A systematic approach to performing a comprehensive transesophageal echocardiogram. A call to order

Abstract

BACKGROUND: While the order for a clinical transthoracic examination is fairly standardized, there is considerable variability between laboratories and even among physicians in the same laboratory with regard to the order for transesophageal echocardiograms (TEE). A systematic approach is desirable for more efficient use of physician and patient time, avoidance of inadvertent omission of important views, and to facilitate study review. METHODS: We propose a standardized approach to TEE data acquisition in which cardiac structures are systematically identified and characterized at sequential positions and imaging planes to facilitate organized, efficient and comprehensive assessment. RESULTS: Our approach to TEE study begins in the mid-esophagus with the imaging plane at 0 degrees. Based on the specific indication for the TEE, a cardiac structure (e.g., mitral valve, left atrial appendage, or interatrial septum) is chosen as the primary focal point for a comprehensive, multiplane analysis. This structure is assessed in 20 degrees-30 degrees increments as the imaging plane is advanced from 0 degrees to 165 degrees . Using the aortic valve as a reference point, pertinent cardiac structures are then assessed as the imaging plane is reduced to 135 degrees, to 90 degrees, to 40 - 60 degrees and then back to 0 degrees. The probe is then advanced into the stomach to obtain transgastric images at 0 degrees, 90 degrees, and 120 degrees. Finally, the thoracic aorta and pulmonary artery are assessed as the probe is withdrawn from the body. Using this method, an organized and comprehensive TEE can be performed in 10-15 minutes. CONCLUSION: A standardized and systematic TEE approach is described for efficient and comprehensive TEE study.