Transesophageal echocardiography (TEE) provides high temporal and spatial resolution images of the heart that permit assessment of structure and function. In experienced hands, the complication rate of TEE is very low.
Perhaps the two abnormalities for which TEE is uniquely useful is in the diagnosis of endocarditis and intra-cardiac clot. TEE is far more sensitive for finding a vegetation than transthoracic echocardiography. There is no modality that offers any real alternative to echocardiography for the diagnosis of vegetation. Similarly, echocardiography is the only practical way to examine for clots, which are not infrequently present in the patients with atrial fibrillation.
Dissecting aneurysm can be rapidly diagnosed and TEE is particularly useful when patients are intolerant of x-ray contrast (such as individuals with renal insufficiency) or cannot undergo magnetic resonance imaging (MRI). Anomalous cardiac anatomy can be investigated although MRI is probably preferred.
Well-defined criteria exist for assessing the severity of valvular stenosis and regurgitation. TEE is particularly useful in this setting when the transthoracic echocardiogram is inadequate. Aortic stenosis and mitral stenosis can both be quantified.
Left ventricular function can be assessed and the right ventricle is well visualized. Other modalities, such as MRI, are competitive.
Two new chapters have been added to the second edition with substantial updates on some of the previous chapters. This fully updated, comprehensive guide to TEE is intended to cover all aspects of performing and interpreting TEEs. More than 2,300 detailed illustrations, anatomic drawings, and tissue specimens demonstrate the fine points of contemporary imaging and help avoid pitfalls.