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|+'''Normal Doppler echocardiographic values of aortic valve prosthesis'''
|+'''Normal Doppler echocardiographic values of aortic valve prosthesis'''
! Valve
! style="width:200px" | Valve
! Size
! style="width:50px" | Size
! <em>n</em>
! style="width:50px" | <em>n</em>
! Peak gradient (mm Hg)
! style="width:100px" | Peak gradient<br/>(mm Hg)
! Mean gradient (mm Hg)
! style="width:100px" | Mean gradient<br/>(mm Hg)
! Peak velocity (m/s)
! style="width:100px" | Peak velocity<br/>(m/s)
! Effective orifice area (cm<sup>2</sup>)
! style="width:100px" | Effective orifice area<br/>(cm<sup>2</sup>)


|-
|-
Line 256: Line 257:
|-
|-
| rowspan="3" | Biocor extended stentless (stentless bioprosthesis)
| rowspan="3" | Biocor extended stentless (stentless bioprosthesis)
| align="center" | 19-21
| align="center" | 19&ndash;21
| align="center" | 12
| align="center" | 12
| align="center" | 17.5 ± 5.8
| align="center" | 17.5 ± 5.8
Line 1,387: Line 1,388:


|-
|-
| align="center" | 27-29
| align="center" | 27&ndash;29
| align="center" | 8
| align="center" | 8
| align="center" | 11.4 ± 4.6
| align="center" | 11.4 ± 4.6
Line 1,760: Line 1,761:


|+'''Normal Doppler echocardiographic values for mitral valve prosthesis'''
|+'''Normal Doppler echocardiographic values for mitral valve prosthesis'''
! Valve
! style="width:200px" | Valve
! Size
! style="width:50px" | Size
! <em>n</em>
! style="width:50px" | <em>n</em>
! Peak gradient (mm Hg)
! style="width:100px" | Peak gradient<br/>(mm Hg)
! Mean gradient (mm Hg)
! style="width:100px" | Mean gradient<br/>(mm Hg)
! Peak velocity (m/s)
! style="width:100px" | Peak velocity<br/>(m/s)
! Pressure half-time (ms)
! style="width:100px" | Pressure half-time<br/>(ms)
! Effective orifice area (cm<sup>2</sup>)
! style="width:100px" | Effective orifice area<br/>(cm<sup>2</sup>)


|-
|-
Line 2,499: Line 2,500:
| align="center" | &nbsp;
| align="center" | &nbsp;
| align="center" | 2.5 ± 1.1
| align="center" | 2.5 ± 1.1
|-
| rowspan="4" | Sorin Allcarbon (tilting disk)
| align="center" | 25
| align="center" | 8
| align="center" | 15 ± 3
| align="center" | 5 ± 1
| align="center" | 2 ± 0.2
| align="center" | 105 ± 29
| align="center" | 2.2 ± 0.6
|-
| align="center" | 27
| align="center" | 20
| align="center" | 13 ± 2
| align="center" | 4 ± 1
| align="center" | 1.8 ± 0.1
| align="center" | 89 ± 14
| align="center" | 2.5 ± 0.5
|-
| align="center" | 29
| align="center" | 34
| align="center" | 10 ± 2
| align="center" | 4 ± 1
| align="center" | 1.6 ± 0.2
| align="center" | 85 ± 23
| align="center" | 2.8 ± 0.7
|-
| align="center" | 31
| align="center" | 11
| align="center" | 9 ± 1
| align="center" | 4 ± 1
| align="center" | 1.6 ± 0.1
| align="center" | 88 ± 27
| align="center" | 2.8 ± 0.9
|-
| rowspan="4" | Sorin Bicarbon (bileaflet)
| align="center" | 25
| align="center" | 3
| align="center" | 15 ± 0.25
| align="center" | 4 ± 0.5
| align="center" | 1.95 ± 0.02
| align="center" | 70 ± 1
| align="center" | &nbsp;
|-
| align="center" | 27
| align="center" | 25
| align="center" | 11 ± 2.75
| align="center" | 4 ± 0.5
| align="center" | 1.65 ± 0.21
| align="center" | 82 ± 20
| align="center" | &nbsp;
|-
| align="center" | 29
| align="center" | 30
| align="center" | 12 ± 3
| align="center" | 4 ± 1.25
| align="center" | 1.73 ± 0.22
| align="center" | 80 ± 14
| align="center" | &nbsp;
|-
| align="center" | 31
| align="center" | 9
| align="center" | 10 ± 1.5
| align="center" | 4 ± 1
| align="center" | 1.66 ± 0.11
| align="center" | 83 ± 14
| align="center" | &nbsp;
|-
| rowspan="5" | St. Jude Medical (bileaflet)
| align="center" | 23
| align="center" | 1
| align="center" | &nbsp;
| align="center" | 4.0
| align="center" | 1.5
| align="center" | 160
| align="center" | 1.0
|-
| align="center" | 25
| align="center" | 4
| align="center" | &nbsp;
| align="center" | 2.5 ± 1
| align="center" | 1.34 ± 1.12
| align="center" | 75 ± 4
| align="center" | 1.35 ± 0.17
|-
| align="center" | 27
| align="center" | 16
| align="center" | 11 ± 4
| align="center" | 5 ± 1.82
| align="center" | 1.61 ± 0.29
| align="center" | 75 ± 10
| align="center" | 1.67 ± 0.17
|-
| align="center" | 29
| align="center" | 40
| align="center" | 10 ± 3
| align="center" | 4.15 ± 1.8
| align="center" | 1.57 ± 0.29
| align="center" | 85 ± 10
| align="center" | 1.75 ± 0.24
|-
| align="center" | 31
| align="center" | 41
| align="center" | 12 ± 6
| align="center" | 4.46 ± 2.22
| align="center" | 1.59 ± 0.33
| align="center" | 74 ± 13
| align="center" | 2.03 ± 0.32
|-
| rowspan="5" | Starr-Edwards (ball-and-cage)
| align="center" | 26
| align="center" | 1
| align="center" | &nbsp;
| align="center" | 10.0
| align="center" | &nbsp;
| align="center" | &nbsp;
| align="center" | 1.4
|-
| align="center" | 28
| align="center" | 27
| align="center" | &nbsp;
| align="center" | 7 ± 2.75
| align="center" | &nbsp;
| align="center" | &nbsp;
| align="center" | 1.9 ± 0.57
|-
| align="center" | 30
| align="center" | 25
| align="center" | 12.2 ± 4.6
| align="center" | 6.99 ± 2.5
| align="center" | 1.7 ± 0.3
| align="center" | 125 ± 25
| align="center" | 1.65 ± 0.4
|-
| align="center" | 32
| align="center" | 17
| align="center" | 11.5 ± 4.2
| align="center" | 5.08 ± 2.5
| align="center" | 1.7 ± 0.3
| align="center" | 110 ± 25
| align="center" | 1.95 ± 0.4
|-
| align="center" | 34
| align="center" | 1
| align="center" | &nbsp;
| align="center" | 5.0
| align="center" | &nbsp;
| align="center" | &nbsp;
| align="center" | 2.6
|-
| rowspan="3" | Stentless quadrileaflet bovine pericardial (stentless bioprosthesis)
| align="center" | 26
| align="center" | 2
| align="center" | &nbsp;
| align="center" | 2.2 ± 1.7
| align="center" | 1.6
| align="center" | 103 ± 31
| align="center" | 1.7
|-
| align="center" | 28
| align="center" | 14
| align="center" | &nbsp;
| align="center" | &nbsp;
| align="center" | 1.58 ± 0.25
| align="center" | &nbsp;
| align="center" | 1.7 ± 0.6
|-
| align="center" | 30
| align="center" | 6
| align="center" | &nbsp;
| align="center" | &nbsp;
| align="center" | 1.42 ± 0.32
| align="center" | &nbsp;
| align="center" | 2.3 ± 0.4
|-
| rowspan="2" | Wessex (stented bioprosthesis)
| align="center" | 29
| align="center" | 9
| align="center" | &nbsp;
| align="center" | 3.69 ± 0.61
| align="center" | 1.66 ± 0.17
| align="center" | 83 ± 19
| align="center" | &nbsp;
|-
| align="center" | 31
| align="center" | 22
| align="center" | &nbsp;
| align="center" | 3.31 ± 0.83
| align="center" | 1.41 ± 0.25
| align="center" | 80 ± 21
| align="center" | &nbsp;


|}
|}
==Transesophageal Echocardiographic Anatomy==
{| class="wikitable" style="font-size:90%;"
|+'''Transesophageal Echocardiographic Anatomy'''
! ME two-chamber
| Probe adjustment: neutral
| Sector depth: ~14 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>LA appendage</li>
      <li>Mass/thrombus</li>
      <li>LV apex pathology</li>
      <li>LV systolic dysfunction (apical segments)</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>LA appendage</li>
      <li>Mitral valve</li>
      <li>LV apex (i.e., maximal LV length)</li>
  </ul>
|-
! ME LAX
| Probe adjustment: neutral
| Sector depth: ~12 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>Mitral valve pathology</li>
      <li>LVOT pathology</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>LV</li>
      <li>Mitral valve</li>
      <li>LVOT</li>
  </ul>
|-
! ME mitral commissural
| Probe adjustment: neutral
| Sector depth: ~12 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>Localization of mitral valve pathology</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>Mitral valve (P<sub>1</sub>, P<sub>3</sub> and A<sub>2</sub> scallops)</li>
      <li>Papillary muscles/chordae tendineae</li>
      <li>LA</li>
      <li>LV</li>
  </ul>
|-
! TG mid-SAX
| Probe adjustment: neutral
| Sector depth: ~12 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>Hemodynamic instability</li>
      <li>LV enlargement</li>
      <li>LV hypertrophy</li>
      <li>LV systolic dysfunction (global and regional)</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>LV cavity</li>
      <li>LV walls (at least 50% of circumference with visible endocardium)</li>
      <li>Papillary muscles (approximately equal in size and distinct from ventricular wall)</li>
  </ul>
|-
! TG two-chamber
| Probe adjustment: neutral
| Sector depth: ~12 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>LV systolic dysfunction (anterior and inferior basal segments)</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>Mitral leaflets</li>
      <li>Mitral subvalvular apparatus</li>
      <li>LV (anterior and inferior: basal plus mild segments)</li>
  </ul>
|-
! TG RV inflow
| Probe adjustment: neutral-rightward
| Sector depth: ~12 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>RV systolic dysfunction</li>
      <li>Tricuspid valve pathology</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>Tricuspid leaflets</li>
      <li>Tricuspid subvalvular apparatus</li>
  </ul>
|-
! TG RV inflow-outflow
| Probe adjustment: neutral-rightward
| Sector depth: ~14 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>RV systolic dysfunction</li>
      <li>RVOT pathology</li>
      <li>Pulmonary artery pathology</li>
      <li>Pulmonic valve evaluation</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>RA</li>
      <li>RV</li>
      <li>Main pulmonary artery</li>
      <li>Pulmonic valve</li>
  </ul>
|-
! TG basal SAX
| Probe adjustment: neutral
| Sector depth: ~12 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>LV systolic dysfunction (basal segments)</li>
      <li>Mitral valve pathology</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>Mitral leaflets</li>
      <li>Mitral subvalvular apparatus</li>
      <li>LV (basal segments)</li>
  </ul>
|-
! TG LAX
| Probe adjustment: neutral-leftward
| Sector depth: ~12 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>LV systolic dysfunction (anteroseptal and posterior: basal segments)</li>
      <li>Doppler evaluation of aortic valve</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>Mitral leaflets</li>
      <li>Mitral subvalvular apparatus</li>
      <li>LV (anteroseptal and posterior: basal plus midsegments)</li>
      <li>Aortic valve</li>
  </ul>
|-
! Deep TG LAX
| Probe adjustment: neutral
| Sector depth: ~16 cm
|-
| image
| valign="top" | Primary diagnostic issues
  <ul>
      <li>Aortic valve pathology</li>
      <li>LVOT pathology</li>
      <li>Doppler evaluation of aortic valve</li>
  </ul>
| valign="top" | Required structures
  <ul>
      <li>LV</li>
      <li>Aortic valve</li>
      <li>Aorta</li>
  </ul>
|-
| colspan="3" |
<ul>
<li>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.</li>
<li>Modified from Miller JP, Lambert SA, Shapiro WA, et al. The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologist. <em>Anesth Analg</em> 2001;92:1103&ndash;1110, with permission.</li>
</ul>
|}
[[File:deep TG LAX.svg|thumb|left|300px]]
[[File:desc aortic LAX.svg|thumb|left|300px]]
[[File:desc aortic SAX.svg|thumb|left|300px]]
[[File:ME asc aortic LAX.svg|thumb|left|300px]]
[[File:ME asc aortic SAX.svg|thumb|left|300px]]
[[File:ME AV LAX.svg|thumb|left|300px]]
[[File:ME AV SAX.svg|thumb|left|300px]]
[[File:ME bicaval.svg|thumb|left|300px]]
[[File:ME four chamber.svg|thumb|left|300px]]
[[File:ME LAX.svg|thumb|left|300px]]
[[File:ME mitral commissural.svg|thumb|left|300px]]
[[File:ME RV inflow-outflow.svg|thumb|left|300px]]
[[File:ME two-chamber.svg|thumb|left|300px]]
[[File:TEE coronary region.svg|thumb|left|300px]]
[[File:TEE LV Sections.svg|thumb|left|300px]]
[[File:TEE mitral valve.svg|thumb|left|300px]]
[[File:TEE mitral valve2.svg|thumb|left|300px]]
[[File:TG basal SAX.svg|thumb|left|300px]]
[[File:TG LAX.svg|thumb|left|300px]]
[[File:TG mid SAX.svg|thumb|left|300px]]
[[File:TG RV inflow-outflow.svg|thumb|left|300px]]
[[File:TG RV inflow.svg|thumb|left|300px]]
[[File:TG two-chamber.svg|thumb|left|300px]]
[[File:UE aortic arch LAX.svg|thumb|left|300px]]
[[File:UE aortic arch SAX.svg|thumb|left|300px]]
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