Mid- esophageal bicaval view demonstrating a guide wire passed via the femoral vein with the tip in the SVC
Mid- esophageal bicaval view demonstrating a femoral venous cannula with its tip in the SVC
Mid- esophageal bicaval view demonstrating a guide wire entering the right atrium via the SVC for cannulation and a femoral venous cannula with tip in the superior vena cava
Biplane view with the TEE probe advanced into the stomach to visualize the intrahepatic IVC and hepatic vein. The femoral venous cannula is visualized. Resistance was met during advancement due to a prominent ridge at the junction of the IVC and hepatic vein.
Trans gastric short axis view of the distal descending aorta demonstrating the guide wire for femoral arterial cannulation
Inflated Endoballoon (red arrow) in a Valsalva graft optimally position just distal to the junction of the skirt and body of the graft
Mid- esophageal bicaval view demonstrating the retrograde coronary sinus cardioplegia catheter
Mid- esophageal 4 chamber view demonstrating the retrograde coronary sinus cardioplegia catheter
Balloon dilation of the native aortic annulus
Deployment of a balloon expandable (Edwards-Sapien) valve
A normally seated balloon expandable (Edwards-Sapien) valve
A normally seated self-expandable (CoreValve) valve
Sequential 2D imaging of the interatrial septum at different multiplane angles with the relevant structures identified. 2D ME views of the IAS at 0, 45, 90 and 120° with anatomy identified.
Example of an atrial septal defect with “floppy” rims where balloon sizing can be beneficial.
Mid-esophageal bicaval view with and without color flow Doppler showing two atrial septal defects (ASD).
Three-dimensional volume-rendered image showing two occluding devices next to each other.
Example of an atrial septal defect with a deficient aortic rim where the occluding device is “splayed” on the aortic root.
Positive bubble test.
Sequential 2D ME images of atrial septal defect with rims measurements.
Wire crossing one atrial septal defect in a case with multiple defects.
Example of device indenting on aortic root.
Device after release (with and without color doppler).
Device after release with residual effect.
Embolized device seen on the anterior leaflet of the mitral valve.
Device embolization after deployment or as a late complication.
Interatrial septum aneurysm due to redundant and floppy septum primum.
A prominent Eustachian valve at the junction of the inferior vena cava with the right atrium may make manipulation of guidewires and sheaths more difficult.
Secundum atrial septal defect.
Atrial septal defect sizing using the “stop flow” technique. On transesophageal echocardiography, the balloon is inflated just until no more flow can be observed with color doppler between the balloon and the interatrial septum.
3D TEE measurement of atrial septal defect.
Transthoracic echocardiographic apical four-chamber view demonstrating severe, global left ventricular dysfunction.
Transesophageal echocardiographic transgastric left ventricular short axis showing global hypokinesis and severe left ventricular dysfunction.
Transesophageal echocardiographic transgastric left ventricular short axis showing regional hypokinesis and left ventricular dysfunction. The anterolateral wall appears hyperkinetic while the septal segments appear dyskinetic.
Transthoracic echocardiographic apical four-chamber view demonstrating right ventricular dysfunction. There is little to no tricuspid plane annular systolic excursion. There are also apical segmental wall motion abnormalities of the left ventricle.
Transthoracic echocardiographic parasternal aortic valve short axis view (also considered the right ventricular inflow-outflow view) demonstrating severe aortic stenosis. The cusps of the aortic valve are calcified with reduced systolic opening.
Transesophageal echocardiographic midesophageal aortic valve short axis view demonstrating severe aortic stenosis. The cusps are heavily calcified with significantly reduced systolic excursion.
Transesophageal echocardiographic midesophageal aortic valve long axis view showing systolic anterior motion of the anterior mitral leaflet. During systole the anterior leaflet is seen briefly obstruction the left ventricular outflow track and contacting the ventricular septum. The ventricular septal contact during diastole is normal.
Transthoracic echocardiographic apical four-chamber view demonstrating a large pericardial effusion. This finding in the presence of hypotension is consistent with a clinical diagnosis of tamponade.
Transgastric left ventricular short axis showing both a small end-diastolic and small end-systolic area consistent with hypovolemia
Displays the real time ultrasonographic appearance of “B lines” obtained by using B-Mode. Such artifact consists of hyperechoic, vertical lines extending distally from the pleural line. They also are described as comet tail artifacts or “lung comets or rockets”.
Displays the real time ultrasonographic appearance of “Z lines” obtained by using B-Mode. Such artifact presents as ill-defined vertical lines arising from the pleural line and extending into the distal field, that do not erase A-lines.
Displays the real time ultrasonographic appearance of the Left Hemidiaphragm Motion during the ventilatory movements. In addition, the anatomic relationship between the left pleural cavity, the spleen and the left kidney is clearly demonstrated.
Displays the real time ultrasonographic appearance of the “Lung Point Sign” obtained by using B-Mode. Such lung point is depicted as an area of transition between normal lung sliding during inspiration and an area where lung sliding is not detected.
Real-time--guided thoracentesis or thoracostomy tube placement for identification of diaphragm, effusion, and lung parenchyma
Linear probe for real-time identification of needle insertion to the chest wall.
Linear probe faciliatates the contrast between the pericardium and the pleura.
The operator should take care to advance the needle over the superior border of the rib when entering the chest wall to avoid injury to the intercostal artery and nerve.
Pigtail catheter drainage requires insertion of a metalic guidewire via the catheter in place and assessment of its position as well as demonstrated reexpansion of cardiac chambers.
Subxiphoid approach with ultrasound providing a four-chamber view.
The sector as well as the linear probe can be useful to guide the insertion of the catheter.
Needle position confirmed by injecting saline and observing bubbles within the pericardial space.
The catheter is subsequently removed and a longer catheter (pigtail) with side holes is advanced over the wire, which is then removed, leaving only the catheter within the pericardial space.
The pigtail catherter is then connected to a three-way stopcock contianing a transducer and a syringe; this allows for pericardial pressure monitoring and continued fluid aspiration with subsequent reexpansion of the cardiac chambers.
The peritoneal needle attached to a syringe is subsequently inserted under direct ultrasound visualization until ascites is aspirated. A pigtail catheter can then be placed over a guidewire for large volume paracentesis if necessary.
Color flow Doppler for identification of intercostal blood vessels prior to needle insertion and characterization of free fluid.
Continuous aspiration is performed during advancement of needle during thoracentesis until pleural fluid is reached.
A stopcock connected to a large syringe is placed on the cather, and pleural fluid is subsequently aspirated.
Evaluation for pneumothorax performed using ultrasound.
Coronal cross-sectional view of the long axis of the heart,
Midesophageal RV inflow outflow view showing baseline RV function
Midesophageal right sided view showing baseline RV function
Midesophageal 4 chamber view showing thrombus in left atrium and ventricle
Midesophageal 4 chamber view showing RV thrombus propagation
Venous Cannula. A dual stage femoral venous cannula for ECMO can be visualized in the intrahepatic IVC along with a hepatic vein.
Portal Vein Bifurcation. In select patients the portal vein maybe imaged between TEE multiplane angles 70º-100º by advancing the probe to upper transgastric imaging depth with clockwise adjustments. Color-flow Doppler interrogation demonstrates low velocity, continuous monophasic flow directed away from the transducer.
Absence of the Intrahepatic Inferior Vena Cava. No anatomical intrahepatic IVC can be detected in the upper right corner of the image using the appropriate TEE imaging windows. Notice dilated hepatic venules seen throughout the liver parenchyma.
Midesophageal Mid Papillary View showing a Left Ventricle with a low LVEDD indicating hypovolemia.
Midesophageal Mid Papillary View showing a Left Ventricle with global decreased systolic function.
Transgastric Mid Papillary View showing dyskinetic inferior and inferoseptal walls.
Midesophageal Four Chamber view demonstrating a pericardial effusion with collapse of the Right Ventricle.
Midesophageal Long Axis View showing a flail non coronary cusp after a blunt chest trauma
Zoomed in Ascending Aorta Long Axis view demonstrating the Right Pulmonary Artery with a large thrombus in the lumen.
Midesophageal Four Chamber view demonstrating small air microbubbles in the Right Atrium and Right Ventricle with a layer of air on the Right Ventricular Free Wall.
Midesophageal Four Chamber View showing a thrombus in the Right Atrium and Right Ventricle during the anhepatic phase of a liver transplant.
Midesophageal Right Ventricular Inflow-Outflow View demonstrating a large Renal Cell Carcinoma extending into the Right Atrium and occluding inflow through the Tricuspid Valve.