TEE - standard imaging views

Transesophageal Echocardiographic imaging views. Adapted from Shanewise et al. [1]

Transesophageal Echocardiographic Anatomy

ME two-chamber	Probe adjustment: neutral	Sector depth: ~14 cm
	Primary diagnostic issues LA appendage Mass/thrombus LV apex pathology LV systolic dysfunction (apical segments)	Required structures LA appendage Mitral valve LV apex (i.e., maximal LV length)
ME LAX	Probe adjustment: neutral	Sector depth: ~12 cm
	Primary diagnostic issues Mitral valve pathology LVOT pathology	Required structures LV Mitral valve LVOT
ME mitral commissural	Probe adjustment: neutral	Sector depth: ~12 cm
image	Primary diagnostic issues Localization of mitral valve pathology	Required structures Mitral valve (P1, P3 and A2 scallops) Papillary muscles/chordae tendineae LA LV
TG mid-SAX	Probe adjustment: neutral	Sector depth: ~12 cm
image	Primary diagnostic issues Hemodynamic instability LV enlargement LV hypertrophy LV systolic dysfunction (global and regional)	Required structures LV cavity LV walls (at least 50% of circumference with visible endocardium) Papillary muscles (approximately equal in size and distinct from ventricular wall)
TG two-chamber	Probe adjustment: neutral	Sector depth: ~12 cm
image	Primary diagnostic issues LV systolic dysfunction (anterior and inferior basal segments)	Required structures Mitral leaflets Mitral subvalvular apparatus LV (anterior and inferior: basal plus mild segments)
TG RV inflow	Probe adjustment: neutral-rightward	Sector depth: ~12 cm
image	Primary diagnostic issues RV systolic dysfunction Tricuspid valve pathology	Required structures Tricuspid leaflets Tricuspid subvalvular apparatus
TG RV inflow-outflow	Probe adjustment: neutral-rightward	Sector depth: ~14 cm
image	Primary diagnostic issues RV systolic dysfunction RVOT pathology Pulmonary artery pathology Pulmonic valve evaluation	Required structures RA RV Main pulmonary artery Pulmonic valve
TG basal SAX	Probe adjustment: neutral	Sector depth: ~12 cm
image	Primary diagnostic issues LV systolic dysfunction (basal segments) Mitral valve pathology	Required structures Mitral leaflets Mitral subvalvular apparatus LV (basal segments)
TG LAX	Probe adjustment: neutral-leftward	Sector depth: ~12 cm
image	Primary diagnostic issues LV systolic dysfunction (anteroseptal and posterior: basal segments) Doppler evaluation of aortic valve	Required structures Mitral leaflets Mitral subvalvular apparatus LV (anteroseptal and posterior: basal plus midsegments) Aortic valve
Deep TG LAX	Probe adjustment: neutral	Sector depth: ~16 cm
image	Primary diagnostic issues Aortic valve pathology LVOT pathology Doppler evaluation of aortic valve	Required structures LV Aortic valve Aorta
ME, midesophageal; Asc, ascending; SAX, short axis; LAX, long axis; UE, upper esophageal; Desc, descending; AV, aortic valve; RV, right ventricular; LVOT, left ventricular outflow tract; RA, right atrium; LA, left atrium; LV, left ventricular; RVOT, right ventricular outflow tract; TG, transgastric.

References

1. Shanewise JS, Cheung AT, Aronson S, Stewart WJ, Weiss RL, Mark JB, Savage RM, Sears-Rogan P, Mathew JP, Quiñones MA, Cahalan MK, and Savino JS. ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Anesth Analg. 1999 Oct;89(4):870-84. DOI:10.1097/00000539-199910000-00010 |