By Albert C. Perrino Jr. MD, Scott T. Reeves MD MBA FACC
--Up-to-date perform directions by means of the ASE,SCA, and ecu organization of Echocardiography.
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Extra resources for A practical approach to transesophageal echocardiography
5 License 2006; no usage restrictions except please preserve our creative credits: Patrick J. Lynch, medical illustrator; C. Carl Jaffe, MD, cardiologist. indd 31 14/06/13 11:35 AM 32 I. 13 Midesophageal four-chamber view. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle. This view may be helpful in the placement of pulmonary artery catheters in patients where entry into the right ventricle is difficult. The pulmonary artery catheter is floated to 20 cm and the balloon inflated and advanced.
In transesophageal echocardiography (TEE), the measurements are usually made in a TG SAX (just above the papillary muscles) and may be calculated from either of the two formulae given earlier. RWT is expressed as a decimal and used to describe LV hypertrophy and remodeling. 42 denotes eccentric hypertrophy (dilated internal ventricular dimension). The distinction between the two forms of hypertrophy is of prognostic interest, as concentric hypertrophy is associated with a higher incidence of cardiovascular events than eccentric hypertrophy.
Most commonly these measurements are made from the TG mid-SAX view of the LV, but when this view is suboptimal long-axis views can be substituted. The endocardium is manually traced around the LV cavity ignoring the papillary muscles. Alternatively, automated border detection obviates the need to manually trace cavity area and provides real time, beat-to-beat measures of LVAd, LVAs, and FAC (Fig. 2). The acoustic properties of tissue and blood are discriminated because they create significantly different backscatter and thereby signal strength, allowing for automated detection of the endocardial border.