Using the TEE probe and making sense of the views

Transesophageal echo is a superpowerful tool. If you're taking care of cardiac patients and want to differentiate yourself from the bulk, you NEED to learn TEE. Period. In this short video, cardiac imaging expert Andrew Houghton, MD explains how to arrive at various views in TEE (TOE).

This video was taken from our TEE Essentials course. Sign up for a free trial account and get access to it today!

[00:00:00] As we've seen in the lessons so far in this chapter, there are many different ways in which we can manipulate a TEE probe, to obtain the images that we want. This gives us a lot of versatility for obtaining the images but it can make things rather confusing because it is quite easy to become disorientated. To recap, there are four different ways in which we can physically manipulate the position of the TEE probe. The first of these is

[00:00:30] to withdraw or advance the probe up or down the patient's esophagus. Secondly, we can turn the probe to the right or to the left. Thirdly, we can selectively flex the tip of the probe in the anterior direction, known as anteflexing or in the posterior direction, known as retroflexing. And fourthly, we can flex the tip of the probe to the left or to the right.

[00:01:00] As well as these four physical probe manipulations, we can also adjust the angle of the transducer, which is housed within the tip of the probe. We can rotate the transducer so that the imaging plane itself rotates. We can rotate the transducer forward, increasing the imaging plane angle from 0 to 180 degrees, and we can rotate the transducer backward to rotate the imaging plane angle back down

[00:01:30] towards 0 degrees. As we've already said, this wide variety of probe manipulations gives us a lot of flexibility for obtaining our TEE images. However, it can make things appear confusing and if you're new to TEE, it's easy to get disoriented. So, for the rest of this TEE course, how are we going to help you to maintain your bearings and find the views that you want? Well, whenever we show you

[00:02:00] a TEE image in this course, we'll describe which probe manipulations you need to make, in order to obtain the image for yourself. And to assist with that, we'll be using the sidebar on the right-hand side of the screen. At the top of the sidebar, we will name the key structure, which is the focus of interest for that image. In this case, it's the aortic valve, seen in the center of the sector, here. We'll describe which TEE

[00:02:30] probe location we've used, in this case, it's the mid-esophageal location. And we'll also represent that graphically, using this image in the center of the sidebar. This shows where the TEE probe is located, in relation to the structures around it. We'll also name the view, this is known as the short-axis view of the aortic valve because the valve is seen on [unintelligible 00:02:56] in the image. Finally, we'll describe

[00:03:00] which transducer imaging plane angle to select, to begin with, in order to try and obtain the image. In this case, for a short-axis view of the aortic valve, we would recommend starting with transducer imaging plane angle of 40 degrees. However, in most cases, you will need to make some slight adjustment of the imaging plane angle in order to optimize the view and avoid any foreshortening of the structure that we're interested in. Therefore,

[00:03:30] on the TEE image itself, you'll notice that we always show you the exact angle that was used, to obtain that particular image, after any fine tuning adjustments have been made. In this case, we stayed with the angle of 40 degrees, that we'd started with because that happened to give us the optimized view that we wanted of the valve. So, in conclusion, during this course, we will help you find

[00:04:00] the views that you want, by carefully describing every probe manipulation that you need to make, in order to obtain exactly the view that we're after.