ASE Guidelines and Standards
Guidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists

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Section snippets

Table of contents

  • IntroductionĀ 921

  • General GuidelinesĀ 922

    • Training and CertificationĀ 922

    • Indications for TEEĀ 923

    • Management of Patient SedationĀ 927

    • Sedation and AnesthesiaĀ 929

    • Probe Insertion TechniquesĀ 930

    • Instrument ControlsĀ 930

    • Instrument ManipulationĀ 931

  • Comprehensive Imaging ExaminationĀ 932

    • ME ViewsĀ 932

    • TG ViewsĀ 939

    • Aorta ViewsĀ 941

  • Transesophageal 3D Examination ProtocolĀ 942

  • Specific Structural ImagingĀ 942

    • MVĀ 942

    • AV and AortaĀ 945

    • PVĀ 949

    • TVĀ 950

    • Assessment of Ventricular Size and FunctionĀ 951

    • LA and Pulmonary VeinsĀ 953

    • Right Atrium and Venous

Training and Certification

There are several published guidelines addressing training and maintenance of competence for physicians performing TEE that are summarized in TableĀ 1.13, 14, 15, 16 TTE is a prerequisite to TEE for cardiology-based training but not anesthesiology-based training. Demonstration of competence in TEE is usually accomplished by successful completion of a training program and passing an examination. The National Board of Echocardiography, founded in 1998 in collaboration with the ASE and SCA, offers

Comprehensive Imaging Examination

Prior guidelines developed by the ASE and SCA have described the technical skills for acquiring 20 views in the performance of a comprehensive intraoperative multiplane TEE examination.5 With the development of technology and expansion of indications for TEE, the views necessary to perform a comprehensive examination have expanded. A comprehensive examination can still be performed using three primary positions within the gastrointestinal tract (FigureĀ 3B): midesophageal (ME), transgastric

Transesophageal 3D Examination Protocol

A comprehensive 3D TEE examination using the matrix transducer usually starts with ā€œreal-timeā€ or ā€œliveā€ acquisition using single-beat mode. However, to obtain acquisitions with high temporal and spatial resolution, electrocardiographically gated 3D transesophageal acquisitions should be used, especially when the patient's rhythm and respirations allow high-quality images to be obtained. When moving from a narrow-angle to a wide-angle pyramid of acquisition, there is a reduction in temporal

General Considerations

The following section describes the anatomy and imaging or Doppler of specific structures. It is important to remember that the comprehensive imaging views discussed previously are not intended to represent all the imaging planes that can be obtained when imaging specific structures, particularly in the setting of significant individual anatomic variability. From standard imaging planes, small adjustments in position of the probe or transducer angle may be integral in the complete structural

Conclusions

This document presents the 28 views in a comprehensive TEE examination. A suggested protocol of image acquisition is provided, with the caveat that anatomic variability may require unconventional imaging planes be used. Although the performance of a comprehensive TEE examination is recommended whenever possible, individual patient characteristics, anatomic variations, pathologic features, or time constraints imposed may limit the ability to perform all aspects of the examination described in

Notice and Disclaimer

This report contains recommendations only and should not be used as the sole basis to make medical practice decisions or for disciplinary action against any employee. The statements and recommendations contained in this report are based primarily on the opinions of experts rather than on scientifically verified data. The ASE makes no express or implied warranties regarding the completeness or accuracy of the information in these reports, including the warranty of merchantability or fitness for

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    The following authors reported no actual or potential conflicts of interest in relation to this document: Rebecca T. Hahn, MD, FASE, Theodore Abraham, MD, FASE, Mark S. Adams, RDCS, FASE, Charles J. Bruce, MD, FASE, Jack S. Shanewise, MD, FASE, Samuel C. Siu, MD, FASE, William Stewart, MD, FASE, and Michael H. Picard, MD, FASE. The following authors reported relationships with one or more commercial interests: Kathryn E. Glas, MBA, MD, FASE, edited and receives royalties for The Practice of Perioperative Transesophageal Echocardiography: Essential Cases (Wolters Kluwer Health, Amsterdam, The Netherlands). Roberto M. Lang, MD, FASE, received research support from Philips Medical Systems (Andover, MA). Scott T. Reeves, MD, MBA, FASE, edited and receives royalties for A Practical Approach to Transesophageal Echocardiography (Lippincott Williams & Wilkins, Philadelphia, PA).

    Reprint requests: American Society of Echocardiography, 2100 Gateway Centre Boulevard, Suite 310, Morrisville, NC 27560 (E-mail: [email protected]).

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