the TEE Mid-esophageal 2 Chamber View typically acquired?

$60^{\circ}$.

What is the prominent ridge of tissue between the $LUPV$ and the $LA\,app$?

Coumadin Ridge.

At what angle is the Bicaval View shown in the mid-esophageal position?

$112^{\circ}$.

Which valve is identified at the entrance of the $IVC$ in the Bicaval View?

Eustachian Valve.

What does the label FO represent in the Bicaval View?

Foramen Ovale.

At what angle is the Transgastric 2 Chamber View acquired?

$90^{\circ}$.

What is the angle for the Transgastric Long Axis Left Heart view?

$120^{\circ}$.

What angle is used for the TEE Long Axis Descending Aorta view?

$90^{\circ}$.

What angle is used for the TEE Short Axis Descending Aorta view?

$0^{\circ}$.

What is the heart rate ($HR$) recorded on the TEE Short Axis Descending Aorta image?

$64\,bpm$.

What anatomy is evaluated in the TEE - Long Axis Right Heart (Inflow View)?

$RA$, $RV$, $TV$, $IVC$, and coronary sinus.

What is the primary indicator for a saline bubble study?

Shunt flow detection.

Is shunt flow detected in the 'Bicaval View Bubble Study' image provided?

No Shunt Flow Detected.

Which probe position is used for the Short Axis Apical $LV$ view?

Transgastric.

What anatomy is evaluated in the High Esophageal Long Axis view of the aortic arch?

Aortic arch.

What is the probe location for evaluating the $MPA$, $RPA$, and $LPA$?

Very high esophageal.

Which TEE view evaluates the $RV$, $LV$, and $MV$ in short axis?

Short Axis Mid $LV$.

Which views can be obtained from the high esophageal position besides the arch?

Long Axis $LV$, Long Axis $RV$ Inflow, Long Axis $RV$ Outflow, and Short Axis Base of Heart.

What is the probe position for the TEE 4 Chamber View?

Mid-esophageal.

What is the probe position for the TEE 5 Chamber View?

Mid-esophageal.

What is the probe position for the TEE 2 Chamber View?

Mid-esophageal.

In the Mid-esophageal 5 Chamber View, which outflow tract is visualized?

$LVOT$.

In the Mid-esophageal 5 Chamber View, which right-sided outflow tract is visualized?

$RVOT$.

What structures are on either side of the Coumadin Ridge?

The Left Upper Pulmonary Vein ($LUPV$) and the Left Atrial Appendage ($LA\,app$).

What is the angle listed for the Mid-esophageal Bicaval View with the Eustachian Valve?

$100^{\circ}$.

What is the angle listed for the TEE - Long Axis Right Heart (Inflow View)?

$120^{\circ}$.

Does TEE require sedation?

Yes, it requires sedation or sometimes general anesthesia.

What are the two most common levels for transgastric short-axis views?

Basal and mid levels.

Name a risk related to temperature in TEE.

Temperature hazards (tissue damage).

What is an indication for TEE related to potential embolism?

Thrombus formation or embolism source.

Can TEE be used to monitor during surgery?

Yes, intraoperative monitoring.

What is one contraindication related to gastric health?

Gastric bleeding.

In the Bicaval View, which two large veins enter the $RA$?

$IVC$ and $SVC$.

According to the transcript, which view shows the coronary sinus?

Long Axis $RV$ Inflow.

What is the probe location for the Long Axis PA view?

Very high esophageal.

What angle is indicated for the image 'Basal View Left Atrial Appendage'?

$34^{\circ}$.

Which heart chambers are shown in the Mid-esophageal 4 Chamber View?

$LA$, $RA$, $LV$, and $RV$.

Which valves are shown in the Mid-esophageal 4 Chamber View?

$MV$ and $TV$.

What frequency is generally used for TTE?

Lower frequency than $5-7\,MHz$.

In which view is the interatrial septum most clearly evaluated for shunts using the Bicaval position?

Bicaval View.

What probe level is used for the Long Axis RV Outflow?

High esophageal.

Which view evaluates the $RA$, $LA$, and interatrial septum together from the base of the heart?

Short Axis Base of Heart.

What does the abbreviation $MPA$ stand for?

Main Pulmonary Artery.

What does the abbreviation $RPA$ stand for?

Right Pulmonary Artery.

What does the abbreviation $LUPV$ stand for?

Left Upper Pulmonary Vein.

Which view is best for assessing the Left Atrial Appendage for thrombus?

2 Chamber View (Mid-esophageal or Apical).

What angle is shown for the 'TEE 2 Chamber View Apical 2 Chamber with LA Appendage'?

$34^{\circ}$.

What is the probe position for the 'Long Axis Left Heart' showing the $LV$, $MV$, and $LA$ at $120^{\circ}$?

Transgastric.

Which view shows the $AO$, $RV$, and $LV$ in context of five chambers?

TEE 5 Chamber View.

What pathology includes dissection often checked by TEE?

Aortic pathology.

What is one reason a TEE might be requested after a TTE?

Suboptimal TTE exam.

What position is the probe in when it is in the stomach?

Transgastric.