TEE Basics
What does TEE stand for?
Transesophageal echocardiography
What are the three major parts of a TEE probe?
Handle, flexible shaft, transducer tip
At approximately what angle is the mid-esophageal 4-chamber view obtained?
Approximately 0°
Name one cardiac condition for which TEE is commonly useful.
Valve pathology, endocarditis, aortic disease, or evaluation for an embolic source
What should happen to the TEE probe immediately after the procedure?
Immediate pre-cleaning
Where is the TEE transducer positioned during the examination?
On a probe passed into the esophagus
What control allows the imaging plane to rotate from approximately 0° to 180°?
Multiplane/omniplane control
Which TEE view shows the left atrium and left ventricle and is useful for mitral valve evaluation?
Mid-esophageal 2-chamber view
What small structures associated with infective endocarditis can TEE help identify?
Vegetations
What type of disinfection is required for a TEE probe?
High-level disinfection
Why can TEE provide excellent visualization of the heart compared with TTE?
The transducer is closer to the heart and avoids some transthoracic imaging limitations
Name three ways the TEE probe can be manipulated.
Advance, withdraw, anteflex, retroflex, lateral flexion, or rotate the imaging plane
Which view displays the LVOT, mitral valve, and aortic valve at approximately 120°?
Mid-esophageal long-axis view
What cardiac structure is especially important when looking for thrombus as a potential embolic source?
Left atrial appendage
Name two contraindications to TEE.
Esophageal stricture, active GI bleeding, recent upper GI surgery, or unstable cervical spine
Name two posterior structures that are particularly well visualized with TEE.
Left atrium, left atrial appendage, or pulmonary veins
What is the difference between anteflexion and retroflexion?
They describe opposite directions of flexing the probe tip
Which view displays the SVC, IVC, and right atrium and is useful for ASD/PFO assessment?
Mid-esophageal bicaval view
Why is TEE useful during cardiac surgery?
It provides real-time information about cardiac anatomy and function
Why is leak testing important?
The probe contains electrical components, and fluid entering through a leak can damage the probe
Explain the primary imaging advantage of placing the ultrasound transducer in the esophagus.
The esophagus lies directly behind the heart, allowing the transducer to get closer to cardiac
Why is understanding probe position, manipulation, and imaging angle essential when performing TEE?
Each movement changes the anatomy and imaging plane being visualized.
Which view provides improved alignment with the LVOT and aortic valve for Doppler assessment?
Deep transgastric view.
Name three interventional procedures that TEE can help guide.
TAVR, TEER, Watchman, ASD closure, or PFO closure.
If obtaining the perfect image conflicts with patient safety, which takes priority?
Patient safety—always.