Ultrasound Morphology of the Heart: Transesophageal Examination

The heart is a very complex three-dimensional structure with a lot of anatomic components bound together; therefore, perfect knowledge of the anatomy is very important to understand two-dimensional echo images of the heart. Sometimes the images are very bad because of anatomic conditions (cardiac cavity dilatation) or air in the stomach (it is possible to improve the image after suction). Instrument settings and adjustments are important for optimizing image quality and the diagnostic capabilities of transesophageal echocardiography (TEE). Rarely TEE can cause serious and even fatal complications. The comprehensive, intraoperative TEE examination, recommended in the guidelines written by the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists in 1999, consists of a series of 20 cross-sectional views of the heart and great vessels. One should not start to study immediately a pathological element (surgical indication); one should use a standard protocol to practice the TEE examination. One should get only one cardiac structure (valve or cavity) in focus, and analyze it and its relationship to other structures. It is very important to move the scan plane and build up a three-dimensional structure from the two-dimensional image. Everyone has to develop a personal approach to the intraoperative TEE examination; we suggest a simplified intraoperative TEE examination that reduces the number of views from the 20 standard views, and is able to analyze all the main heart structures. The main advantage of this systematic approach is the minimization of the manipulation of the TEE probe to perform a complete examination of major cardiac structures.