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| <!-- TABLE 3 --> | | <!-- TABLE 3 --> |
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| ==Transesophageal Echocardiographic Anatomy==
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| {| class="wikitable" style="font-size:90%;"
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| |+'''Transesophageal Echocardiographic Anatomy'''
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| ! ME two-chamber
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| | Probe adjustment: neutral
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| | Sector depth: ~14 cm
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|
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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>LA appendage</li>
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| <li>Mass/thrombus</li>
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| <li>LV apex pathology</li>
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| <li>LV systolic dysfunction (apical segments)</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>LA appendage</li>
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| <li>Mitral valve</li>
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| <li>LV apex (i.e., maximal LV length)</li>
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| </ul>
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|
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| |-
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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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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>Mitral valve pathology</li>
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| <li>LVOT pathology</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>LV</li>
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| <li>Mitral valve</li>
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| <li>LVOT</li>
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| </ul>
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|
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| |-
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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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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>Localization of mitral valve pathology</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>Mitral valve (P<sub>1</sub>, P<sub>3</sub> and A<sub>2</sub> scallops)</li>
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| <li>Papillary muscles/chordae tendineae</li>
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| <li>LA</li>
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| <li>LV</li>
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| </ul>
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|
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| |-
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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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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>Hemodynamic instability</li>
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| <li>LV enlargement</li>
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| <li>LV hypertrophy</li>
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| <li>LV systolic dysfunction (global and regional)</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>LV cavity</li>
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| <li>LV walls (at least 50% of circumference with visible endocardium)</li>
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| <li>Papillary muscles (approximately equal in size and distinct from ventricular wall)</li>
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| </ul>
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|
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| |-
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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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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>LV systolic dysfunction (anterior and inferior basal segments)</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>Mitral leaflets</li>
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| <li>Mitral subvalvular apparatus</li>
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| <li>LV (anterior and inferior: basal plus mild segments)</li>
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| </ul>
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|
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| |-
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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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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>RV systolic dysfunction</li>
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| <li>Tricuspid valve pathology</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>Tricuspid leaflets</li>
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| <li>Tricuspid subvalvular apparatus</li>
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| </ul>
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|
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| |-
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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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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>RV systolic dysfunction</li>
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| <li>RVOT pathology</li>
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| <li>Pulmonary artery pathology</li>
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| <li>Pulmonic valve evaluation</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>RA</li>
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| <li>RV</li>
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| <li>Main pulmonary artery</li>
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| <li>Pulmonic valve</li>
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| </ul>
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|
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| |-
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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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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>LV systolic dysfunction (basal segments)</li>
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| <li>Mitral valve pathology</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>Mitral leaflets</li>
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| <li>Mitral subvalvular apparatus</li>
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| <li>LV (basal segments)</li>
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| </ul>
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|
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| |-
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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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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>LV systolic dysfunction (anteroseptal and posterior: basal segments)</li>
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| <li>Doppler evaluation of aortic valve</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>Mitral leaflets</li>
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| <li>Mitral subvalvular apparatus</li>
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| <li>LV (anteroseptal and posterior: basal plus midsegments)</li>
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| <li>Aortic valve</li>
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| </ul>
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|
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| |-
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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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| |-
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| | image
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| | valign="top" | Primary diagnostic issues
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| <ul>
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| <li>Aortic valve pathology</li>
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| <li>LVOT pathology</li>
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| <li>Doppler evaluation of aortic valve</li>
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| </ul>
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|
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| | valign="top" | Required structures
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| <ul>
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| <li>LV</li>
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| <li>Aortic valve</li>
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| <li>Aorta</li>
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| </ul>
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|
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| |-
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| | colspan="3" |
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| <ul>
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| <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>
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| <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;92:1103–1110, with permission.</li>
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| </ul>
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| |}
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| ==Positions of measurements== | | ==Positions of measurements== |
| <gallery> | | <gallery> |