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TEE – Basic Examination Introducing probe • • •

Rule out esophageal disease Suction the stomach with nasogastric tube; apply gentle massage to left upper quadrant of abdomen to remove as much air from stomach as possible Lubricate the probe and introduce it with controls in neutral position and patient's head in extended position

Basic views •

Mid-Esophageal (ME) level 28-32 cm ◦ get AV in view; adjust the depth and angle (25-45°) until all three cusps appear equal in size and shape ◦ Adjust image depth to 10-12 cm to position AV in the center of screen ▪ Aortic Stenosis Change multiplane angle forward to 110-130º to get LAX view of AV ◦ Use color doppler for AV competence ◦ Set Nyquist limit to 50-60cm.sec-1. ▪ Problems in ascending aorta Stop color doppler; Turn the probe (rotate) right to get bicaval cross section ◦ angle may have to be adjusted to 90-110º ▪ Compressions of RA, LA ▪ Interatrial septum ▪ Air in RA, LA Change angle to 60-80º and turn to left past AV ▪ ME - RV inflow and outflow ◦ Adjust image depth to to 12-14 cm to get RVOT in the center of screen ▪ RV contractility, RVOT, Pumonic valve ( use color doppler) Change angle to 0º, advance probe 4-6cm and gently retroflex to get ME four chamber cross section ◦ Rotate transducer 10-15º for tricuspid annulus ◦ Image depth of 14-16 cm for LV apex ▪ Contractility of lateral wall of RV ▪ Contractility of septal and lateral wall of LV ▪ MV and TV with color doppler (image depth 10-12 cm) Stop color doppler. Position LV in the center and change angle to 90º. ◦ ME two chamber cross section ◦ Image depth to 14-16 cm ▪ Basal and apical segments of the anterior and inferior wall of LV ▪ Anterior and inferior pericardial collections ▪ Best view for air in LV Rotate forward to 135º ◦ ME – LAX ▪ Anteroseptal and posterior wall contractility Change angle to 0º ; with LV centered on the screen advance the probe 4-6 cm into stomach, flex anteriorly to reveal TG-SAX ▪ LV filling and contractile functiions (keep image depth constant at 12 cm for

repeated examination) â–Ş All major coronary arteries

sample TEE