Tips and Tricks of Transesophageal Echocardiographic Guidance During Cardiac Interventions

Abstract

Online transesophageal echocardiographic (TEE) guidance has become a useful and convenient technique for various structural heart disease interventions, e.g., interatrial septal puncture, balloon mitral commissurotomy, mitraClipping, atrial septal defect (ASD) device closure etc. There are some important tips and tricks. (1). For septal puncture, 2D echo may be better than 3-D echo. The optimal tenting sign should be managed to appear on the bicaval plane before protruding the puncture needle. If the tenting sign appears on a plane showing the right upper pulmonary vein, it indicates that the needle is pointing too posteriorly, increasing the risk of atrial wall perforation. Conversely, if the tenting sign appears on a plane showing the ascending aorta, it indicates that the needle is pointing too anteriorly, increasing the risk of aortic perforation. (2). Live 3D zoom mode is very convenient and better than 2D for monitoring ASD device deployment. (3). Fluoroscopy is still useful for monitoring some parts of the intervention procedures. If available, fusion imaging would be very convenient. (4). The duration of using color Doppler and 3-D echo should be kept short. Long duration tends to elevate the temperature of the TEE probe. (5). When using loop function, the time mode may be more desirable than the beat mode to prevent interruption of an important recording.