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Transesophageal echocardiography (TEE) training and certification have become standardized with the use of recognized nomenclature and tomographic views. A consistent nomenclature has the advantage of not only facilitating communication between physicians but also promoting the performance of comprehensive examinations. Familiarity with standard views enables the echocardiographer to spot abnormalities more easily and compare sequential images. However, in some patients, it will not be possible to obtain a complete set of perfect two-dimensional views because of time constraints, or because the patient's body habitus or anatomy impedes the ability to develop the appropriate imaging planes. With practice, a complete TEE examination generally can be performed in 10 minutes or less, with images recorded on videotape or, preferably, in a digital format. A written report should then be generated as part of the patient's medical record (see Chapter 25). Recommendations presented in this chapter primarily pertain to the widely available TEE equipment, which permits multiplane two-dimensional imaging. As experience with the newly available real-time three-dimensional (3D) TEE grows, standardized recommendations are sure to follow.

Guidelines for a comprehensive TEE examination have been established jointly by the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.1 The indications for performing a TEE examination continue to evolve on the basis of evidence attesting to its value and the weight of expert opinion and are listed in Table 5–1.2

Table 5–1. Recommendations for the Use of TEE in the Perioperative Period.

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