A practical approach to the standard TEE examination
A systematic TEE exam helps ensure that the cardiac chambers, valves, great vessels, and aorta are not overlooked.
The examination usually begins at the mid-esophageal level, with most standard views obtained using multiplane imaging.
Key sequence:
0°: Mid-esophageal 4-chamber view (Assess LA, LV, mitral and tricuspid valves)
~60°: Mitral commissural view.
~90°: 2-chamber view (Assess LV and LA)
~120°: Long-axis view (Assess LV, LA and mitral valve)
Then withdraw or adjust the probe to assess:
◻️Aortic valve and ascending aorta
◻️RV, RVOT, pulmonary valve and pulmonary artery
◻️Additional structures such as the LAA, interatrial septum and pulmonary veins
Advance the probe to the transgastric level for LV short-axis and long-axis views, with additional right-sided views as needed.
Finally, withdraw the probe systematically to examine the thoracic aorta and arch.
The exact views and angles are adjusted according to the clinical indication. In an unstable patient, the primary clinical question should be addressed first.
Think of TEE as a systematic survey: level, angle, structure, then indication-specific views.