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TEE VIEWS

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BASIC TEE VIEWS AND MODIFIED VIEWS

Published in: Health & Medicine
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TEE VIEWS

  1. 1. BASIC AND MODIFIED TTE &TEE VIEWS
  2. 2. Seminar outline • TTE imaging windows and planes • Basic TTE views • Modified TTE views • TEE imaging windows and planes • Basic TEE views • Modified TEE views
  3. 3. Views • PLAX • PSAX – Aortic Valve • PSAX – Mitral Valve • PSAX – Papillary Muscle • PSAX - Apex • Suprasternal Long Axis • Suprasternal Short Axis • Apical 4-Chamber • Apical 2-Chamber • Apical 3-Chamber (Apical Long Axis) • Apical 5 Chamber • Subcostal 4 Chamber • Subcostal 5 Chamber • Subcostal Short Axis
  4. 4. Echocardiographic Examination
  5. 5. Standard positions on the chest wall are used for placement of the transducer called “echo windows
  6. 6. PATIENT POSITIONING
  7. 7. PARASTERNAL AND APICAL VIEWS
  8. 8. SUBCOSTAL VIEW
  9. 9. SUPRASTERNAL VIEW
  10. 10. Parasternal Long-Axis View (PLAX) • Patient position:Left lateral • Transducer position: left sternal edge 3rd – 4th intercostal space. • Indicator direction: points towards right shoulder.
  11. 11. Structures visualized
  12. 12. PARASTERNAL LONG AXIS VIEW (PLAX)
  13. 13. PARASTERNAL LONG AXIS – RV INFLOW VIEW • Modification of PLAX. • Tilting the head of transducer down toward patient right hip.
  14. 14. Structures visualized
  15. 15. PARASTERNAL LONG AXIS – RV OT VIEW • Modification of PLAX. • Tilting the head of transducer down toward patient left shoulder • For evaluating pulmonic stenosis and regurgitation
  16. 16. Structures visualized
  17. 17. Parasternal Short Axis View (PSAX) • Transducer position: left sternal edge; 2nd – 4th intercostal space • Marker dot direction: points towards left shoulder(900 clockwise from PLAX view) • By tilting transducer on an axis between the left hip and right shoulder, short axis views are obtained at different levels, from the aorta to the LV apex.
  18. 18. Apical 4-Chamber View (AP4CH) • Transducer position: apex of heart • Indicator direction: points towards left shoulder
  19. 19. APICAL 5 CHAMBER VIEW • modified apical 4 chamer view • Sight clockwise rotation & tilting the transducer towards the patient’s head
  20. 20. Apical 2-Chamber View • Transducer position: apex of the heart • Marker dot direction: points towards left side of neck (450 anticlockwise from AP4CH view)
  21. 21. APICAL LONG AXIS VIEW (Apical three chamber view) • Modification of apical 4 chamer view. • Transducer rotated counterclockwise approximately 60 degrees
  22. 22. Apical 3 chamer
  23. 23. Sub–Costal 4 Chamber View • Transducer position: under the xiphisternum. • Indicator position: points towards left shoulder. • The subject lies supine with head slightly low (no pillow). With feet on the bed, the knees are slightly elevated
  24. 24. SUBCOSTAL SHORT AXIS • Transducer is rotated counterclockwis e from long-axis position. • basal to apical apical angling of transducer produces planes at aortic valve,mitral valve,mid LV and apical LV levels.
  25. 25. SUBCOSTAL GREAT VESSEL VIEW • Transducer rotated counterclockwise from 4 chamber subcoastal view • Indicator position:12o’clock(toward s head)
  26. 26. Inferior vena cava • Transducer is tilted medially.
  27. 27. Abdominal aorta • Transducer is tilted laterally
  28. 28. Suprasternal View • Transducer position: suprasternal notch • Indicator direction: 1 o’clock (points towards left jaw) • The subject lies supine with the neck hyperextended and rotated slightly towards the left.
  29. 29. SUPRASTERNAL LONG AXIS
  30. 30. SUPRASTERNAL SHORT AXIS
  31. 31. TRANSESOPHAGEAL ECHO
  32. 32. Transesophageal Echocardiography
  33. 33. TEE views Upper oesophageal (UE) level 20-25cm Mid Esophageal (ME) level 30- 40cm Trans Gastric (TG) level beyond 40 cm
  34. 34. I- UPPER ESOPHAGEAL II- MID ESOPHAGEAL III- TRANSGASTRIC I III II
  35. 35. • Standard imaging planelevels(from the incisors): • upper or high esophageal (25–28 cm) • mid-esophageal (29–33 cm) • gastroesophageal junction (34–37 cm) • transgastric (38–42 cm) • deep-transgastric (>42 cm)
  36. 36. TEE probeorientation :
  37. 37. Transducer manipulation options: [1] Advancement/withdrawal (for inferior or superior structuresrespectively) [2] Rotation (clockwiseto view rightward structuresand counter- clockwisefor leftward structures)
  38. 38. [3] Anteflexion and retroflexion of theprobeshaft (to view structures towardstheheart baseor towardstheapex) [4] Leftward and rightward flexion of theprobeshaft [5] Electronic imageplanerotation (0–1800 )
  39. 39. Midesophageal views
  40. 40. MID ESOPHAGEAL 4 CHAMER VIEW • TRANSDUCER POSITION:position theprobein themid-esophagusbehind the LA. • OMNIPANEANGLE:0-10 DEGRESS.
  41. 41. Structures visualized
  42. 42. ME Mitral Commissural View • TRANSDUCER POSITION:position the probein themid- esophagusbehind the LA. • OMNIPANEANGLE: 50 and 70 DEGRESS.
  43. 43.  turning the probe leftward (counterclockwise) -- PML (P3P2P1).  Turning the probe rightward (clockwise ) ----AML (A3A2A1).
  44. 44. ME Two-Chamber View • TRANSDUCER POSITION:position the probein themid- esophagusbehind the LA. • OMNIPANEANGLE: 80 and 100 DEGRESS.
  45. 45. ME LAX View • TRANSDUCER POSITION:position theprobein themid- esophagusbehind the LA. • OMNIPANEANGLE: 120 and 140 DEGRESS
  46. 46. ME BICAVAL VIEW • From the2 chamber view(90°). • Turn theentireprobe right.
  47. 47. Descending Aorta SAX Views • From the4 chamber view(0°). • Turn theentireprobe left. • Decreasedepth to 5cm.
  48. 48. • Aortic Pathology • Color flow reversal: AI severity • IABPposition
  49. 49. ME DA LAX(90°) • From ME DA SAX • OMNIPANEANGLE: 90 DEGRESS
  50. 50. • Distal aortaisto thedisplay left and theproximal aorta to thedisplay right.
  51. 51. Trans gastric views
  52. 52. ADVANTAGES • best for evaluating left and right ventricular function • commonly employed intra operative TEE to assess ejection fraction and wall motion post- operatively. • to obtain accurate gradients across the aortic valve to assess the degree of AS or AR
  53. 53. TG Basal SAX View • From the ME views and at a transducer angle of 0° to 20° • the probe is straightened and advanced into the stomach • the probe is then anteflexed
  54. 54. • This view demonstrates the typical SAX view or “fish mouth” appearance of the MV • anterior leaflet on the left of the display and the posterior leaflet on the right. • The medial commissure is in the near field, with the lateral commissure in the far field
  55. 55. TG Midpapillary SAX View • from the TG basal SAX view. • the anteflexed probe, relaxed to a more neutral position. • transducer angle maintained at 0° to 20°.
  56. 56. TG Apical SAX View • From the TG midpapillary SAX view (0°-20°) • the probe is advanced, to obtain the TG apical SAX view
  57. 57. Transgastric short axis 0 degrees mitral valve level
  58. 58. Transgastric short axis 0 degrees at papillary muscle level
  59. 59. TG Two-Chamber View • From mid TG SAX (0°) • Rotateomniplaneangle to 90°. • Anteflex until LV is horizontal
  60. 60. • LV function • Mitral Valve subvalvular pathology • Theanterior and inferior wallsof theleft ventricleareimaged in addition to thepapillary muscles, chordae, and MV.
  61. 61. TG RV Inflow View • From the TG two- chamber view (90° to 110°), • turning to the right (clockwise).
  62. 62. TG LAX • From TG 2 chamber (90°) • omniplaneangleto 110- 120°. • Imaging planeis directed longitudinally thru theLV to imagethe aortic root.
  63. 63. • MV: leaflets, subvalvular • LV systolic function • AV Doppler gradient • LVOT Doppler gradient • Ventricular septal defect (VSD) • Prosthetic AV function
  64. 64. ME Five-Chamber View • From ME 4 chamber view(0°) withdraw cephalad to obtain the ME 5C(0°).
  65. 65. ME AV SAX (30-45°) • From ME 5C (0°) • Omniplaneangleto 30- 45degrees.
  66. 66. ME RV Inflow-Outflow View • From ME 5C (0°) • omniplaneangleto 60- 75°
  67. 67. • Pulmonic valve pathology • Pulmonary artery pathology • RVOT pathology • TV pathology • Atrial septal defect (ASD secundum) • Ventricular septal defect (VSD)
  68. 68. ME AV LAX View • From ME 5C (0°) • Omniplaneangleto 120 -150° • From ME 4C (0°), decreasing sector depth.
  69. 69. ME Ascending Aorta LAX View • From the ME AV LAX view, withdrawal of the probe, typically with backward rotation to approximately 90 to 110, results in theME ascending aorta LAX view. • This view allows evaluation of the proximal ascending aorta. • The right pulmonary artery (PA) lies posterior to the ascending aorta in this view
  70. 70. ME Ascending Aorta LAX View
  71. 71. ME Ascending Aorta SAX View • From the ME AV and ascending aorta view, backward transducer rotation to approximately 0 to 30 results in the ME ascending aorta SAX view. • In addition to the ascending aorta in SAX and the superior vena cava in SAX, the main PA and right lobar PA can be seen. • From this neutral probe orientation, turning the probe to the left (counterclockwise) allows imaging of the PA bifurcation.
  72. 72. . ME Ascending Aorta SAX View
  73. 73. ME Right Pulmonary Vein View • From the ME ascending aorta SAX view, advancing the probe and turning to the right (clockwise) will result in the ME right pulmonary vein view. • The right pulmonary veins can also be imaged from the 90 to 110 view by first obtaining a ME bicaval view and turning the probe to the right (clockwise). • the left pulmonary veins may be imaged by turning the probe to the left (counterclockwise) just beyond the left atrial appendage.
  74. 74. ME Right Pulmonary Vein View
  75. 75. ME LA Appendage View • From the ME left pulmonary vein view (at a transducer angle of 90° to 110°), turning the probe to right (clockwise) with possible advancement and/or anteflexion of the probe will open the LA appendage for the ME LA appendage view. • Backward rotating from 90° to 0° while imaging the LA appendage and/or simultaneous multiplane imaging should be performed. • Color flow Doppler and pulsed-wave Doppler may be useful, particularly for assessment of emptying velocities.
  76. 76. ME LA Appendage View
  77. 77. upper esophageal High esophageal views are helpful for evaluating the great vessels including the aortic root and coronary arteries, ascending aorta and the pulmonary artery
  78. 78. UE Aortic Arch LAX (0°): • From ME(0°)… ME Descending AortaSAX (0°) view. • Withdraw probeuntil aortachangesinto oval shape. • Turn probeslightly to theright.
  79. 79. • Imaging planeis directed thru the transverseaortic arch in SAX and thepulmonary artery in LAX.
  80. 80. UE Aortic Arch SAX(60-90°): • From UE Aortic Arch LAX (0°) view • Rotatetheomniplane angleto 60-90° • Bring thepulmonic valveand pulmonary artery in view
  81. 81. • Imaging planeis directed thru the transverseaortic arch in SAX and thepulmonary artery in LAX.
  82. 82. THANK YOU

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