Introduction to Trans-oesophageal Echocardiography

TEE
5-10% of echocardiography studies.
In IJN, around 200 cases (2003) to >1000 cases (2007)
Knowledge of appropriate indications, contraindications and risks of TEE.
Knowledge of the physical principles of echocardiographic image formation, cardiac anatomy and alterations and blood flow velocity measurement.
Knowledge of adequate data, adequate or inadequate TEE examination.

TEE

Physician should be assisted by an experience sonographer, to make sure optimum image acquisition and to ensure patients safety.
Nearest crash trolley.
Oxygen outlet and suction facility available.
Pulse oximeter should be available.
Obtain baseline vital signs.
Check indications for procedure.
Patient consent.
Inspection of probe, mobility of the probe tip, full flexion/extension and right/left flexion

TEE
Fasted for at least 4 hrs prior to the procedure.
Explain in brief the procedure, inform to expect mild abdominal discomfort and gagging sensation with probe advancement.
Trolley ( IV supplies, N/saline, 3-way tap, gloves.
20G IV cannula.
Dentures and eye-glasses to be removed.
Lidocaine spray (must cover posterior pharynx and tongue).
Warn not to eat or drink for at least 1 hr after local anaesthesia.

TEE
Help in patient positioning (left lateral decubitus)
Bite guard (must).
Reassure patient through-out procedure.

TEE
Check-list:
Swallowing problems, haematemesis.
Liver disease (varices).
Low oxygen saturation.
Allergy to latex.

TEE
Complication:
Hypoxia (0.6%)
Hypotension (0.5%)
PSVT,NSVT (0.2%)
Haematemesis (0.1%)
Oesophageal tear (<0.02%)>

TEE
Probe insertion (oesophageal intubation)
Nausea is common (just pause and leave the probe alone)
Start imaging in the oesophagus then the gastric views. GE junction is usually around 40 cm.

TEE
Image Format:
Right sided structures are on the left and left sided on the right.
Apex of the imaging plane with the electronic artefact is at the top of the screen.

TEE
Mid-oesophageal view (LAA & LPV).
Push down – LVOT.
Swing across to look at IAS.
Swing across to look at RPV.
Swing back , push probe in to get 4 chamber view.
Change angle to around 40 degrees (aortic valve en-face).
Look at septum, TV, RVOT and PV.
Change angle to around 60-90 degrees (MV).
Rotate probe to et bi-caval view.
Change angle to 110%.
Go trans-gastric.