introduction to use of TEE in anesthesia

1. TEE INTEE IN
ANESTHESIAANESTHESIA
(Introduction)(Introduction)
BYBY
USAMA ELSAYEDUSAMA ELSAYED
LECTURER OF ANESTHESIA AND INTENSIVELECTURER OF ANESTHESIA AND INTENSIVE
CARECARE

2. OBJECTIVESOBJECTIVES
EquipementsEquipements
IndicationsIndications
ContraindicationsContraindications
ViewsViews
complicationscomplications

3. EQUIPEMENTEQUIPEMENT
 Ultrasound transducerUltrasound transducer
 Flexible endoscopeFlexible endoscope
 Piezoelectric crystalsPiezoelectric crystals
 Two-dimensional (2D) video imageTwo-dimensional (2D) video image
 Anteflexion, retroflexionAnteflexion, retroflexion

4. EQUIPEMENTS cont.EQUIPEMENTS cont.
 MonoplaneMonoplane
 BiplaneBiplane
 MultiplaneMultiplane

7. Probe insertionProbe insertion
 Blindly with jaw thrustBlindly with jaw thrust
 Laryngoscopic visualisationLaryngoscopic visualisation
 Assisstant supportAssisstant support
 Bite guardBite guard

9. IndicationsIndications
 Cardiac surgeriesCardiac surgeries
 Noncardiac surgeriesNoncardiac surgeries

10. ContraindicationsContraindications
 Esophageal pathologyEsophageal pathology
 Gastric pathologyGastric pathology
 InexperienceInexperience

11. ComplicationsComplications
 Esophageal injury…….perforationEsophageal injury…….perforation
 Upper GIT hemorrhageUpper GIT hemorrhage
 Dental injuryDental injury
 EndotrachealEndotracheal
 ProbeProbe
 FailureFailure

12. TEE viewsTEE views
 ME 4 Chamber ViewME 4 Chamber View
Advance probe to mid esophageal position(35 cm)Advance probe to mid esophageal position(35 cm)
(0 angle)(0 angle)
Left atriumLeft atrium
Left ventricleLeft ventricle
Right atriumRight atrium
Right ventricleRight ventricle
Mitral valveMitral valve
Tricuspid valveTricuspid valve

13. Mid esophageal 4 chambres viewMid esophageal 4 chambres view

15. Mid esophageal 4 chambres viewMid esophageal 4 chambres view
 Chamber sizeChamber size
 Ventricular functionVentricular function
 Mitral Valve diseaseMitral Valve disease
 Tricuspid Valve diseaseTricuspid Valve disease
 Atrial Septal DefectAtrial Septal Defect
 Pericardial EffusionPericardial Effusion

16. ME 2 Chamber ViewME 2 Chamber View
Advance probe to mid esophageal position(35 cm)Advance probe to mid esophageal position(35 cm)
(80-100 angle)(80-100 angle)
 Left Atrium (LA)Left Atrium (LA)
 Left Atrial Appendage (LAA)Left Atrial Appendage (LAA)
 Mitral Valve: Posterior (PMVL) + AnteriorMitral Valve: Posterior (PMVL) + Anterior
(AMVL)(AMVL)
 Left Ventricle (LV)Left Ventricle (LV)
 Coronary Sinus (CS)Coronary Sinus (CS)
 ““Coumadin ridge”(CR) tissue that separates theCoumadin ridge”(CR) tissue that separates the
LAA and LUPVLAA and LUPV

17. ME 2 Chamber ViewME 2 Chamber View
 LAA mass/thrombusLAA mass/thrombus
 LV size and functionLV size and function
 MV diseaseMV disease
 MV annulus measureMV annulus measure

21. ME LAX ViewME LAX View
 ME 4 chambres + 120- 130 angleME 4 chambres + 120- 130 angle
 Left ventricle (LV)Left ventricle (LV)
 Left ventricular outflow tract (LVOT)Left ventricular outflow tract (LVOT)
 Aortic Valve (AV)Aortic Valve (AV)
 Mitral Valve: Anterior(AMVL) +Mitral Valve: Anterior(AMVL) +
Posterior(PMVL) LeafletsPosterior(PMVL) Leaflets

22. ME LAX ViewME LAX View
 LV functionLV function
 MV diseaseMV disease
 AV and Aortic Root diseaseAV and Aortic Root disease
 Interventricular Septum pathologyInterventricular Septum pathology

24. ME LAX ViewME LAX View

25. ME Aortic Valve SAX ViewME Aortic Valve SAX View
 Probe ME + 45 angleProbe ME + 45 angle
 Aortic Valve: (RCC), (LCC) and (NCC)Aortic Valve: (RCC), (LCC) and (NCC)
 Inter-atrial Septum (IAS)Inter-atrial Septum (IAS)
 Left Atrium (LA)Left Atrium (LA)
 Right Atrium (RA)Right Atrium (RA)

26. ME Aortic Valve SAX ViewME Aortic Valve SAX View
 Aortic Valve diseaseAortic Valve disease
 Atrial septal defect (ASD) (secundum)Atrial septal defect (ASD) (secundum)
 LA sizeLA size

28. ME Aortic Valve SAX ViewME Aortic Valve SAX View

29. ME Bicaval ViewME Bicaval View
ME,ME, angle 90-100°, turn entire probe rightangle 90-100°, turn entire probe right
 RA, RAARA, RAA
 Eustachian valve (EV) (at the border of the IVC /Eustachian valve (EV) (at the border of the IVC /
RA)RA)
 Crista Terminalis (CT)(at the border of the SVC /Crista Terminalis (CT)(at the border of the SVC /
RA)RA)
 SVCSVC
 IASIAS
 LALA
 IVCIVC

30. ME Bicaval ViewME Bicaval View
 ASD (secundum, sinus venosus)ASD (secundum, sinus venosus)
 Atrial pathologyAtrial pathology
 Lines/wiresLines/wires
 Venous Cannula (SVC, IVC)Venous Cannula (SVC, IVC)

33. ME Bicaval ViewME Bicaval View

34. TG midpapillary viewTG midpapillary view
Insert the probe to the stomach, sector depth 12cm, angleInsert the probe to the stomach, sector depth 12cm, angle
0° , Anteflex to contact stomach wall0° , Anteflex to contact stomach wall
 LV CavityLV Cavity
 LV WallsLV Walls
 Papillary Muscles: (ALPM), (PMPM)Papillary Muscles: (ALPM), (PMPM)
 Right VentricleRight Ventricle

36. TG midpapillary viewTG midpapillary view
 Left Ventricle: size, functionLeft Ventricle: size, function
 Interventricular Septal motion, thicknessInterventricular Septal motion, thickness
 Ventricular Septal Defect (VSD)Ventricular Septal Defect (VSD)
 HypovolemiaHypovolemia

38. TG midpapillary viewTG midpapillary view

41. ConclusionConclusion
Introduction to use of TEE IN anesthesiaIntroduction to use of TEE IN anesthesia
as regard equipements, indications,as regard equipements, indications,
contraindications, complications and somecontraindications, complications and some
important viewsimportant views