Transesophageal Echocardiography
Section snippets
INSTRUMENTATION
The TEE transducer is a modified endoscope with a set of crystals at the tip, which are activated to produce the ultrasound beam. In 1994, the highest evolved TEE technology is a multiplane (capable of ultrasonically sectioning the heart in multiple planes) or biplane (a device with horizontal and longitudinal plane arrays), multifrequency (can electronically change the frequency from 3.5 MHz to 7.0 MHz) transducer equipped with Doppler and color flow imaging capabilities (Fig. 3).
PREPARATION AND EXAMINATION OF PATIENTS
For prescheduled outpatient or inpatient TEE, the patient must refrain from oral intake of food or water for at least 4 hours before the examination. The procedure should be explained in detail to the patient. The history should be elicited, with emphasis on gastrointestinal tract-related symptoms such as dysphagia, odynophagia, hematemesis, esophageal varices, prior endoscopic examination, upper gastrointestinal surgical procedures, and drug-associated allergies. Any dentures or oral
PREMEDICATION
Awake patients scheduled to undergo TEE receive premedication for the following reasons: (1) topical anesthesia (with an aerosol local anesthetic solution such as 10% lidocaine) of the oropharynx and the hard and soft palate to diminish the gag reflex and to eliminate retching and laryngospasm; (2) a drying agent (glycopyrollate, 0.2 mg intravenously) to minimize salivary and gastrointestinal secretions and reduce the risk of aspiration; (3) sedative and analgesic agents (midazolam
CLINICAL APPLICATIONS
The indications for performing a TEE examination encompass all cardiac pathologic conditions, as reflected in the Mayo Clinic experience with 7,134 procedures during a 6-year period (Fig. 4). The indications for TEE continue to be refined; the following discussion emphasizes areas in which the role of TEE is well established.
Training Requirements.
Errors caused by misdiagnosis can be minimized if the procedure is performed by properly trained personnel. Only specially trained echocardiologists should perform TEE. At some institutions, esophageal intubation is performed by a gastroenterologist, and the TEE examination is done by an echocardiologist. Physicians who wish to learn TEE should have attained at least level II training in echocardiography. In 1987, the American Society of Echocardiography published recommendations for the
COST
The best assessment of cost for TEE and other cardiac imaging modalities is to compare the relative value units assigned by the Health Care Financing Administration (Table 1). A note of caution is warranted when such cost comparisons are analyzed; a combination of technologies may be necessary when one study is nondiagnostic. In all circumstances, the well-being of the patient overrides cost considerations. Quality of care cannot and should not be jeopardized for cost-containment.
The
CONCLUSION
TEE is a low-risk procedure that provides highly relevant information for clinical decision making. TEE studies should be performed by appropriately trained physicians, and in patients with relative contraindications, the risk-to-benefit ratio must be considered before the examination is performed. Future considerations include smaller transducers and three-dimensional reconstruction of the cardiac anatomy.
REFERENCES (19)
- et al.
Multiplane transesophageal echocardiography: image orientation, examination technique, anatomic correlations, and clinical applications
Mayo Clin Proc
(1993) - et al.
Transesophageal echocardiography: a sonographer's perspective
J Am Soc Echocardiogr
(1991) - et al.
Biplanar transesophageal echocardiography: anatomic correlations, image orientation, and clinical applications
Mayo Clin Proc
(1990) - et al.
Transesophageal echocardiography: technique, anatomic correlations, implementation, and clinical applications
Mayo Clin Proc
(1988) Prophylaxis or no prophylaxis before transesophageal echocardiography? [editorial]
J Am Soc Echocardiogr
(1992)- et al.
Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology
J Am Coll Cardiol
(1991) - et al.
Recognition and embolic potential of intraaortic atherosclerotic debris
J Am Coll Cardiol
(1991) - et al.
Transesophageal echocardiography and cardiac masses
Mayo Clin Proc
(1991) - et al.
Intraoperative evaluation of mitral valve regurgitation and repair by transesophageal echocardiography: incidence and significance of systolic anterior motion
J Am Coll Cardiol
(1992)
Cited by (94)
The Quality and Safety of Sedation and Monitoring in Adults Undergoing Nonoperative Transesophageal Echocardiography
2023, American Journal of CardiologyComplications Associated With Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions
2023, Journal of the American Society of EchocardiographyComplications of Transesophageal Echocardiography: A Review of Injuries, Risk Factors, and Management
2022, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Gastroesophageal bleeding caused by trauma from TEE probe placement or manipulation can vary in severity from mild and self-limiting to copious and life-threatening. Minor trauma to the mucosal tissue can result in bleeding that presents as blood on the tip of the TEE probe at removal, blood visible in orogastric secretions, or postoperative hematemesis.43 Daniel et al reported minor pharyngeal bleeding in 0.01% of their cohort (1 in 10,218) in a series of ambulatory patients undergoing TEE.
Propofol sedation administered by cardiologists in echocardiography studies
2022, REC: CardioClinicsCitation Excerpt :Transesophageal echocardiography (TEE) is an essential diagnostic procedure in cardiology with a low complication rate in the adult population.1 However, the poor tolerance of the procedure in non-sedated patients made it necessary to carry out studies that were very focused on the pathology being sought, especially when the indications were sources of systemic embolism and suspected endocarditis.2,3 In the last decade, the clinical profile of patients and the complexity of procedures seem to have changed.
Rescue Echocardiography/Ultrasonography in the Management of Combined Cardiac Surgical and Medical Patients in a Cardiac Intensive Care Unit
2020, Journal of Cardiothoracic and Vascular Anesthesia