ME two-chamber
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Probe adjustment: neutral
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Sector depth: ~14 cm
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Primary diagnostic issues
- LA appendage
- Mass/thrombus
- LV apex pathology
- LV systolic dysfunction (apical segments)
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Required structures
- LA appendage
- Mitral valve
- LV apex (i.e., maximal LV length)
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ME LAX
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Probe adjustment: neutral
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Sector depth: ~12 cm
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Primary diagnostic issues
- Mitral valve pathology
- LVOT pathology
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Required structures
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ME mitral commissural
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Probe adjustment: neutral
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Sector depth: ~12 cm
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Primary diagnostic issues
- Localization of mitral valve pathology
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Required structures
- Mitral valve (P1, P3 and A2 scallops)
- Papillary muscles/chordae tendineae
- LA
- LV
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TG mid-SAX
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Probe adjustment: neutral
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Sector depth: ~12 cm
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Primary diagnostic issues
- Hemodynamic instability
- LV enlargement
- LV hypertrophy
- LV systolic dysfunction (global and regional)
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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)
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TG two-chamber
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Probe adjustment: neutral
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Sector depth: ~12 cm
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Primary diagnostic issues
- LV systolic dysfunction (anterior and inferior basal segments)
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Required structures
- Mitral leaflets
- Mitral subvalvular apparatus
- LV (anterior and inferior: basal plus mild segments)
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TG RV inflow
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Probe adjustment: neutral-rightward
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Sector depth: ~12 cm
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Primary diagnostic issues
- RV systolic dysfunction
- Tricuspid valve pathology
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Required structures
- Tricuspid leaflets
- Tricuspid subvalvular apparatus
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TG RV inflow-outflow
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Probe adjustment: neutral-rightward
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Sector depth: ~14 cm
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Primary diagnostic issues
- RV systolic dysfunction
- RVOT pathology
- Pulmonary artery pathology
- Pulmonic valve evaluation
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Required structures
- RA
- RV
- Main pulmonary artery
- Pulmonic valve
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TG basal SAX
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Probe adjustment: neutral
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Sector depth: ~12 cm
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Primary diagnostic issues
- LV systolic dysfunction (basal segments)
- Mitral valve pathology
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Required structures
- Mitral leaflets
- Mitral subvalvular apparatus
- LV (basal segments)
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TG LAX
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Probe adjustment: neutral-leftward
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Sector depth: ~12 cm
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Primary diagnostic issues
- LV systolic dysfunction (anteroseptal and posterior: basal segments)
- Doppler evaluation of aortic valve
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Required structures
- Mitral leaflets
- Mitral subvalvular apparatus
- LV (anteroseptal and posterior: basal plus midsegments)
- Aortic valve
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Deep TG LAX
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Probe adjustment: neutral
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Sector depth: ~16 cm
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Primary diagnostic issues
- Aortic valve pathology
- LVOT pathology
- Doppler evaluation of aortic valve
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Required structures
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- 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.
- Modified from Miller JP, Lambert SA, Shapiro WA, et al. The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologist. Anesth Analg 2001;92:1103–1110, with permission.
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