Transesophageal echocardiography (TEE) is an ultrasound-based test that provides detailed images of the heart by using a specialized probe inserted through the esophagus. The procedure involves patient preparation, sedation, and careful positioning of the probe to capture heart images, with advantages including its safety and ability to monitor heart conditions over time. However, TEE has contraindications and potential complications, making careful patient selection crucial.

1. TRANSESOPHAGEAL
ECHOCARDIOGRAPHY
PRESENTED BY : SHEERSHA
PRAMANIK
COURSE INSTRUCTOR : DR. GOVINDA
KAPUSETTI

2. FLOW OF PRESENTATION
• Introduction
• Patient preparation
• Equipments
• Procedure
• Different views
• 3D Version
• Advantages
• Contradictions
• References

3. INTRODUCTION
• What is Transesophageal Echocardiography or TEE?
Transesophageal echocardiography (TEE) is a test that produces
pictures of your heart.
TEE uses high-frequency sound waves (ultrasound) to make
detailed pictures of your heart and the arteries that lead to and
from it.

4. PATIENT PREPARATION
• Informed consent
• Pt. should fast for at least 4 – 6 hrs
• Thorough history should be taken – any dysphagia
• I.V. access
• Pre oxygenation
• Suction should be available

5. EQUIPMENTS
• TEE probe (modified gastroesophageal endoscopy probe with 3-7 MHz
transducer at tip) should be examined before use.
• Diameter of transducer tip in adults and paediatric use are 9-14 mm
and < 3 mm respectively.
• Anterior flexion should exceed 90%, and right and left flexion should
approach 90%.
• A miniaturized echocardiographic transducer (about 40 mm long, 13
mm wide, and 11 mm thick) mounted on the tip of a gastroscope.
• Transducer is with 64 piezoelectric elements operating at 3.7 to 7.5
MHz

6. STANDARD TEE PROBE

7. PHOTO OF A TRANSDUCER AND CLOSE UP
OF THE BODY OF A TRANSDUCER

8. • Like the standard gastroscope,
two rotary knobs control the movement.

9. PROCEDURE OF TEE
• A technician sprays your throat with a medicine to numb it and suppress the gag
reflex. You’ll lie on a table.
• A nurse puts an IV (intravenous line) in your arm, and gives you a mild sedative
(medicine) to help you stay calm.
• The technician then places small metal disks (electrodes) on your chest. He or she
attaches the electrodes by wires to a machine that will record
your electrocardiogram (ECG) to track your heartbeat.
• The doctor then gently guides a thin, flexible tube (probe) through your mouth and
down your throat, and asks you to swallow as it goes down.
• A transducer on the end of the probe sends sound waves to your heart and collects
the echoes that bounce back. These echoes become pictures that show up on a
video screen. This part of the test takes 10 to 15 minutes.
• When the doctor is finished taking pictures, the probe, IV and electrodes are
removed and nurses watch you until you are fully awake. Then you can usually get

10. TRANSESOPHAGEAL ECHOCARDIOGRAPHY

11. TEE VIEWS
UPPER ESOPHAGEAL
LEVEL 20-25 CM
MID ESOPHAGEAL
LEVEL 30-40 CM
TRANS GASTRIC
LEVEL BEYOND 40 CM

12. TRANS GASTRIC VIEW

13. FOUR CHAMBER VIEW IN ESOPHAGUS

14. MID-ESOPHAGEAL AV SHORT AXIS VIEW

16. 3D TEE
• Main advantages of Real-time three-dimensional (RT3D) TEE during
catheter-based interventions:
• Ability to visualize the entire lengths of
• Intracardiac catheters, including the tips of all catheters and the
balloons
• Devices they carry, along with a clear depiction of the positions in
relation to other cardiac structures
• To demonstrate certain structures in an ‘‘en face’’ view
• RT3D TEE is a powerful new imaging tool

17. ADVANTAGES OF TEE
• Close proximity of esophagus to post wall of heart – no intervening structure like
bone or lung
• Monitor the heart over time, such as during cardiac surgeries
• Extremely safe & well tolerated so that it can be performed in critically ill
patients & very small infants
• Atrial thrombi/mass
• Left atrial appendage clot , clot in LA , thrombus in RA
• Mitral valve
• MR (very precisely) , function of prosthetic valves , refined suitability for
valvotomy in severe MS

18. CONTRADICTIONS
Absolute
1.Previous esophagectomy,
2.Severe esophageal obstruction,
3.Esophageal perforation, and
4.Ongoing esophageal hemorrhage

19. CONTD.
Relative
1.Esophageal diverticulum,
2.Varices,
3.Fistula, and
4.Previous esophageal surgery, as well as a history of gastric
surgery, mediastinal irradiation, unexplained swallowing difficulties

20. PROCEDURE COMPLICATION WITH TEE
• MAJOR
o Death
o Esophageal rupture/perforation
o Upper gi bleed
o Laryngospasm or bronchospasm
o Congestive heart failure or pulmonary edema
o Sustained ventricular tachycardia

21. REFERENCES
• http://www.heart.org
• https://my.clevelandclinic.org