Transesophageal echocardiography
- 1. TRANSESOPHAGEAL ECHOCARDIOGRAPHY PRESENTED BY : SHEERSHA PRAMANIK COURSE INSTRUCTOR : DR. GOVINDA KAPUSETTI
- 2. FLOW OF PRESENTATION Introduction Patient preparation Equipments Procedure Different views 3D Version Advantages Contradictions References
- 3. INTRODUCTION What is Transesophageal Echocardiography or TEE? Transesophageal echocardiography (TEE) is a test that produces pictures of your heart. TEE uses high-frequency sound waves (ultrasound) to make detailed pictures of your heart and the arteries that lead to and from it.
- 4. PATIENT PREPARATION Informed consent Pt. should fast for at least 4 6 hrs Thorough history should be taken any dysphagia I.V. access Pre oxygenation Suction should be available
- 5. EQUIPMENTS TEE probe (modified gastroesophageal endoscopy probe with 3-7 MHz transducer at tip) should be examined before use. Diameter of transducer tip in adults and paediatric use are 9-14 mm and < 3 mm respectively. Anterior flexion should exceed 90%, and right and left flexion should approach 90%. A miniaturized echocardiographic transducer (about 40 mm long, 13 mm wide, and 11 mm thick) mounted on the tip of a gastroscope. Transducer is with 64 piezoelectric elements operating at 3.7 to 7.5 MHz
- 7. PHOTO OF A TRANSDUCER AND CLOSE UP OF THE BODY OF A TRANSDUCER
- 8. Like the standard gastroscope, two rotary knobs control the movement.
- 9. PROCEDURE OF TEE A technician sprays your throat with a medicine to numb it and suppress the gag reflex. Youll lie on a table. A nurse puts an IV (intravenous line) in your arm, and gives you a mild sedative (medicine) to help you stay calm. The technician then places small metal disks (electrodes) on your chest. He or she attaches the electrodes by wires to a machine that will record your electrocardiogram (ECG) to track your heartbeat. The doctor then gently guides a thin, flexible tube (probe) through your mouth and down your throat, and asks you to swallow as it goes down. A transducer on the end of the probe sends sound waves to your heart and collects the echoes that bounce back. These echoes become pictures that show up on a video screen. This part of the test takes 10 to 15 minutes. When the doctor is finished taking pictures, the probe, IV and electrodes are removed and nurses watch you until you are fully awake. Then you can usually get
- 11. TEE VIEWS UPPER ESOPHAGEAL LEVEL 20-25 CM MID ESOPHAGEAL LEVEL 30-40 CM TRANS GASTRIC LEVEL BEYOND 40 CM
- 13. FOUR CHAMBER VIEW IN ESOPHAGUS
- 14. MID-ESOPHAGEAL AV SHORT AXIS VIEW
- 16. 3D TEE Main advantages of Real-time three-dimensional (RT3D) TEE during catheter-based interventions: Ability to visualize the entire lengths of Intracardiac catheters, including the tips of all catheters and the balloons Devices they carry, along with a clear depiction of the positions in relation to other cardiac structures To demonstrate certain structures in an en face view RT3D TEE is a powerful new imaging tool
- 17. ADVANTAGES OF TEE Close proximity of esophagus to post wall of heart no intervening structure like bone or lung Monitor the heart over time, such as during cardiac surgeries Extremely safe & well tolerated so that it can be performed in critically ill patients & very small infants Atrial thrombi/mass Left atrial appendage clot , clot in LA , thrombus in RA Mitral valve MR (very precisely) , function of prosthetic valves , refined suitability for valvotomy in severe MS
- 18. CONTRADICTIONS Absolute 1.Previous esophagectomy, 2.Severe esophageal obstruction, 3.Esophageal perforation, and 4.Ongoing esophageal hemorrhage
- 19. CONTD. Relative 1.Esophageal diverticulum, 2.Varices, 3.Fistula, and 4.Previous esophageal surgery, as well as a history of gastric surgery, mediastinal irradiation, unexplained swallowing difficulties
- 20. PROCEDURE COMPLICATION WITH TEE MAJOR o Death o Esophageal rupture/perforation o Upper gi bleed o Laryngospasm or bronchospasm o Congestive heart failure or pulmonary edema o Sustained ventricular tachycardia