Transesophageal Echocardiography in Clinical Practice
Format: PDF / Kindle (mobi) / ePub
Over the last 30 years the technological advances in TEE have been exponential and have been reflected by its increasing utilization. Currently almost all echocardiography labs undertake TEE and the vast majority of valve operations are performed with TEE guidance.
When imaging a patient’s heart the number of modalities available to choose from seems to be ever increasing and the clinician needs to be aware of the strengths and weaknesses of each modality in order to best answer the question posed. Those in cardiac imaging know that the spatial and temporal resolution of the modality is unsurpassed and that it is relatively easy to get good images with minimal training.
The purpose of this book is thus to give practical guidance to those undertaking training in the art of TEE. It is not an exhaustive text to be used for reference but one that should be used in conjunction with hands-on experience. If used correctly it will help in realizing the true potential of TEE.
5. Nagueh SF et al. JASE. 2009; 22(2):107–133. 42 2. The Left Ventricle A systematic approach to left ventricular assessment. View Level Angle Data acquired 4Ch ME 0–40 Qualitative estimation of systolic function Regional wall motion assessment l Anterolateral wall l Inferior septum Mitral Doppler (CW and PW) Annular Doppler tissue imaging (septal and lateral) Pulmonary vein Doppler (PW in LUPV) 2Ch ME 80–120 Volume measurements (EDV and ESV) Ejection fraction calculation
tend to find it quite uncomfortable so I frequently omit it from my routine studies. 5.2 Aorta 5.2.1 Root The aortic root extends from the fibrous annulus that supports the AV to the portion of the proximal ascending aorta that lies just distal to the sino-tubular junction, and can be seen in the same views as those used to visualize the AV (although slight manipulations are often required to optimize the imaging of one area at the expense of the other). When describing the root the dimensions
atrium (based on the shell-shaped appendage), identify the presence of a Eustachian valve (seen at the junction of the RA and inferior vena cava (IVC)) or Chiari network (a membranous structure seen within the RA itself), and ensure that the inferior and superior vena cavae are draining appropriately. In addition to these standard views, the RA can also be imaged at the gastro-esophageal junction (Fig. 6.12) as the probe is passed into the stomach; this allows visualization of the coronary sinus
(33%) being considered severe. 114 7. Artificial Valves Figure 7.7. Bileaflet mechanical mitral valve replacement seen from the mid esophageal 4 chambers view with two small transvalvular (normal) washing jets of regurgitation (thin arrows) and a single large paravalvular (abnormal) jet of regurgitation (thick arrow). 7.2 Mitral Valve Replacements The Doppler-derived parameters that should be reported when evaluating a mitral valve replacement are the peak E wave velocity, the mean
is transmitted at (Table 1.1). 14 1. Introduction Figure 1.7. Laterally flexed probe tip. Table 1.1 Approximate values for the attenuation of ultrasound in different human mediums. Blood Fat Soft tissue Myocardium Skeletal muscle Bone Lung 0.18 dB/cm/MHz 0.63 dB/cm/MHz 1 dB/cm/MHz 1.8 dB/cm/MHz 1.3–3.3 dB/cm/MHz 20 dB/cm/MH 41 dB/cm/MHz 1.8. Physics 15 1.8.3 Spatial Resolution This term refers to the ability to detect two points in space that are separate and display them as