Normal Values of TEE

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Reference values for normal adult TEE measurements

Reference values for normal adult TEE measurements
Parameter   Mean ± SD (mm) Range (mm)
  Right pulmonary artery diametera 17 ± 3 12-22
Left upper pulmonary vein diameter 11 ± 2 7-16
Left atrial appendage Length 28 ± 5 15-43
Diameter 16 ± 5 10-28
Superior vena cava diameter 15 ± 3 8-20
Right ventricular outflow tract diameterb 27 ± 4 16-36
Left atriumc Anteroposterior diameter 38 ± 6 20-52
Medial-lateral diameter 39 ± 7 24-52
Right atriumc Anteroposterior diameter 38 ± 5 28-52
Medial-lateral diameter 38 ± 6 29-53
Tricuspid annular diameterc 28 ± 5 20-40
Mitral annular diameterc 29 ± 4 20-38
Coronary sinus diameter 6.6 ± 1.5 4-10
Left ventricled Anteroposterior diameter (diastole) 43 ± 7 33-55
Medial-lateral diameter (diastole) 42 ± 7 23-54
Anteroposterior diameter (systole) 28 ± 6 18-40
Medial-lateral diameter (systole) 27 ± 6 18-42
Aortic root diameterb 28 ± 3 21-34
Descending thoracic aorta diameter Proximal 21 ± 4 14-30
Distal 20 ± 4 13-28
  • aRight pulmonary artery diameter measured in midesophageal ascending aorta short-axis view.
  • bAortic root and right ventricular outflow tract diameters measured in the midesophageal right ventricular inflow/outflow tract view.
  • cAtrial (end-systole) and both mitral and tricuspid annular (mid-diastole) diameters measured in the midesophageal four-chamber view.
  • dLeft ventricular dimensions measured in transgastric mid short-axis view.
  • SD, standard deviation.
  • Adapted from Cohen G, White M, Sochowski R, et al. Reference values for normal transesophageal measurements. J Am Soc Echocardiogr 1995;8:221-230.


Transesophageal Echocardiographic Anatomy

Transesophageal Echocardiographic Anatomy
ME two-chamber Probe adjustment: neutral Sector depth: ~14 cm
image 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
image 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.
  • 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.

Positions of measurements