Overview
Transesophageal echocardiography (TEE) involves the insertion of an ultrasound probe into the esophagus to obtain detailed cardiac images. It provides high-resolution images of cardiac structures and is essential for cardiac surgery and critical care.
TEE is the gold standard for intraoperative cardiac imaging, providing real-time assessment of cardiac function, valve pathology, and surgical outcomes. It is crucial for cardiac surgery, hemodynamic monitoring, and diagnosis of cardiac pathology.
Learn more in our comprehensive RxDx Anesthesia Course
Indications
Intraoperative monitoring and assessment
Assessment of valve function and repair
Assessment of ventricular function
Donor and recipient assessment
Hemodynamic assessment in ICU
Emergency assessment of pericardial effusion
Assessment of valve vegetations
Evaluation of intracardiac masses
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient assessment (esophageal pathology, coagulation status), equipment check (TEE probe, ultrasound machine), informed consent, and understanding the cardiac anatomy and standard views.Step-by-Step Procedure
Step 1: Patient Assessment
Assess patient for contraindications, check coagulation status, perform airway examination, and obtain informed consent.
⚠️ Common Mistakes to Avoid:
- Inadequate assessment
- Missing contraindications
- Poor airway evaluation
💡 Pro Tip:
Always check for esophageal pathology and coagulation status before TEE.
Step 2: Equipment Setup
Prepare TEE probe, check ultrasound machine, apply lubricant, and ensure adequate monitoring.
⚠️ Common Mistakes to Avoid:
- Broken equipment
- Poor lubrication
- Inadequate monitoring
💡 Pro Tip:
Always test the TEE probe and ultrasound machine before starting.
Step 3: Patient Positioning
Position patient with head extended, insert bite block, and prepare for probe insertion.
⚠️ Common Mistakes to Avoid:
- Poor positioning
- No bite block
- Inadequate preparation
💡 Pro Tip:
Use proper positioning and always use a bite block to protect the probe.
Step 4: Probe Insertion
Insert TEE probe gently through mouth, advance to esophagus, and position for optimal imaging.
⚠️ Common Mistakes to Avoid:
- Forceful insertion
- Wrong angle
- Esophageal injury
💡 Pro Tip:
Insert probe gently and never force. Use proper technique to avoid injury.
Step 5: Image Acquisition
Obtain standard TEE views: mid-esophageal 4-chamber, 2-chamber, long-axis, and transgastric views.
⚠️ Common Mistakes to Avoid:
- Poor image quality
- Incomplete views
- Wrong probe position
💡 Pro Tip:
Learn standard TEE views and optimize image quality for each view.
Step 6: Image Interpretation
Interpret images for cardiac function, valve pathology, and surgical assessment.
⚠️ Common Mistakes to Avoid:
- Wrong interpretation
- Missing pathology
- Poor documentation
💡 Pro Tip:
Take time to interpret images carefully. Document all findings.
Step 7: Probe Removal
Remove probe gently, clean equipment, and monitor for complications.
⚠️ Common Mistakes to Avoid:
- Forceful removal
- Poor cleaning
- Inadequate monitoring
💡 Pro Tip:
Remove probe gently and clean thoroughly after use.
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Post-procedure Care
Post-procedure care includes monitoring for complications (esophageal injury, bleeding), assessing for sore throat, and documenting the procedure details and findings.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Esophageal injury | 0.1-0.5% | Chest pain, dysphagia, fever, mediastinitis | Immediate evaluation, antibiotics, surgical consultation | Gentle technique, proper lubrication, avoid force |
| Dental injury | 1-3% | Tooth damage, bleeding, pain | Document injury, dental consultation, monitoring | Use bite block, gentle technique, proper positioning |
| Sore throat | 10-20% | Throat pain, dysphagia, voice changes | Analgesics, time, reassurance | Gentle technique, adequate lubrication, proper positioning |
| Bleeding | 0.5-2% | Blood on probe, hematemesis, melena | Remove probe, endoscopy, blood products if needed | Check coagulation status, gentle technique |
| Arrhythmias | 1-3% | Premature beats, bradycardia, heart block | Remove probe, antiarrhythmics, monitoring | Gentle technique, avoid prolonged manipulation |
| Infection | <0.1% | Fever, chest pain, mediastinitis | Antibiotics, surgical consultation, monitoring | Proper probe cleaning, sterile technique |
Clinical Pearls
Always check for esophageal pathology before TEE - safety first.
Use gentle technique - never force the probe insertion.
Learn standard TEE views - they are essential for proper assessment.
Take time to interpret images - quality is more important than speed.
Document all findings - TEE reports are crucial for patient care.
Practice sterile technique - clean probe thoroughly after use.
Be prepared for complications - have emergency equipment ready.
Monitor for complications - especially in the first 24 hours.
Use appropriate probe size - too large can cause injury.
TEE is the gold standard for intraoperative cardiac imaging.