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TEE IN TEE IN ANESTHESIAANESTHESIA(Introduction)(Introduction)
BYBY
USAMA ELSAYEDUSAMA ELSAYEDLECTURER OF ANESTHESIA AND INTENSIVE LECTURER OF ANESTHESIA AND INTENSIVE
CARECARE
OBJECTIVESOBJECTIVES
EquipementsEquipementsIndicationsIndicationsContraindicationsContraindicationsViewsViewscomplicationscomplications
EQUIPEMENTEQUIPEMENT
Ultrasound transducerUltrasound transducer Flexible endoscopeFlexible endoscope Piezoelectric crystals Piezoelectric crystals Two-dimensional (2D) video image Two-dimensional (2D) video image Anteflexion, retroflexionAnteflexion, retroflexion
EQUIPEMENTS cont.EQUIPEMENTS cont.
MonoplaneMonoplane
BiplaneBiplane
MultiplaneMultiplane
Probe insertionProbe insertion
Blindly with jaw thrustBlindly with jaw thrust
Laryngoscopic visualisationLaryngoscopic visualisation
Assisstant supportAssisstant support
Bite guardBite guard
IndicationsIndications
Cardiac surgeriesCardiac surgeries
Noncardiac surgeriesNoncardiac surgeries
ContraindicationsContraindications
Esophageal pathologyEsophageal pathology
Gastric pathologyGastric pathology
InexperienceInexperience
ComplicationsComplications
Esophageal injury…….perforationEsophageal injury…….perforation
Upper GIT hemorrhageUpper GIT hemorrhage
Dental injuryDental injury
Endotracheal Endotracheal
ProbeProbe
FailureFailure
TEE viewsTEE views
ME 4 Chamber ViewME 4 Chamber ViewAdvance probe to mid esophageal Advance probe to mid esophageal
position(35 cm) (0 angle)position(35 cm) (0 angle) Left atriumLeft atriumLeft ventricleLeft ventricleRight atriumRight atriumRight ventricleRight ventricleMitral valveMitral valveTricuspid valveTricuspid valve
Mid esophageal 4 chambres Mid esophageal 4 chambres viewview
Mid esophageal 4 chambres Mid esophageal 4 chambres viewview
Chamber sizeChamber size Ventricular functionVentricular function Mitral Valve diseaseMitral Valve disease Tricuspid Valve diseaseTricuspid Valve disease Atrial Septal Defect Atrial Septal Defect Pericardial EffusionPericardial Effusion
ME 2 Chamber ViewME 2 Chamber View
Advance probe to mid esophageal position(35 Advance probe to mid esophageal position(35 cm) (80-100 angle)cm) (80-100 angle)
Left Atrium (LA)Left Atrium (LA) Left Atrial Appendage (LAA)Left Atrial Appendage (LAA) Mitral Valve: Posterior (PMVL) + Anterior Mitral Valve: Posterior (PMVL) + Anterior
(AMVL) (AMVL) Left Ventricle (LV) Left Ventricle (LV) Coronary Sinus (CS)Coronary Sinus (CS) ““Coumadin ridge”(CR) tissue that separates Coumadin ridge”(CR) tissue that separates
the LAA and LUPV the LAA and LUPV
ME 2 Chamber ViewME 2 Chamber View
LAA mass/thrombusLAA mass/thrombus
LV size and functionLV size and function
MV diseaseMV disease
MV annulus measureMV annulus measure
ME LAX ViewME LAX View
ME 4 chambres + 120- 130 angleME 4 chambres + 120- 130 angle Left ventricle (LV)Left ventricle (LV) Left ventricular outflow tract (LVOT)Left ventricular outflow tract (LVOT) Aortic Valve (AV)Aortic Valve (AV) Mitral Valve: Anterior(AMVL) + Mitral Valve: Anterior(AMVL) +
Posterior(PMVL) LeafletsPosterior(PMVL) Leaflets
ME LAX ViewME LAX View
LV functionLV function
MV diseaseMV disease
AV and Aortic Root diseaseAV and Aortic Root disease
Interventricular Septum pathologyInterventricular Septum pathology
ME LAX ViewME LAX View
ME Aortic Valve SAX View ME Aortic Valve SAX View
Probe ME + 45 angleProbe ME + 45 angle Aortic Valve: (RCC), (LCC) and (NCC) Aortic Valve: (RCC), (LCC) and (NCC)
Inter-atrial Septum (IAS)Inter-atrial Septum (IAS)
Left Atrium (LA)Left Atrium (LA)
Right Atrium (RA)Right Atrium (RA)
ME Aortic Valve SAX ViewME Aortic Valve SAX View
Aortic Valve diseaseAortic Valve disease
Atrial septal defect (ASD) Atrial septal defect (ASD) (secundum)(secundum)
LA size LA size
ME Aortic Valve SAX ViewME Aortic Valve SAX View
ME Bicaval ViewME Bicaval View
ME, ME, angle 90-100°, turn entire probe rightangle 90-100°, turn entire probe right RA, RAARA, RAA Eustachian valve (EV) (at the border of the Eustachian valve (EV) (at the border of the
IVC / RA)IVC / RA) Crista Terminalis (CT)(at the border of the Crista Terminalis (CT)(at the border of the
SVC / RA)SVC / RA) SVCSVC IASIAS LALA IVCIVC
ME Bicaval ViewME Bicaval View
ASD (secundum, sinus venosus)ASD (secundum, sinus venosus)
Atrial pathologyAtrial pathology
Lines/wiresLines/wires
Venous Cannula (SVC, IVC)Venous Cannula (SVC, IVC)
ME Bicaval ViewME Bicaval View
TG midpapillary viewTG midpapillary view
Insert the probe to the stomach, sector depth 12cm, Insert the probe to the stomach, sector depth 12cm, angle 0° , Anteflex to contact stomach wallangle 0° , Anteflex to contact stomach wall
LV Cavity LV Cavity
LV WallsLV Walls
Papillary Muscles: (ALPM), (PMPM) Papillary Muscles: (ALPM), (PMPM)
Right Ventricle Right Ventricle
TG midpapillary viewTG midpapillary view
Left Ventricle: size, functionLeft Ventricle: size, function
Interventricular Septal motion, thicknessInterventricular Septal motion, thickness
Ventricular Septal Defect (VSD)Ventricular Septal Defect (VSD)
HypovolemiaHypovolemia
TG midpapillary viewTG midpapillary view
ConclusionConclusion
Introduction to use of TEE IN Introduction to use of TEE IN anesthesiaanesthesia
as regard equipements, indications, as regard equipements, indications, contraindications, complications and contraindications, complications and some important viewssome important views
