The Standard TEE Examination: Procedure, Safety, Typical Cross-Sections and Anatomic Correlations, and Systematic Analysis

Multiplane transesophageal echocardiography (TEE) is a semiinvasive, very low-risk imaging procedure utilizing the upper gastric and esophageal echo windows to image the heart with the use of high-frequency transducers. It allows for high spatial resolution and access to structures that are routinely not well seen by transthoracic echocardiography, such as the left atrial appendage, the thoracic aorta, and the pulmonary veins, or where transthoracic imaging may be insufficient to answer a specific question, such as the presence of small vegetations, endocarditic abscesses, abnormalities of the interatrial septum, and others. Another important indication is the ventilated patient or the patient in the operating room, where transthoracic echocardiography is unrewarding or impossible. A particular role has emerged for TEE for identifying candidates for mitral valve repair by providing detailed functional and morphologic information on the diseased valve and by checking intraoperatively the results of surgery. A set of cross-sections, defined by anatomic landmarks, has been compiled, which can be systematically sought, evaluated, and modified according to the clinical question in order to extract the maximal information from TEE