Figure 1
Anatomical relationships for transesophageal probe, esophagus, and heart.
Figure 2
Probe and transducer handling movements to acquire echocardiographic images. Adapted from Galhardo et al.66 Galhardo Júnior C, Botelho ESL, Diego LAS. Intraoperative monitoring with transesophageal echocardiography in cardiac surgery. Rev Bras Anestesiol. 2011;61:495-512.
Figure 3
(A) Mid-esophageal five-chamber cross-section. (B) Mid-esophageal four-chamber cross-section. (C) Mid-esophageal commissural cross-section. (D) Mid-esophageal two-chamber cross-section.
Figure 4
(A) Mid-esophageal long axis cross-section. (B) Mid-esophageal ascending aorta long axis cross-section. (C) Mid-esophageal aortic valve long axis cross-section. (D) Mid-esophageal ascending aorta short axis.
Figure 5
(A) Mid-esophageal aortic valve short axis cross-section. (B) Mid-esophageal right ventricle inflow-outflow cross-section. (C) Mid-esophageal modified bicaval cross-section. (D) Mid-esophageal bicaval cross-section.
Figure 6
(A) Upper-esophageal right and left pulmonary veins cross-section. (B) Mid-esophageal left atrial appendage cross-section. (C) Transgastric basal short axis cross-section. (D) Transgastric mid-papillary short axis cross-section.
Figure 7
(A) Transgastric apical short axis cross-section. (B) Transgastric basal right ventricle cross-section. (C) Transgastric right ventricle inflow-outflow cross-section. (D) Deep transgastric cross-section.
Figure 8
(A) Transgastric long axis cross-section. (B) Transgastric long axis cross-section. (C) Descending aorta short axis cross-section. (D) Descending aorta long axis cross-section.
Figure 9
(A) Upper-esophageal aortic arch long axis cross-section. (B) Upper-esophageal aortic arch short axis cross-section.
Figure 10
Mitral annulus assessment by three-dimensional echocardiography. (A) Anteroposterior diameter. (B) Anterolateral-posteromedial diameter. Ao, aortic ring; A, anterior; P, posterior; AL, anterolateral; PM, posteromedial.
Figure 11
Carpentier nomenclature: segments #1 are anterolateral, #3 are posteromedial, and #2 correspond to the valve mid-portion. The anterior and posterior commissures are also visualized.1212 Dal-bianco JP, Levine RA. Anatomy of the mitral valve apparatus Role of 2D and 3D echocardiography. Cardiol Clin. 2013;31:151-64.
Figure 12
Mitral subvalvar apparatus, showing the chordae tendineae distribution at each cusp.1212 Dal-bianco JP, Levine RA. Anatomy of the mitral valve apparatus Role of 2D and 3D echocardiography. Cardiol Clin. 2013;31:151-64.
Figure 13
Mitral valve view in three-dimensional image. (A) Mitral valve in diastole. (B) Mitral valve in systole.
Figure 14
Mitral valve view of left ventricle in three-dimensional image. (A) Mitral valve in diastole. (B) Mitral valve in systole.
Figure 15
Three-dimensional color Doppler of mitral valve.
Figure 16
Carpentier classification: (A) normal motion; (B) excessive motion; (C) restricted motion.
Figure 17
Mitral valve anterior systolic motion.
Figure 18
Aortic complex. LV, left ventricle; LVOT, left ventricular outflow tract; RVOT, right ventricular outflow tract.
Figure 19
Mid-esophageal aortic valve short axis cross-section. NC, non-coronary; LC, left coronary; RC, right coronary.
Figure 20
Mid-esophageal aortic valve long axis cross-section. LVOT, left ventricular outflow tract; IVS, interventricular septum; RC, right coronary; Asc Ao, ascending aorta.
Figure 21
Renal artery cross-section.
Figure 22
Atheroma plaques in descending aorta short axis.
Figure 23
Pulsed Doppler in descending aorta showing a holodiastolic reflux of severe aortic regurgitation.
Figure 24
Three-dimensional volumetric analysis of aortic valve.
Figure 25
Three-dimensional multiplanar reconstruction of aortic valve.
Figure 26
Multiplanar reconstruction in assessing aortic valve area.
Figure 27
Three-dimensional image of descending aorta atherosclerotic plaque.
Figure 28
(A) Echocardiographic image of left atrium thrombus. (B) Thrombus. LA, left atrium; RA, right atrium; AV, aortic valve; RV, right ventricle.
Figure 29
Mid-esophageal four-chamber cross-section showing rheumatic mitral stenosis. Note the presence of spontaneous contrast in left atrium and mitral valve leaflets thickening. LA, left atrium; LV, left ventricle; RV, right ventricle. Source: Personal collection. Yellow arrow indicates mitral stenosis. Red arrow indicates "cigarette smoke" in left atrium.
Figure 30
Transgastric cross-sections for left ventricle assessment. (A) Mid-esophageal two-chamber view. (B) Transgastric two-chamber view. (C) Transgastric mid-papillary short axis view.
Figure 31
Anatomic relationship and coronary irrigation with left ventricle walls in transgastric cross-section. DA, anterior descending coronary artery; CX, circumflex coronary artery; RC, right coronary artery. Adapted from Galhardo et al.66 Galhardo Júnior C, Botelho ESL, Diego LAS. Intraoperative monitoring with transesophageal echocardiography in cardiac surgery. Rev Bras Anestesiol. 2011;61:495-512.
Figure 32
Tricuspid annular plane systolic excursion (TAPSE) is acquired by placing the M mode on tricuspid annulus and measuring the longitudinal systolic motion amplitude. Transesophageal echo transducer should be positioned in mid-esophageal four-chamber and RV centralized.33 Barbosa MM, Nunes MCP, Campos Filho O, et al. Sociedade Brasileira de Cardiologia. Diretrizes das indicações da ecocardiografia. Arq Bras Cardiol. 2009;93:e265-302.,55 Rengasamy S, Subramaniam B. Basic physics of transesophageal echocardiography. Int Anesthesiol Clin. 2008;46:11-29.,66 Galhardo Júnior C, Botelho ESL, Diego LAS. Intraoperative monitoring with transesophageal echocardiography in cardiac surgery. Rev Bras Anestesiol. 2011;61:495-512. In a minority of patients, a modified incidence of RV deep transgastric can be obtained by rotating the probe to the right (as in the figure), which allows US good alignment with tricuspid ring motion.
Figure 33
Tissue Doppler image of tricuspid ring: S′, right ventricular longitudinal peak velocity; IPMVD, right ventricular myocardial performance index or Tei index; TRIV, isovolemic relaxation time; AIV, isovolemic acceleration; TA, acceleration time; TE, ejection time; IVCT, isovolemic contraction time; VVI, isovolemic peak velocity. Isovolemic acceleration is a systolic performance index relatively independent on pre- and post-load. More information about its use in cardiac surgery is required.
Figure 34
Right ventricular myocardial performance index (RMPI) or Tei index. This figure shows the tissue Doppler of tricuspid ring in deep transgastric right ventricular view.
Figure 35
(A) Trasmitral pulsed Doppler, E wave > A wave. (B) Trasmitral pulsed Doppler, E wave < A wave. (C) Trasmitral pulsed Doppler, E wave > A wave. (D) Pulmonary Doppler on pulmonary vein, S wave < D wave.
Figure 36
Color M-mode Doppler in diastolic evaluation.
Figure 37
Flowchart of diastolic dysfunction evaluation with impaired left ventricular systolic function. E/A, mitral E wave and A wave ratio; E/E′, mitral E wave and tissue E′ wave velocity ratio; S/D, pulmonary vein systolic and diastolic ratio; Ar, reverse pulmonary A wave; LAP, left atrial pressure.
Figure 38
Flowchart of diastolic dysfunction evaluation with normal left ventricular systolic function. E/E′, mitral E wave and tissue E′ wave velocity ratio; Ar, reverse pulmonary A wave; LAP, left atrial pressure.
