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EACVI Echo Handbook - sample

Discover the EACVI Echo Handbook

Chapter 3 The Standard

Chapter 3 The Standard Transoesophageal Examination 3.1 Transoesophageal echocardiography (TOE) Clinical indications, procedure, and contraindications TOE examination is indicated when TTE is unable or unlikely to answer the clinical question Search for a potential cardiovascular source of embolism ◆◆ Left ventricular apex or aneurysm (transgastric and low TOE 2CV views) ◆◆ Aortic and mitral valve (look for vegetations, degenerative changes, or tumours, i.e. fibroelastoma) ◆◆ Ascending and descending aorta, aortic arch (aneurysm, thrombi, atherosclerotic lesions) ◆◆ Left atrial appendage (including PW Doppler); note spontaneous contrast ◆◆ Left atrial body including atrial septum; note spontaneous contrast ◆◆ Fossa ovalis/foramen ovale/atrial septal defect/atrial septal aneurysm; contrast + Valsalva Infective endocarditis ◆◆ Mitral valve in multiple cross-sections ◆◆ AV in long- and short-axis views; para-aortic tissue (in particular short-axis views of AV and aortic root) to rule out abscess 112

Chapter 3 The Standard Transoesophageal Examination 3.2 The standard transoesophageal 3D echo examination General principles (Boxes 3.2.1, 3.2.2) Box 3.2.2 General principles ◆ ◆ Usually starts with real-time imaging ◆ ◆ Gated 3D modes (including colour Doppler 3D mode) if ECG and quiet respiration are possible 3D TOE protocol Aortic valve (AV) ◆◆ 60° mid-oesophageal, short-axis view ◆◆ With or without colour (zoomed or full-volume acquisition) (Fig. 3.2.2A) ◆◆ 120° mid-oesophageal, long-axis view ◆◆ With or without colour (zoomed or full-volume acquisition) (Fig. 3.2.2B) Box 3.2.1 General principles and procedure ◆ ◆ Instrumentation and procedure ◆ ◆ Checklist before TOE ◆ ◆ Introduction of the TOE probe (Fig. 3.2.1) ◆ ◆ Safety and contraindications ◆ ◆ Course of the examination Fig. 3.2.1 TOE probe ➡ Similar to 2D TOE 126

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