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Guidelines for Performing a Comprehensive Transesophageal ASE GUIDELINES AND STANDARDS Guidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination in Children and All Patients with Congenital Heart Disease: Recommendations from the American Society of Echocardiography Michael D. Puchalski, (Chair), MD, FASE, George K. Lui, MD, FASE, Wanda C. Miller-Hance, MD, FASE, Michael M. Brook, MD, FASE, Luciana T. Young, MD, FASE, Aarti Bhat, MD, FASE, David A. Roberson, MD, FASE, Laura Mercer-Rosa, MD, MSCE, Owen I. Miller, BMed (Hons), FRACP, David A. Parra, MD, FASE, Thomas Burch, MD, Hollie D. Carron, AAS, RDCS, ACS, FASE, and Pierre C. Wong, MD, Salt Lake City, Utah; Stanford, San Francisco and Los Angeles, California; Houston, Texas; Seattle, Washington; Chicago, Illinois; Philadelphia, Pennsylvania; London, United Kingdom; Nashville, Tennessee; Boston, Massachusetts; and Kansas City, Missouri This document is endorsed by the following American Society of Echocardiography International Alliance Partners: Argentina Society of Cardiology, Asian-Pacific Association of Echocardiography, British Society of Echocardiography, Department of Cardiovascular Imaging of the Brazilian Society of Cardiology, Echocardiography Section of the Cuban Society of Cardiology, Indian Academy of Echocardiography, Indian Association of Cardiovascular Thoracic Anaesthesiologists, Indonesian Society of Echocardiography, Italian Association of Cardiothoracic Anesthesiologists, Japanese Society of Echocardiography, Korean Society of Echocardiography, National Society of Echocardiography of Mexico, Saudi Arabian Society of Echocardiography. Keywords: Transesophageal echocardiography, TEE, Congenital heart disease, CHD, Echocardiography From the University of Utah, Primary Children’s Hospital, Salt Lake City, Utah the warranty of merchantability or fitness for a particular purpose. In no event shall (M.D.P.); Stanford University School of Medicine, Stanford, California (G.K.L.); ASE be liable to you, your patients, or any other third parties for any decision made Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas or action taken by you or such other parties in reliance on this information. Nor (W.C.M-H.); University of California, San Francisco, California (M.M.B.); Seattle does your use of this information constitute the offering of medical advice by Children’s Hospital and University of Washington, Seattle, Washington (L.T.Y. ASE or create any physician-patient relationship between ASE and your patients and A.B.); Advocate Children’s Hospital, Chicago, Illinois (D.A.R.); University of or anyone else. Pennsylvania Perelman School of Medicine, The Children’s Hospital of Reviewers: This document was reviewed by members of the 2017–2018 ASE Philadelphia, Philadelphia, Pennsylvania (L.M-R.); Evelina London Children’s Guidelines and Standards Committee, ASE Board of Directors, and ASE Executive Hospital, London, United Kingdom (O.I.M.); Vanderbilt Medical Center, Committee. Reviewers included Alicia Armour, BS, MA, RDCS, FASE, Federico M. Nashville, Tennessee (D.A.P.); Tufts Medical Center, Boston, Massachusetts Asch, MD, FASE, Scott D. Choyce, RDCS, RVT, RDMS, FASE, Frederick C. Co- (T.B.); Children’s Mercy Hospital, Kansas City, Missouri (H.D.C.); Children’s bey, MD, FASE, Gregory J. Ensing, MD, FASE, Craig Fleishman, MD, FASE, Hospital, Los Angeles, California (P.C.W.). Mark K. Friedberg, MD, FASE, Neal Gerstein, MD, FASE, Yvonne E. Gilliland, The following authors reported no actual or potential conflicts of interest in relation MD, FASE, Robi Goswami, MD, FASE, Lanqi Hua, RDCS (AE/PE/FE), FASE, Pei- to this document: Michael D. Puchalski, MD, FASE, George K. Lui, MD, FASE, Hol- Ni Jone, MD, FASE, James N. Kirkpatrick, MD, FASE, Stephen H. Little, MD, lie D. Carron, AAS, RDCS, ACS, FASE, Laura Mercer-Rosa, MD, MSCE, Owen I. FASE, Rick Meese, ACS, RDCS, RCS, RCIS, FASE, Andy Pellett, PhD, RCS, Miller, BMed (Hons), FRACP, Wanda C. Miller-Hance, MD, FASE, David Parra, RDCS, FASE, Dermot Phelan, MD, PhD, FASE, and David H. Wiener, MD, FASE. MD, FASE, Luciana T. Young, MD, FASE. The following authors reported relationships with one or more commercial inter- Attention ASE Members: ests: Michael Brook, MD, FASE receives research funding from Siemens. Thomas Visit www.aseuniversity.org to earn free continuing medical education credit Burch, MD is owner and manager of PTEmasters, LLC, a board review website for through an online activity related to this article. Certificates are available for the PTEeXAM. David A. Roberson, MD, FASE serves on the speakers bureau for immediate access upon successful completion of the activity. Nonmembers Philips Ultrasound. Pierre C. Wong, MD, serves on the speakers bureau for Astra will need to join the ASE to access this great member benefit! Zeneca. NOTICE AND DISCLAIMER: This report is made available by ASE as a courtesy Reprint requests: American Society of Echocardiography, Meridian Corporate reference source for members. This report contains recommendations only and Center, 2530 Meridian Parkway, Suite 450, Durham, NC 27713 (E-mail: ase@ should not be used as the sole basis to make medical practice decisions or for asecho.org). disciplinary action against any employee. The statements and recommendations 0894-7317/$36.00 contained in this report are primarily based on the opinions of experts, rather Copyright 2018 by the American Society of Echocardiography. than on scientifically-verified data. ASE makes no express or implied warranties https://doi.org/10.1016/j.echo.2018.08.016 regarding the completeness or accuracy of the information in this report, including 1 PGL 5.5.0 DTD YMJE4089_proof 6 December 2018 4:21 pm ce 2 Puchalski et al Journal of the American Society of Echocardiography - 2018 Abbreviations INTRODUCTION Table 1 Indications for TEE in the patient with CHD 2D = Two-Dimensional Since its introduction nearly Diagnostic Indications four decades ago, transesopha- Patient with suspected CHD and non-diagnostic TTE 3D = Three-Dimensional geal echocardiography (TEE) Presence of patent foramen ovale (PFO) with and without agitated ACHD = Adult Congenital has witnessed a remarkable saline contrast and direction of shunting as possible etiology for stroke Heart Disease evolution. The important Evaluation for cardiovascular source of embolus with no identified ASE/SCA = American strides made in improving TEE non-cardiac source Society of Echocardiography/ technology – including devel- Evaluation of intra- or extra-cardiac baffles following the Fontan, Society of Cardiovascular opment of multiplane phased Senning, or Mustard procedure Anesthesiologists array transducers, matrix array Suspected acute aortic pathology including but not limited to AoV = Aortic Valve transducers for three- dissection/transection (e.g., Marfan syndrome, bicuspid aortic dimensional (3D) imaging, and valve, coarctation of the aorta) Asc Ao = Ascending Aorta extensive improvements in Intra-cardiac evaluation for vegetation or suspected abscess Evaluation for intra-cardiac thrombus prior to cardioversion for CA = Coronary Artery echocardiographic imaging platform technology – have atrial flutter/fibrillation and/or radiofrequency ablation Pericardial effusion or cardiac function evaluation and monitoring CHD = Congenital Heart catalyzed the establishment of Disease postoperative patient with open sternum or poor acoustic TEE as a critically important car- 1-15 windows DTG = Deep Transgastric diovascular imaging modality. Evaluating status of prosthetic valve in the setting of inadequate The esophageal position of the IVC = Inferior Vena Cava TTE images ultrasonic transducer provides Re-evaluation of prior TEE finding for interval change (e.g., LA = Left Atrium superior cardiac imaging and resolution of thrombus after anticoagulation, resolution of vegetation after antibiotic therapy) LAX = Long Axis allows monitoring of the heart before, during, and after cardiac Perioperative Indications LV = Left Ventricle or non-cardiac procedures Immediate preoperative definition of cardiac anatomy and without interruption. function LVOT = Left Ventricular Postoperative surgical results and function TEE in the pediatric popula- Outflow Tract Intraoperative monitoring of ventricular volume and function tion became widespread after ME = Midesophageal Monitoring of intra-cardiac/intravascular air and adequacy of the introduction of commercially cardiac de-airing MV = Mitral Valve available miniaturized probes in TEE-guided Interventions 1-3 the late 1980s. Since then, Guidance for placement of occlusion device (e.g., septal defect, PA = Pulmonary Artery the safety and invaluable clinical Fontan or intra-atrial baffle fenestration) PV = Pulmonary Valve utility of this technique for Guidance for blade or balloon atrial septostomy many types of pediatric and Guidance for creation/stenting of interventricular communication RA = Right Atrium adult congenital cardiac surgery Guidance during percutaneous valve interventions RV = Right Ventricle and cardiac interventional Guidance during radiofrequency ablation procedure Assessment of results of minimally invasive surgical incision or procedures has become well RVOT = Right Ventricular 4-15 video-assisted cardiac procedure Outflow Tract established. The increasing Guidance during placement of catheter-based cardiac assist applications of TEE coupled device (e.g., Impella â heart pump) SAX = Short Axis with newer technology led 31 SVC = Superior Vena Cava the American Society of Modified from Ayres et al. Echocardiography
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