TRANSNESOPHAGEAL ECHO SEMINAR pptx

TEE is a semi-invasive procedure in that the probe must enter the body but does not require surgical (i.e., invasive) cutting for this procedure. Before inserting the probe, mild to moderate sedation is induced in the patient to ease the discomfort and to decrease the gag reflex. Usually a local anesthetic spray (e.g., lidocaine, benzocaine, xylocaine) is used for the back of the throat or as a jelly/lubricant anesthetic for the esophagus. Sedation and anesthesia are required to make the procedure tolerable and safer, as biting the probe, coughing, vomiting, and patient movement would drastically reduce the value of the procedure.[citation needed]

Mild or moderate sedation can be induced with medications such as midazolam (a benzodiazepine with sedating, amnesiac qualities), fentanyl (an opioid), or propofol (a sedative/general anesthetic, depending on dosage). Children are anesthetized. Adults are sometimes anesthetized as well if moderate sedation is unsuccessful.[citation needed]

Due to the procedure being invasive, sonographers do not perform this procedure unlike transthoracic echo.

Once adequate sedation and anesthesia are achieved, the probe is passed through the mouth and into the esophagus. From here, the protocol used for the procedure is highly variable. As the study could be terminated any second (e.g., respiratory compromise, hypotension, intolerance to the probe) the structures of particular interest could be visualized first. For example, if the TEE is ordered to look for mitral regurgitation then the mitral valve may be fully inspected first. At the completion of the study, the probe is removed and patient is monitored for recovery from sedation.
The advantage of TEE over TTE is usually clearer images, especially of structures that are difficult to view transthoracically (through the chest wall). This difficulty with TTE is exemplified with obesity and COPD, as both of these can drastically limit both the window available and the quality of the images obtained through those windows This reduces the attenuation (weakening) of the ultrasound signal, generating a stronger return signal, ultimately enhancing image and Doppler quality. Comparatively, transthoracic ultrasound must first traverse skin, fat, ribs and lungs before reflecting off the heart and back to the probe before an image can be created. All these structures, along with the increased distance the beam must travel, weaken the ultrasound signal thus degrading the image and Doppler quality.[citation needed]

In adults, several structures can be evaluated and imaged better with the TEE, including the aorta, pulmonary artery, valves of the heart, both atria, atrial septum, left atrial appendage, and coronary arteries. TEE has a very high sensitivity for locating a blood clot inside the left atrium.[3]

TEE is also frequently used concurrently with cardiac surgery to provide immediate visualization, inspection, and monitoring of the patient throughout the procedure. .

1. TRANSESOPHAGEAL ECHOCARDIOGRAM Presented by SATHVIK.K Bsc.Cardiovascular technology

2. Transesophageal Echocardiography is a test that produces pictures of your heart. TEE uses High-Frequency sound waves (Ultrasound) to make detailed pictures of your heart and arteries that lead to and from it. Unlike a Standard Echocardiogram, the echo transducer that produces the sound waves for TEE is attached to a thin tube that passes through your mouth, down the throat and into esophagus. Because esophagus is close to the upper chambers of the heart, very clear images of the heart structures and valves can be obtained.

3. The concept of TEE was introduced by DR.LEON FRAZIN in the year 1976 . PRINCIPLE OF TEE : During Echocardiography, a balance has to be struck between tissue penetration and image resolution. Low frequency transducers used for Transthoracic echo have Good penetration but relatively poor resolution. On other hand, high frequency transducers have poor penetration but better Resolution. Anatomically ,The oesophagus in its mid course is strategically located posterior to the heart and anterior to the descending aorta.

4. This provides an opportunity to examine the heart and related structures with a high frequency transducer positioned in the oesophagus for better image resolution. This is known as TEE .

5. ADVANTAGES OF TEE Improved image quality and resolution. Some Aspects of the heart can be examined which cannot be seen by TTE Eg : Posterior parts such as LA Appendage, Descending Aorta and pulmonary veins.

6. Dis advantages of tee Invasive Technique – Uncomfortable with potential small risk New views have to be learnt

7. USES OF TEE TEE IS USED TO ASSESS: M itral valve disease – MS,MR,MV P Endocarditis – Vegetations,Abscess Prosthetic valves – haemodynamics ; stability; endocarditis Aortic disease – dissection of ascending, arch or descending thoracic aorta; trauma; atheroma Aortic valve disease Thromboembolic vascular disease – stroke/TIA or peripheral embolism Left atrial appendage – thrombus Intracardiac masses – myxoma or other tumour ; thrombus Septal defects – atrial , ventricular; contrast studies Intraoperative monitoring – assessment of mitral valve repair; left ventricular function and regional wall motion abnormalities Congenital heart disease – anatomy; haemodynamic assessment Critically ill individuals on ITU Air or fat embolism – haemodynamics

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