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 Table of Contents  
LETTER TO THE EDITOR
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 86-87

Three-Dimensional Transesophageal Echocardiography Workflow in the Operating Room and Intervention Suits


Salalah Heart Centre, Salalah, Muscat, Oman

Date of Submission30-Jan-2022
Date of Acceptance15-Feb-2022
Date of Web Publication29-Apr-2022

Correspondence Address:
Dr. Rahul Shabadi
MD, FASE, Salalah Heart Centre, Salalah, Muscat
Oman
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_10_22

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How to cite this article:
Shabadi R. Three-Dimensional Transesophageal Echocardiography Workflow in the Operating Room and Intervention Suits. J Indian Acad Echocardiogr Cardiovasc Imaging 2022;6:86-7

How to cite this URL:
Shabadi R. Three-Dimensional Transesophageal Echocardiography Workflow in the Operating Room and Intervention Suits. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2022 [cited 2022 May 23];6:86-7. Available from: https://www.jiaecho.org/text.asp?2022/6/1/86/344309



To the Editor,

Transesophageal echocardiography (TEE) has been in clinical practice since 1982. Over the past 40 years, it has evolved as a pivotal tool in the diagnosis, monitoring, and management of patients with cardiac pathology. For more than a decade now, three-dimensional (3D) echocardiography is in the clinical setup, and presently, it is used widely. 3D echocardiography is now salutary in diagnosis as well as during surgical or transcatheter interventions. With the advent of interventional procedures, the utility of 3D echocardiography will increase in the near future.

In operating rooms or hybrid room suits, there is a lot of time pressure on the cardiac anesthesiologist or echocardiologists to understand exact pathology, confirm the diagnosis as well as assist in the surgical or transcatheter interventions. This warrants a workflow about acquiring images and utilizing them for effective clinical as well as time management. To meet this objective, we propose below a workflow for intraprocedural TEE [Figure 1].
Figure 1: Three-dimensional transesophageal echocardiography workflow. 2D: Two-dimensional; 3D: Three-dimensional; AV: Aortic valve; CS: Coronary sinus; IAS: Interatrial septum; IVC: Inferior vena cava; LA: Left atrium; LAA: Left atrial appendage; LV: Left ventricle; LVOT: Left ventricular outflow tract; ROI: Region-of-interest; RV: Right ventricular; SVC: Superior vena cava; TV: Tricuspid valve

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The steps and the protocol for acquiring 3D images have been described in the 2013 American Society of Echocardiography guideline document.[1],[2] Most of the 3D image acquisition can be done at the mid-esophageal level. Hence, after completing comprehensive two-dimensional (2D) TEE acquisition of the 26 basic views, 3D imaging can be done by acquiring 3D images at the mid-esophageal level. Full-volume multibeat acquisition, as well as the region of interest (also known as zoom mode), either single-beat or multibeat acquisition, can be done. This can be followed by more focused imaging as per the pathology and the proposed intervention [Figure 1].

Following this stepwise imaging protocol can facilitate effective acquisition of the data which can be used later during or after the intervention while minimizing the chances of missing important information.

Some operators prefer to start with 2D transgastric imaging first, to assess the overall ventricular volume and functional status and then move to mid-esophageal level for simultaneous 2D and 3D imaging. While this may be one of the options, we prefer the scheme describe above [Figure 1]. Completion of a comprehensive 2D examination first provides the operator with the best understanding of the underlying pathology and the imaging needs. It also ensures acquisition of at least a complete 2D TEE study in case further image acquisition needs to be abandoned due to any technical or logistic reasons.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013;26:921-64.  Back to cited text no. 1
    
2.
Burkule NJ, Bansal M, Govind SC, Alagesan R, Ponde CK, Parashar SK. Indian academy of echocardiography guidelines for performance of transesophageal echocardiography in adults. J Indian Acad Echocardiogr Cardiovasc Imaging 2021;5:89-126.  Back to cited text no. 2
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