Echo From Scratch | Post #44 TEE From Scratch: The Standard Examination Sequence TEE is more than inserting a probe and obtaining images. A systematic examination helps assess all four chambers, the cardiac valves, the aorta and adjacent structures. 1. Understand the probe positions The standard examination uses several positions: - Upper esophageal - Midesophageal - Transgastric - Deep transgastric 2. Master the key midesophageal views Multiplane angle refers to the rotation of the imaging plane, not the direction of probe advancement. - 0°: Four-chamber view. Assess both atria, both ventricles and the AV valves. - Around 60°: Mitral commissural view. Evaluate mitral leaflet anatomy and commissures. - Around 90°: Two-chamber view. Focus on the LV and LA. - Around 120°: Long-axis view. Visualize the LV, LVOT, aortic valve and mitral valve. These angles are approximate starting points. Small adjustments are often needed to obtain the optimal view. 3. Assess the aortic valve and right heart As the probe is withdrawn, additional views help evaluate: - Aortic valve in short axis and long axis - Aortic root and ascending aorta - RV inflow and outflow - Tricuspid valve and pulmonary valve 4. Advance into the stomach Transgastric imaging provides additional ventricular views: - Basal LV short axis - Mid-LV short axis - Two-chamber view - LV long-axis view - RV inflow view These are particularly useful for assessing ventricular function, regional wall motion and selected Doppler measurements. 5. Finish with the aorta A systematic examination also includes imaging the descending thoracic aorta and, when indicated, the aortic arch. Key takeaway: A standard TEE examination follows a structured sequence, but the final views must be tailored to the clinical question. No single view provides a complete assessment of cardiac anatomy or function.