Transesophageal Echocardiography in Clinical Practice (eBook)

Acknowledgements 5
Preface 6
Contents 7
Introduction 8
1.1 The Role of Transesophageal Echocardiography ( TEE) 8
1.1.1 Guidelines for the Use of TEE 8
1.1.2 Contraindications to Transesophageal Echocardiography 9
1.2 Equipment and Personnel 10
1.3 Preparation of the Patient 11
1.4 Sedation and Local Anesthesia 12
1.4.1 Oropharyngeal Local Anesthetic 12
1.4.2 Intravenous Sedation 12
1.4.3 What method(s) to Use? 13
1.5 Intubation 13
1.6 Anatomical Considerations and Terminology 14
1.7 Image Acquisition and Probe Manipulation 16
1.8 Physics 18
1.8.1 Characteristics of Ultrasound 19
1.8.2 Tissue Penetration 20
1.8.3 Spatial Resolution 22
1.8.4 Temporal Resolution 22
1.8.5 Image Optimization 23
1.9 Targeted vs. Complete TOE Studies 25
References 26
The Left Ventricle 27
2.1 Standard Image Planes 27
2.2 Data Set Required 31
2.3 Chamber Size 33
2.4 Wall Thickness and Mass 34
2.5 Systolic Function 35
2.5.1 Ejection Fraction 35
2.5.2 Fractional Shortening 36
2.5.3 dP/dt 36
2.5.4 Stroke Distance 37
2.5.5 Regional Segmental Assessment 38
2.5.6 Wall Motion Score Index 39
2.5.7 Coronary Artery Distribution 40
2.6 Diastolic Function 40
References 47
The Left Atrium 49
3.1 Standard Image Planes 49
3.2 Left Atrial Size 49
3.3 Left Atrial Appendage 51
3.4 Pulmonary Veins 54
3.4.1 Right 54
3.4.2 Left 57
References 59
The Mitral Valve 60
4.1 Valve Structure 60
4.2 Standard Image Planes 61
4.2.1 Four Chambers View 63
4.2.2 Commissural View 64
4.2.3 Two Chambers and the Long Axis Views 64
4.2.4 Mitral Annulus 66
4.2.5 Transgastric Views 66
The Aortic Valve and Aorta 71
5.1 Aortic Valve 71
5.1.1 Valve Structure 71
5.1.2 Standard Image Planes 72
5.1.3 Five Chambers View 72
5.1.4 Short Axis View 73
5.1.5 Long Axis View 73
5.1.6 Transgastric Views 75
5.2 Aorta 76
References 83
The Right Heart 84
6.1 Right Ventricle 84
6.1.1 Data Set Required 84
6.1.2 Four Chambers View 85
6.1.3 Right Ventricular Systolic Function 85
6.1.4 Right Ventricular Inflow–Outflow View 88
6.1.5 Right Ventricular 2 Chambers View 90
6.1.6 Transgastric Views 90
6.2 Right Atrium and Interatrial Septum 94
6.3 Tricuspid Valve 97
6.3.1 Standard Views 97
6.3.2 Mid Esophageal Views 98
6.3.3 Estimating Pulmonary Artery Pressure 98
6.3.4 Transgastric Views 102
6.4 Pulmonary Valve 106
6.4.1 Mid Esophageal View 106
6.4.2 Other Views 106
Artificial Valves 109
7.1 General 109
7.1.1 Types of Artificial Valves 109
7.1.2 Image Planes 110
7.1.3 Prosthesis Stability 110
7.1.4 Leaflet Motion 111
7.1.5 Leaflet Thickness 112
7.1.6 Forward Flow 112
7.1.7 Regurgitation 114
7.2 Mitral Valve Replacements 116
7.3 Aortic Valve Replacements 117
Appendix 1: TEE integrated care pathway 120
Appendix 2: Guidance for diabetic patients undergoingTEE 124
What is a transoesophageal echocardiogram? 127
Why do I need it? 127
Are there any alternatives? 127
Appendix 3: Patient information booklet 127
What will happen if I don’t have it? 128
How do I prepare for it? 128
On the day of your examination 128
What does it involve? 129
How long does it take? 129
Will I have any pain or discomfort? 129
Additional procedures 130
What happens afterwards? 130
If you had a sedative injection 130
If you had the throat spray 130
Are there any risks? 131
Any further questions? 131
Intended Benefits 132
Appendix 4: TEE pre-consent information sheet 132
Appendix 5: TEE specific consent form 133