ECHOCARDIOGRAPHY SNIPPETS

Echocardiography Snippets

Added 8 views to the 20 Basic TEE views by ASE/SCA in 2013 -

1. Midesophageal 5 chamber view
2. Midesophageal LAA view
3. Midesophageal Right Pulmonary vein view
4. Midesophageal Modified Bicaval view
5. Upper esophageal Right and Left Pulmonary vein view
6. Transgastric Apical Short axis view
7. Transgastric RV Basal view
8. Transgastric RV Inflow Outflow view

20 Basic TEE views are –

10 Midesophageal views

2 Upper esophageal views

2 Descending aortic views

6 Transgastric views

10 Midesophageal views -

1. Midesophageal 4 chamber view
2. Midesophageal 2 chamber view
3. Midesophageal long axis view
4. Midesophageal mid commissural view
5. Midesophageal AV long axis view
6. Midesophageal AV short axis view
7. Midesophageal RV inflow-outflow view
8. Midesophageal bicaval view
9. Midesophageal ascending aorta short axis view
10. Midesophageal ascending aorta long axis view

2 Upper esophageal views –

1. Upper esophageal aortic arch short axis view
2. Upper esophageal aortic arch long axis view

2 Descending aortic views –

1. Descending aortic short axis view
2. Descending aortic long axis view

6 Transgastric views -

1. Transgastric mid short axis
2. Transgastric basal short axis
3. Transgastric 2 chamber view
4. Transgastric long axis view
5. Transgastric RV inflow view
6. Deep Transgastric view

Important Formulae –

PASP or RVSP = VmaxTR + CVP

PADP = VmaxPR + RVDP (CVP)

PAmean = 0.61( PASP) + 2mmHg

RVSV = 0.785 (PV diam)² (PVVTI)

Atheromas Classification –

Grade 1 – Normal

Grade 2 – Intimal thickening

Grade 3 – Protrudes < 5 mm in aortic lumen

Grade 4 – Protrudes > 5 mm in aortic lumen

Grade 5 – mobile atheroma

TEE in Aortic dissection -

What is Intimal flap ?

Intimal flap is an undulating membrane 2-4 mm thick containing intima and 1/3^rd of media.

Presence of intimal flap, true and false lumen are characteristics of dissection

Typical dissection starts from anterior and right of ascending aorta and goes to left side of descending aorta.So it may involve

Right coronary artery

Left intercostal vessels

Left renal vessels

Left iliac vessels

Differentiating features between –

True Lumen              False lumen

Small                               Large lumen

Expands with systole    Flap moves towards during systole

High velocity flow          Low velocity flow

None                               Thrombus/Spontaneous echo contrast present

Contrast flow faster       Contrast washout slower

- by Dr Amarja