Transesophageal Echo

Introduction to TEE

  • Definition: A Transesophageal Echocardiogram (TEE) is an echocardiographic procedure that uses a specialized probe inserted into the esophagus to obtain detailed images of the heart.

Objectives of TEE

  • Discuss fundamentals of TEE: Definition, patient prep, advantages, disadvantages, indications, and contraindications.

  • Identify roles of the cardiac sonographer, physician, and nurse during TEE.

  • Develop an understanding of TEE probe windows and views.

  • Identify types of TEE probes: omniplane, multiplane, biplane, single plane, pediatric.

  • Discuss modern TEE probes.

Fundamentals of TEE

  • TEE provides superior imaging via a motor-modified gastroscope probe placed in the esophagus.

  • Features:

    • Flexible, controllable shaft designed for maneuverability.

    • Small ultrasound transducer at the distal tip.

Team Roles

Cardiac Sonographer

  • Gather supplies and verify proper probe function.

  • Perform patient education and image acquisition during TEE.

  • Disinfect equipment following established protocols.

Nurse

  • Initiate IV and manage conscious sedation for the patient.

  • Monitor vital signs: blood pressure, heart rate, EKG, oxygen saturation.

  • Ensure patient safety post-procedure, monitoring until full recovery.

  • Educate patient on post-care and recovery times (30-60 min before eating/drinking).

Physician (Cardiologist/Anesthesiologist)

  • Provide patient education regarding TEE procedure.

  • Examine TEE probe for functionality.

  • Position patient appropriately (left lateral decubitus).

  • Use topical anesthetic for throat and guide probe insertion.

Advantages of TEE

  • Superior Resolution: Higher frequency used results in better image clarity.

  • Less Attenuation: Proximity to heart reduces sound wave loss, enhancing detail.

  • Access for Specific Patients: Effective for patients unfit for transthoracic echocardiograms (TTE) due to obesity, lung disease, or critical conditions.

Disadvantages of TEE

  • Invasive Procedure: More risks involved, including trauma to esophagus or dental injuries.

  • Patient Discomfort: Higher anxiety and discomfort associated with sedation and probe insertion.

  • Resource Intensive: Requires intensive nursing and medical care, costlier than TTE.

  • Pediatric Considerations: Requires specially designed smaller probes and experienced staff.

Indications for TEE

  • Evaluate the source of emboli (tumors, contacts, or thrombosis).

  • Useful in patients with atrial fibrillation prior to cardioversion.

  • Assess vegetations related to infective endocarditis.

  • Evaluate septal defects and assist with bubble studies to identify shunts.

  • Monitor valve function and detect prosthetic valve dysfunction.

  • Useful in pre-op, intra-op, and post-op settings in cardiac surgeries.

  • Diagnose congenital heart defects.

Contraindications for TEE

  • Esophageal conditions (bleeding, recent surgery).

  • Uncooperative patients or those with unstable respiratory status.

  • Gastrointestinal disorders or unstable cervical spine.

Types of TEE Probes

Overview

  • Similar appearance with a flexible shaft and transducer.

Probe Types

  • Single Plane Probe: Basic functionality, single imaging plane.

  • Biplane Probe: Offers two distinct imaging planes requiring multiple connector switches.

  • Omniplane (Multiplane) Probe: Most common today; allows rotation of imaging beam (0-180 degrees).

  • Pediatric Probe: Smaller diameter, higher frequency, for pediatric patients.

  • Mini TEE Probe: Delicate probe for smaller patients, similar care as other probes.

Modern TEE Probes

  • Transnasal Echo: Uses a smaller probe via the nose, allowing for easier sedation management; suitable for various clinical settings.

  • 3D TEE: Enhances visualization for volume assessment and valvular heart disease.

TEE Probe Windows and Views

Probe Manipulation

  • Proper angulation and depth determine the acquired views.

Standard Windows

  • Upper Esophageal (UE): ~20-25 cm depth.

  • Mid Esophageal (ME): ~30-40 cm depth.

  • Transgastric (TG): ~40-50 cm depth.

View Acquisition

  • TEE probe positioned to visualize the heart at different angles for comprehensive evaluation.

  • Approximately 20 standard views can be generated, including long access, short access, and four-chamber views.

Summary

  • TEE is a valuable echocardiographic tool with specific applications, benefits, and challenges. Knowledge of techniques, team roles, and probe management is crucial for successful procedures.