TEE


 * TEE**
 * Virtual Transesophageal Echocardiography**
 * Goals of TEE**
 * Not to miss important diagnosis
 * Comprehensive evaluation (each cardiac chamber/valve imaged in at least 2 orthogonal planes)
 * 20 standardized 2-D echocardiographic views.

Actions you can take to adjust the position of the TEE probe and the ultrasound plane
 * TEE Simulation: Introduction to Probe Manipulation **
 * probe insertion and withdrawal
 * probe rotation
 * adjusting the omniplane angle
 * adjusting the omniplane depth
 * flexing the probe tip


 * ME 4 Chamber View **

The ME 4C view (0°) is obtained by positioning the probe in the mid-esophagus behind the LA (Insert probe to the ME / sector depth 14cm, angle 0-10°). The imaging plane is directed thru the LA, center of the MV and apex of theLV.A snapshot of the heart is obtained that includes all 4 chambers (LA, RA,LV, RV), 2 valves (MV, TV), the septums (IAS, IVS) and the inferoseptal and anterolateralLVwalls. Segments of the anterior (A2) and posterior (P2) mitral valve leaflets are typically imaged in this view.

Use this view to Diagnose: Chamber size, Ventricular function Mitral Valve disease, Tricuspid Valve disease AtrialSeptalDefect ,Pericardial Effusion

In the ME 2 chamber view (90°) the imaging plane is directed thru the LA to image the LA, MV andLVapex. (From ME 4 chamber (0°) ,keep the probe tip still and the MV in the center,rotate omniplane angle forward to 80-100°) This view is orthogonal to the ME4C view. The image is displayed with the anterior left ventricular wall to the right and the inferior left ventricular wall to the left. The anterior (A1 & A2) and posterior (P3) segments of the mitral valve are seen.
 * ME 2 Chamber View**

Use this View to Diagnose: LAA mass/thrombus, LVsize and function, MV disease, MV annulus measure

In the ME AV SAX view (30-45°) the image plane is directed thru the LA and aligned parallel to the AV annulus. All three aortic cusps should appear symmetrical. The non-coronary cusp of the aortic valve is adjacent to the inter atrial septum, the right coronary cusp is most anterior and the left coronary cusp is adjacent to the pulmonary artery.
 * ME Aortic Valve SAX View**

Use this View to Diagnose Aortic Valve disease, Atrialseptal defect (ASD) (secundum), LA size, Coronary artery pathology

In the ME AV LAX view (120°) the imaging plane is directed thru the LA to image the aortic root in LAX. The LVOT, part of the AV, proximal ascending aorta (1cm distal to the sino-tubular junction) are lined up on the right side of the display, while the MV andLVare eliminated from the image
 * ME Aortic Valve LAX View**

Use this View to Diagnose Mitral Valve disease, Aortic Valve disease Aortic Root dimensions and pathology LVOT pathology, Ventricular Septal Defect (VSD)

In the ME Bicaval view (90°) the imaging plane is directed in LAX thru the LA, RA, IVC and SVC. The structures are displayed with the LA at the sector apex (closest to probe), RA in the far field, caudad IVC (left) and cephalad SVC (right).
 * ME Bicaval View**

Use this View to Diagnose ASD (secundum, sinus venosus) Atrial pathology Lines/wires, Venous Cannula (SVC, IVC)

In the TG mid SAX view (0°) the imaging plane is directed transversely thru the mid inferior wall of theLVwith all 6 midLVsegments viewed at once from the stomach.
 * Transgastric Mid SAX View**

Use this View to Diagnose Left Ventricle: size, function, Interventricular Septal motion Ventricular Septal Defect (VSD), Pericardial effusi