TRANSESOPHAGEAL ECHOCARDIOGRAPHY
Transesophageal echocardiography (TEE) requires an ultrasound transducer at the tip of a probe that can be passed into the patient’s esophagus, which lies directly behind the left atrium, as well as into the gastric area (see Plate 3-14). Sedation is required, and TEE should be performed only by a certified physician (e.g., cardiologist, cardiac anesthesiologist), not echo technologists. TEE does not replace transthoracic echocardiography but does provide clearer images, especially images that are more difficult to view with transthoracic US, such as the left atrial appendage. This feature is extremely important before cardioversion of patients in atrial fibrillation with uncertain onset. If the atrial appendage is free of clots, the patient is considered at very low risk for emboli to the brain.
The
structures evaluated best in adults with TEE are the aorta, pulmonary artery,
cardiac valves, both atria and ventricular septum, left atrial appendage, and
coronary arteries. However, TEE is rarely used as a diagnostic tool to detect
coronary abnormalities in the adult. As with any invasive technique, there is
some risk with anesthesia, esophageal perforation, and drug side effects.
In
patients undergoing valve surgery, particularly reconstruction (e/g/. mitral
valve repair), anesthesiologists trained in TEE provide important information
to the surgeon on ventricular function and valve status after repair.
