Transesophageal Echocardiography (TEE): Indications, Contraindications, Technique, and Clinical Significance

Clinical Significance of TEE

According to the ASE recommendations on standards for the performance of TEE screening for structural heart intervention (Hahn R.T., Saric M. et al., 2022), echocardiography specialists working within multidisciplinary teams treating patients with structural heart disease must possess expert knowledge in valvular pathology as well as in transcatheter and surgical interventions, regardless of whether they perform intraoperative procedural management. This document focuses on obtaining the essential TEE images in structural heart disease as part of the preprocedural assessment.

Indications

TEE is used in structural heart disease for preprocedural assessment and for intraoperative management. According to the recommendations for the use of echocardiography in rheumatic heart disease (Pandian N.G. et al., 2023), 2D and 3D TEE guide the passage of the balloon catheter across the interatrial septum, then through the stenotic valve, and during balloon inflation, and are also used to guide transseptal catheterization and balloon mitral valvuloplasty (BMV).

The list of general indications for echocardiography (for TTE, according to the textbook by B.V. Blagodir, 2024) includes: cardiomyopathies, congenital heart defects, aortic diseases, heart failure, infective endocarditis, coronary artery disease, myocarditis, pericarditis/tamponade, valve prostheses, cardioembolic disease, tumors/thrombi, and valvular heart disease. [to clarify: a separate list of indications specifically for TEE is not provided in the fragments]

Contraindications

The list of contraindications provided in the fragments refers to TTE (textbook by B.V. Blagodir, 2024): psychoemotional agitation of the patient, interstitial air in the soft tissues after trauma, marked obesity, patient refusal of the examination. [to clarify: specific contraindications for TEE are absent in the fragments]

Technique and Imaging Modes

The method is based on three main modes: M-mode, 2D mode, and Doppler mode (textbook by B.V. Blagodir, 2024). Two-dimensional echocardiography (2D) displays black-and-white real-time information, allowing examination of the cardiac chambers (dimensions, function), valves (anatomy and motion), and the major arteries.

Image Optimization

It is separately noted that the examination is better performed with a higher frame rate, which is achieved by reducing scanning depth or applying ZOOM.

Color Doppler Mapping

When using color Doppler (textbook by B.V. Blagodir, 2024), the specialist selects a color map (velocity or variance). In most laboratories, flow toward the transducer is colored red, flow away from the transducer is colored blue (BART scheme, Blue Away Red Toward). The higher the flow velocity, the more turbulent it becomes, manifesting as a mosaic pattern (yellow, light blue, green shades). The optimal Doppler angle is parallel to the flow (0° or 180°); the specialist should set the optimal CFD gain.