Ultrasound Morphology of theHeart: Transesophageal Examination

  • Ferdinando Luca LoriniEmail author
  • Carlo Sorbara
  • Sergio Cattaneo


The heart is a very complex three-dimensional structure with a lot of anatomic components bound together; therefore, perfect knowledge of the anatomy is very important to understand two-dimensional echo images of the heart. Sometimes the images are very bad because of anatomic conditions (cardiac cavity dilatation) or air in the stomach (it is possible to improve the image after suction). Instrument settings and adjustments are important for optimizing image quality and the diagnostic capabilities of transesophageal echocardiography (TEE). Rarely TEE can cause serious and even fatal complications. The comprehensive, intraoperative TEE examination, recommended in the guidelines written by the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists in 1999, consists of a series of 20 cross-sectional views of the heart and great vessels. One should not start to study immediately a pathological element (surgical indication); one should use a standard protocol to practice the TEE examination. One should get only one cardiac structure (valve or cavity) in focus and analyze it and its relationship to other structures. It is very important to move the scan plane and build up a three-dimensional structure from the two-dimensional image. Everyone has to develop a personal approach to the intraoperative TEE examination; we suggest a simplified intraoperative TEE examination that reduces the number of views from the 20 standard views and is able to analyze all the main heart structures. The main advantage of this systematic approach is the minimization of the manipulation of the TEE probe to perform a complete examination of major cardiac structures.


Transesophageal echocardiography Comprehensive examination Heart morphology Standard transesophageal echocardiography views 

Suggested Reading

  1. Miller JP, Lambert SA, Shapiro WA, et al. The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologists. Anesth Analg. 2001;92:1103–10.CrossRefGoogle Scholar
  2. Shanewise JS, Cheung AT, Aronson S, et al. ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiographic examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Anesth Analg. 1999;89:870–84.CrossRefGoogle Scholar
  3. Stevenson JG. Adherence to physician training guidelines for pediatric transesophageal echocardiography affects the outcome of patients undergoing repair of congenital cardiac defects. J Am Soc Echocardiogr. 1999;12:165–72.CrossRefGoogle Scholar
  4. Thys DM, Abel M, Bollen BA, et al. Practice guidelines for perioperative transesophageal echocardiography. A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology. 1996;84:986–1006.CrossRefGoogle Scholar
  5. Ungerleider RM, Kisslo JA, Greeley WJ, et al. Intraoperative echocardiography during congenital heart operations: experience from 1,000 cases. Ann Thorac Surg. 1995;60:S539–42.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ferdinando Luca Lorini
    • 1
    Email author
  • Carlo Sorbara
    • 2
  • Sergio Cattaneo
    • 1
  1. 1.Department of Anesthesia and Intensive Care MedicineASST Papa Giovanni XXIIIBergamoItaly
  2. 2.Anesthesia and Intensive Care DepartmentRegional Teaching Hospital, Azienda ULSS 9, VenetoTrevisoItaly

Personalised recommendations