A systematic approach to performing a comprehensive transesophageal echocardiogram. A call to order

Table 1 Summary of TEE Examination

TEE probe distance from incisors	Crystal Orientation	Maneuvers/View	Visualized Anatomy
~35–40 cm (mid esophagus)	0°	Probe Rotation	LV, MV; RA, TV; LVOT, AV, IAS; LA, LAA
	20–30° Incremental to 165°	Crystal rotation about area of interest	e.g., MV, LAA, IAS
	135°	LV long axis	MV, AV, ascending Ao
		Anterior/clockwise probe rotation	TV, RA, RAA, IAS, SVC; RUPV, RLPV
	90°	Two-chamber	MV, LV, LA
		Clockwise/anterior probe rotation	PV, RVOT; TV, RA, RAA; IVC, IAS, SVC; RUPV, RLPV
	40–60°	Short Axis	AV, TV, IAS; LAA
~40 cm (distal esophagus)	0°	Passing through GE junction	RAA, CS, TV
~45 cm (gastric)	0°	LV short axis	LV, RV
	90°	LV two-chamber	LV
	120°	LV long-axis	LV
		Clockwise/anterior rotation	RA, TV, RV, PV
~45–50 cm with graded 2–3 cm withdrawal	0°		Descending Ao
	90°	(if plaque seen)	Descending Ao
		Clockwise/anterior rotation	Aortic arch, PA, PV

Ao = aorta; AV = aortic valve; CS = coronary sinus; GE = gastroesophageal; IAS = interatrial septum; IVC = inferior vena cava; LA = left atrium; LAA = left atrial appendage; LLPV = left lower pulmonary vein; LUPV = left upper pulmonary vein; LV = left ventricle; LVOT = left ventricular outflow tract; MV = mitral valve; PA = pulmonary artery; PV = pulmonic valve; RA = right atrium; RAA = right atrial appendage, RLPV = right lower; RUPV = -right upper pulmonary vein; RVOT = right ventricular outflow tract; SVC = superior vena cava; TV = tricuspid valve pulmonary vein

ISSN: 1471-2261